Sec. 191.8. Analysis sheet for determining a child safety zone

Date:

______

 

Completed by: ________

Name of School to Which Qualifying

Student(s) is Walking:

 

Address of the School:

 

City: ________State: ____NY ZIP Code ____.

 

 

POINT DETERMINATION

HAZARD TYPE - Highways Without Sidewalks or Inadequate Shoulders

1. Location on highway (check one):

 

____

Points

[ ] on shoulder ≥ five feet wide or sidewalk

 

[ ] on shoulder ≤ five feet wide without a sidewalk

 

[ ] on roadway with no shoulder

 

[ ] on roadway at a narrow bridge or overpass

 

2.

15 minute vehicular count on roadway being walked by

 

____

Points

the students:

____

vehicles

 

3.

Speed limit on roadway being walked:

__

mph

 

____ Points

 

 

X. Total Points (Line 1 + Line 2 + Line 3)

 

____ Points

 

 

HAZARD TYPE - Highway Intersections

4. Traffic control on roadway being crossed

 

____

Points

(check one):

Number of lanes of traffic:

____

lanes

 

[ ] no control

 

[ ] stop sign or traffic signal w/o ped walk lights

 

[ ] traffic signal with ped walk lights

 

[ ] all way stop signs, adult crossing guard, or

 

pedestrian overpass/underpass

 

5. 15 minute vehicular count on roadway being crossed by

 

____

Points

the students:

____

vehicles

6. Speed limit on roadway being crossed:

____

mph

 

____Points

 

 

Y. Total Points (Line 4 + Line 5 + Line 6)

 

____Points

 

 

HAZARD TYPE - Highway-Railroad Grade Crossings

 

7. a) Number of tracks crossed:

 

____

Points

b) Number of trains daily during school

 

crossing periods:

____

 

 

 

Z. Total Points (Line 7)

 

____ Points

FINDINGS

 

Single Hazard: (Line X, Y, or Z)

 

____

Points

____

Exist for children through grade

____

.

 

____

Does not exist for any school children.

 

Combination of Hazards: (Line X, Y, or Z)

 

____

Points

(Sum of Two Greatest Hazards)

 

____

Exist for children through grade

____

.

 

____

Does not exist for any school children.

 

 

 

I hereby certify that the results of the analysis are accurate and reflect traffic conditions as of this date for the location under study.

__________

 

______

Signature of School Superintendent

 

Date