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Wind Shield Survey Form CHN

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Community Health Nursing

Wind Shield Survey Form


1. Housing and Zoning

 What is the age of the houses, their architecture, of


what materials are they constructed?

 Are all the neighborhood houses similar in age, architecture?


 How would you characterize the from or connected
to others?

 Do they have space in front and behind?


 What is their general condition?
 Are there is signs of disrepair – broken doors,
window, leaks, locks missing?

 Is there central heating, modern plumbing,


air conditioning?

NOTE:Use additional sheets of paper

2. Open Space

 How much open space is there?


 What is the quality of the space – green parks or
rubble filled lots?
 What is the lot size of the houses? Lawns?
Flower boxes?
 Do you see trees on payments, a green island in
the center of the street? Is the open space public
or private? Used by whom?

NOTE:Use additional sheets of paper


3. Boundaries

 What signs are there of where this -----


neighborhood begins, ends?
 Are the boundaries natural a river a different
terrain?
 Physical a highway, rail road? Economic
difference, in real estate, or presence of
industrial, commercial units all units along
with residential?
 The neighborhood has an identity, a name?
 Do you see it displayed? Are there unofficial
names?

4. Commons

What are the neighborhood hangouts? -----

For what groups, at what hours? e.g.


schoolyard, candy store, bar, restaurant, park,
24 hour drugstore?

Do the “commons” have a sense of


“territoriality” or is it open to the stranger?

5. Transportation

How do people get in and out of the


neighborhood?

Car, bus, bike, walk, etc? Are the streets and


roads conductive to good transportation and
also to community life?

Is there major highway near the


neighborhood? Whom does it serve?

How frequent is public transportation


available?
6. Service Centers

Do you see social agencies, clinics, recreation


centers, signs of activity at the schools? Are
there offices of Dr.‘s, dentist? Palmists,
spiritualists, etc? Parks? Are they in use?

7. Stores

Where do residents shop? Shopping centers,

neighborhood stores? How do they travel to shop?

8. Street People

If you are traveling during the day, who do you -----


see on the street? An occasional house wife, a
mother with a baby? Do you see anyone you
would not expects? Teenagers, unemployed
male? Can you spot a welfare worker, an
insurance collector, a door to door salesman? Is
the dress of those you see representative or
unexpected? Along with people what animals
do you see? Stray fats, dogs, pedigreed pets,
“watchdogs”?

9. Signs of Decay

This neighborhood, is it on the way up or


down? Is it “alive”? How would you decide?
Trash, abandoned cars, political posters,
neighborhood meeting posters, real estate signs,
abandoned houses, mixed zoning usage?

10. Race

Are the residents white, black, mixed?


11. Ethnicity

Are there indices of ethnicity food stores,


churches, private schools, information in
another language?

12. Religion

What religion are the residents? Do you see


evidence of heterogeneity or homogeneity?
What denomination are the churches / Masjid?
Do you see evidence of their use other than
Sunday morning?

13. Health and Morbidity

Do you see evidence of acute or of chronic


diseases or conditions? Of accidents,
communicable diseases, alcoholism drug
addiction, mental illness, etc? How far is the
nearest hospital? Clinic?

14. Politics

Do you see any political campaign posters? Is


there a political head-quarter. Do you see any
evidence of a predominant party affiliation?

15. Media

Do you see outside TV antennas? What magazines,


newspapers do residents read? Do you see Forward
Times, Daily News papers, Readers Digest Urdu
digest etc. What media seem most important to the
residents? Radio, T.V.?

16. Community

Would You Characterize This Community as Rural

Or Urban? Or Both? Why? What binds this area

as a “community”.

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