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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.?