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Community Safety Workshop Survey

Survey/Form Review
Community Safety Workshop Survey
In a continuing effort to enhance the quality of lives in Rosemead, we are requesting your assistance in completing a very short survey that will help us plan for future safety meeting workshops. The information you provide us is confidential and your response will be anonymous unless you wish to provide your contact information.
Please provide contact information (optional):
1. Name:

2. Address:

3. Phone:

4. E-mail Address:

Please indicate the topics you are interested in learning more about and would like for the Public Safety team to include in Public Safety Community Workshops. Check all that apply.
5. Personal Safety*
6. Home Safety*
7. Property Safety*
8. Neighborhood Safety*
9. Natural Disaster Safety and Prevention*
10. Vehicle Safety*
11. Workshop for Children*
12. Workshop for Seniors*
13. Other topics that are not listed:

14. Would you be interested in a series of classes or training? Check all that apply.*
15. Do you have an existing Neighborhood Watch Group in your Neighborhood?*
16. If so, who is the Block Captain?

If you would like to start a Neighborhood Watch Group on your street, please leave the following information:
17. Name and phone number: