Required fields are marked with asterisks (*)

Traffic Calming Request Form

Name:

Mailing Address:

City/town:

Postal code:

Telephone number:

Email address:

Please indicate the location (street or area) of the traffic concern:

What is the area/zone of your traffic speeding concern?

School Zone/Community Safety Zone

Residential Area

Hamlet

Park

Road with Limited Visibility

Other

Please select any of the following traffic concerns:

Speeding

Vehicle Volumes

Pedestrian Safety

Collision Concerns

Shortcutting Traffic

When does the problem typically occur?

Morning Rush Hour

Mid-Day

Afternoon Rush Hour

Weekdays

Weekends

Other

Which seasons does the problem occur?

Winter

Spring

Summer

Fall

Please provide any further comments:

This form may contain "Personal Information" as defined under the Municipal Freedom of Information and Protection of Privacy Act and is collected pursuant to the Municipal Act, 2001, as amended. Personal information, such as names, will not be published unless express consent is provided. Email addresses will be utilized to facilitate contact as indicated above. Questions or concerns regarding the collection and/or use of this information can be directed to the Deputy Clerk of the Township of Uxbridge, 51 Toronto Street South, Uxbridge, ON L9P 1T1 905-852-9181, Ext. 209.