| Road link ID from GIS database | |
| City | |
| Name of road | |
| Road No. e.g. A40 | |
| Length (m) | |
| Identified correctly? Give any corrections here | |
| Any houses within 10 m? Y/N | |
| Description of aspect. Buildings both sides? | |
| Continue survey? Y/N | |
| Number of houses along road or block | |
| Distance of building facade from kerb (m) | |
| Hospital or School on road? Y/N (details) | |
| Number of road lanes | |
| Location of photos and videos taken | |
| Date / time | |
| Initials or surveyor. |