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?

Residential Area

Park

Other

Road with Limited Visability

Hamlet

School Zone/Community Safety Zone

Please select any of the following traffic concerns:

Speeding

Pedestrian Safety

Shortcutting Traffic

Vehicle Volumes

Collision Concerns

When does the problem typically occur?

Morning Rush Hour

Afternoon Rush Hour

Weekends

Mid-Day

Weekdays

Other

Which seasons does the problem occur?

Winter

Summer

Spring

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 Personal information, such as names, will not be published unless express consent is provided.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 Clerk of the Township of Scugog, 181 Perry Street, Port Perry, ON L9L 1C5 905-985-7346, Ext. 119