Sidewalk Safety

Pedestrian Accessibility Review Application

The form below will be sent to mopdmail@cityofhouston.net when you click SUBMIT.

  YOUR INFORMATION
Your Name
Your Disability
Your
Mobility Aid
     
Spouse Name
Spouse Disability
Spouse
Mobility Aid
     
Child Name
Child Disability
Child
Mobility Aid
Primary Phone
Alternate Phone
E-Mail
Street Address
Mailing Address
(if different)
Houston
ZIP Code


  ACCESSIBILITY LOCATION(S) INFORMATION

  • Please give as much information about location as possible -- exact address, landmark, hundred block, intersection, etc.. EXAMPLE: From 100 to 200 block of Jackson Street, or 215 Jackson, or the corner of Jackson @ Alberta, etc.
FIRST LOCATION
SECOND LOCATION

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First Location Condition
Second Location Condition
   
First Location Site Info
Second Location Site Info
   

  
  ADDITIONAL ROUTE INFORMATION

  • Please complete the specifics in the drop down boxes below
When I walk out of my door, I walk down the walkway and turn ... ... where the walkway meets the sidewalk and go ... ... when I encounter the condition shown above.
.
When I leave my home, my destination is ... . I have to ... ... to get to my destination. I have no alternative path of travel.
 
  COMMENTS OR CONCERNS


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Public Works ID#
(if applicable)
How did you hear about our office?