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	Name of Commuter Cyclist
	
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	Age of Commuter Cyclist 
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	Name of any ride group or club that Commuter Cyclist may 
	ride with (if applicable)
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	Brief 
	description of route that Commuter Cyclist rides, including listing suburb 
	starting from and ending at, and if you ride roughly the 
 reverse route later that day
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	Approx. 
	length of route that Commuter Cyclist rides 
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	Approx. frequency that Commuter Cyclist rides the Route
	
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	Approx. 
	kilometres that Commuter Cyclist rides each year
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	Bicycle equipment that the Commuter Cyclist wears/displays to mitigate 
a trauma accident (eg. helmet, fluro jacket/jersey, 
 number and location of 
lights, power of light beams, colour of lights, number of reflectors and 
location of reflectors, bell or horn).
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	Details of 
	any Blackspots [roundabout(s), bridge(s) with 
vertical timber beams, drainage grid(s), long term unrepaired road damage etc.]
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	Brief details of any "close calls" whilst commuting. 
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	How much would you reduce your cycling speed approaching 
	road intersections when cycling on a wet surface? 
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	Have you ever been involved in 'road rage'?  If so, 
	can you provide brief details, and upon reflection how much blame would you 
	assign 
 upon yourself (ie 30%, 50% or Nil etc)?
 
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	What percentage of Commuter Cyclists do you consider cycle sensible? 
	
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	Do you have any recommendations as to how Commuter 
	Cycling can be made safer? 
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