Thank you
for your participation!
Personal
One-Day Travel Diary for:
<<First Name>>
of the
<<Last Name>> Household
Your Travel Day is:
<<TDATE>>
MA<<SAMPN>>-<<NDIARIES>>/<<HHSIZE>>-<<ASSN>>
If you need help filling out your travel diary,
please call the
toll-free survey hotline:
1-888-222-7734
For more information about the survey,
please call:
Jeff Livingston, NuStats
1-800-447-8287, ext. 2256
travelsurvey@nustats.com
or
Bob Frey, MassDOT
1-617-973-8900
travelsurvey@eot.state.ma.us
or
Here's what we need:
visit the survey website at
www.mass.gov/eot/travelsurvey
Record ALL the PLACES you go, HOW you travel, and
WHAT you do there on your assigned travel day.
Begin at 3 a.m. (or when you wake up) on your assigned
travel day and end at 2:59 a.m. the next day (or when you
go to sleep on your travel day).
HINT!
Carry this diary with you during your
travel day to help you remember to record
IMPORTANT details like the exact address
of each place, how you get there, and the
precise arrival and departure times.
See the Instructions & Example inside!
Survey conducted by NuStats/DataSource
on behalf of:
Moving Massachusetts Forward.
Massachusetts Department of Transportation
Diary Instructions
Use this diary to record information about ALL the PLACES you visit on
your assigned travel day. Record one PLACE per page. Tell us the:
Example
PLACE
B
A
What is this
PLACE?
My home
My work
My school
Transit stop
What is the NAME and ADDRESS of this PLACE?
Happy Kids Day Care
901 Main St.
Street address OR nearest cross-streets
Anytown
MA
City
What is a PLACE?
If you ride the bus/train or carpool/vanpool:
please record each bus stop, train station, or carpool/vanpool
meeting place where you get on or off as a separate place.
D
HOW did you GET there? (Use LIST 1-MEANS OF TRAVEL on flap)
E
How many people traveled with you?
1
(DON’T include yourself) _______
G
If you GOT THERE by PUBLIC TRANSIT:
Which type of transit
Local bus
Express bus
Shuttle bus
did you take?
Subway
Commuter rail
Ferry/Boat
X am
pm
3
Code: ____
Of those, how many were
1
household members? _______
F
How did you pay for your fare?
Cash
Charlie Card
Weekly pass
Charlie Ticket
Monthly pass
Transfer
Student ID
If you GOT THERE by PERSONAL VEHICLE:
Which household vehicle did you use?
2005 Toyota Camry
Year/Make/Model: _____________________
Did not use a household vehicle
Why not? ___________________________
 ACTIVITIES or what you did at each place.
Write the code from LIST 2-ACTIVITIES (codes are on the flap of
this diary).
Where did you park?
Did not park
Street
Parking
lot
Parking garage
X
Personal garage/driveway
Other: __________________________
Keep your completed travel diaries by the phone. We’ll call you to
collect the information, or you can call us toll-free at 1-888-222-7734.
For anyone who is unable to complete a diary, we ask that a parent or other
adult complete the diary for them. Thank you!
What are the nearest cross-streets to
At location
this parking location?
Main St & E. Broadway
___________________________________
How much did you pay to park?
Confidentiality:
1-888-222-7734
Zip
What TIME did you ARRIVE? (Exact time) ______
7 : ______
32
 How you GET TO each place.
Write the code from LIST 1-MEANS OF TRAVEL (codes are
on the flap of this diary). We are interested in all means of travel
(auto, walking, biking, and transit, etc.).
Questions? Call the toll-free survey hotline:
99999
State
C
 EXACT TIMES you arrive and leave each place.
This survey is conducted in accordance with strict privacy provisions.
All information, whether related to personal identity or travel and activities,
will remain completely confidential. The information will not be published,
sold, distributed, or otherwise made available to any third party.
Another
place
Name of place (if any) OR Transit stop
 PLACES you visit.
The place name, exact address and/or cross-streets, city, state, and
zip are critical for assessing areas with traffic congestion.
A PLACE is any location you travel to, no matter how long you are there.
Examples: stopping for gas, drive-thru window, dropping off or picking up
someone, going to work, walking to lunch or driving to a meeting during
your workday, biking to the park, attending a sporting event, etc.
X
$ ________ per ________ X Did not pay
H
What ACTIVITIES did you do there?
(Use LIST 2-ACTIVITIES on flap)
I
What TIME did you LEAVE?
(Please record exact time)
How did you pay for parking?
Cash/Credit/Debit card
Pre-paid parking pass
Employer-provided parking pass
How much did you pay "out-of-pocket"
to park that was not reimbursed by
your employer? $ ______________
Which toll road did you
X Did not use a toll road
Turnpike
Ted Williams Tunnel
Sumner Tunnel
Tobin Bridge
use?
Cost:
Cost:
Cost:
Cost:
$ ______
$ ______
$ ______
$ ______
Did you use an HOV lane?
Yes X No
Main activity (code): _______
9
Other activity (code): _______
7 : ______
46
______
X am
pm
Did not leave
Next PLACE
DONE
Did you remember to . . .
 Record each place you went,
even short walks, quick stops,
and places you went in the
evening?
 Record the activities that you
did at each place?
 Record exact place names
and complete addresses?
 Record accurate arrival
and departure times?
LIST 1 - MEANS OF TRAVEL
Personal Vehicle:
1
2
3
4
Auto/Van/Truck Driver
Auto/Van/Truck Passenger
Motorcycle Driver
Motorcycle Passenger
5
6
7
8
9
10
97
Walk
Bike
Public Transit
Dial-a-ride/Paratransit
Taxi
School bus
Other (write code 97 and specify)
Other Modes:
LIST 2 - ACTIVITIES
At My Home:
1
2
Working at home (for pay)
All other activities at home
3
4
Work/Job
All other activities at work
5
Volunteer work/Activities
6
7
Attending class
All other activities at school
At My Work Location:
What do I do with
my completed diaries?
Keep your completed
diaries by the phone –
We will call you to collect the
information. Or, you can call
our toll-free survey hotline
(1-888-222-7734) to provide
your information.
At My Volunteer Location:
At My School:
While Traveling:
8
Change type of transportation/transfer
(from car to bus, walk to bus, etc.)
9 Dropped off passenger/driver from car
10 Picked up passenger from car
11 Other (write code 11 and specify activity)
At Other Places:
Mail – Or, return your
completed diaries in the
postage-paid envelope
provided in your packet.
We may have to call you
to clarify or to collect any
missing information.
Questions?
Call the toll-free survey hotline:
1-888-222-7734
LISTS 1 & 2 are inside flap
12 Work/Business-related (meeting, sales call,
delivery, etc.)
13 Service private vehicle (gas, oil, lube, etc.)
14 Routine shopping (groceries, clothing,
convenience store, household maintenance)
15 Shopping for major purchases or specialty
items (appliances, electronics, new vehicle,
major household repairs, etc.)
16 Household errands (bank, dry cleaning, etc.)
17 Personal business (visit government office,
attorney, accountant, etc.)
18
19
20
21
22
23
97
Eat meal outside of home
Health care (doctor, dentist)
Civic/Religious activities
Outdoor recreation/Entertainment
Indoor recreation/Entertainment
Visit friends/Relatives
Other (write code 97 and specify activity)
PLACE
1
Begin recording your travel here
For this diary, the day begins at 3 a.m. when most
people are home asleep. If this is the case with you, check
“My home,” then record all the activities you did before
leaving and the exact time you leave for the first time.
IF YOU RIDE THE BUS/TRAIN OR CARPOOL/VANPOOL:
Please record each bus stop, train station, or carpool/vanpool
meeting place where you got on or off as a separate PLACE.
A
B
WHERE were
you at 3 a.m.?
My home
My work
My school
Transit stop
Another place
What is the NAME and ADDRESS of this PLACE?
PLACE
2
B
City
D
At any time during your assigned travel day, did you shop on the Internet in
place of making an out-of-home trip?
Yes
E
F
am
pm
Did not leave
HOW did you GET there? (Use LIST 1-MEANS OF TRAVEL on flap)
E
How many people traveled with you?
(DON’T include yourself) _______
G
If you GOT THERE by PUBLIC TRANSIT:
IF YOU DIDN'T LEAVE THIS PLACE TODAY:
You are done. Thank you.
pm
Code: ____
Of those, how many were
household members? _______
F
How did you pay for your fare?
Cash
Charlie Card
Weekly pass
Charlie Ticket
Monthly pass
Transfer
Student ID
Which household vehicle did you use?
How did you pay for parking?
Cash/Credit/Debit card
Year/Make/Model: _____________________
Pre-paid parking pass
Did not use a household vehicle
Employer-provided parking pass
Why not? ___________________________
How much did you pay "out-of-pocket"
Where did you park?
to park that was not reimbursed by
Did not park
Street
your employer? $ ______________
Parking lot
Parking garage
Which toll road did you use?
Personal garage/driveway
Did not use a toll road
Other: __________________________
Turnpike
Cost: $ ______
What are the nearest cross-streets to
Ted Williams Tunnel
Cost: $ ______
At location
this parking location?
Sumner Tunnel
Cost: $ ______
___________________________________
Tobin Bridge
Cost: $ ______
Next PLACE
CONTINUE
BELOW
I am home-bound, elderly, or disabled
Worked at home (for pay)
Worked around home (not for pay)
Other: ___________________________
did you take?
Subway
Commuter rail
Ferry/Boat
am
If you GOT THERE by PERSONAL VEHICLE:
What is the MAIN reason you didn’t leave this place today?
I was sick
Child was sick
Other household
member was sick
Zip
D
Main activity (code): _______
Other activity (code): _______
______ : ______
State
What TIME did you ARRIVE? (Exact time) ______ : ______
No
What TIME did you LEAVE?
(Please record exact time)
Another
place
C
Zip
What ACTIVITIES did you do there?
(Use LIST 2-ACTIVITIES on flap)
My school
Transit stop
What is the NAME and ADDRESS of this PLACE?
Which type of transit
Local bus
Express bus
Shuttle bus
C
My home
My work
Street address OR nearest cross-streets
Street address OR nearest cross-streets
State
What is this
PLACE?
Name of place (if any) OR Transit stop
Name of place (if any) OR Transit stop
City
A
How much did you pay to park?
$ ________ per ________
Did not pay
H
What ACTIVITIES did you do there?
(Use LIST 2-ACTIVITIES on flap)
I
What TIME did you LEAVE?
(Please record exact time)
Did you use an HOV lane?
Yes
No
Main activity (code): _______
Other activity (code): _______
______ : ______
am
pm
Did not leave
Next PLACE
DONE
PLACE
3
B
A
What is this
PLACE?
My home
My work
My school
Transit stop
Another
place
What is the NAME and ADDRESS of this PLACE?
PLACE
4
B
A
What is this
PLACE?
Name of place (if any) OR Transit stop
Street address OR nearest cross-streets
Street address OR nearest cross-streets
State
Zip
C
What TIME did you ARRIVE? (Exact time) ______ : ______
D
HOW did you GET there? (Use LIST 1-MEANS OF TRAVEL on flap)
E
How many people traveled with you?
(DON’T include yourself) _______
G
If you GOT THERE by PUBLIC TRANSIT:
Which type of transit
Local bus
Express bus
Shuttle bus
did you take?
Subway
Commuter rail
Ferry/Boat
am
City
pm
Code: ____
Of those, how many were
household members? _______
F
My school
Transit stop
State
What TIME did you ARRIVE? (Exact time) ______ : ______
D
HOW did you GET there? (Use LIST 1-MEANS OF TRAVEL on flap)
E
How many people traveled with you?
(DON’T include yourself) _______
G
If you GOT THERE by PUBLIC TRANSIT:
Which type of transit
Local bus
Express bus
Shuttle bus
How did you pay for your fare?
Cash
Charlie Card
Weekly pass
Charlie Ticket
Monthly pass
Transfer
Student ID
did you take?
Subway
Commuter rail
Ferry/Boat
How did you pay for parking?
Cash/Credit/Debit card
Year/Make/Model: _____________________
Pre-paid parking pass
Did not use a household vehicle
Employer-provided parking pass
Why not? ___________________________
How much did you pay "out-of-pocket"
Where did you park?
to park that was not reimbursed by
Did not park
Street
your employer? $ ______________
Parking lot
Parking garage
Which toll road did you use?
Personal garage/driveway
Did not use a toll road
Other: __________________________
Turnpike
Cost: $ ______
What are the nearest cross-streets to
Ted Williams Tunnel
Cost: $ ______
At location
this parking location?
Sumner Tunnel
Cost: $ ______
___________________________________
Tobin Bridge
Cost: $ ______
Which household vehicle did you use?
How much did you pay to park?
How much did you pay to park?
What ACTIVITIES did you do there?
(Use LIST 2-ACTIVITIES on flap)
I
What TIME did you LEAVE?
(Please record exact time)
______ : ______
am
pm
$ ________ per ________
Did not leave
Next PLACE
DONE
Code: ____
How did you pay for parking?
Cash/Credit/Debit card
Year/Make/Model: _____________________
Pre-paid parking pass
Did not use a household vehicle
Employer-provided parking pass
Why not? ___________________________
How much did you pay "out-of-pocket"
Where did you park?
to park that was not reimbursed by
Did not park
Street
your employer? $ ______________
Parking lot
Parking garage
Which toll road did you use?
Personal garage/driveway
Did not use a toll road
Other: __________________________
Turnpike
Cost: $ ______
What are the nearest cross-streets to
Ted Williams Tunnel
Cost: $ ______
At location
this parking location?
Sumner Tunnel
Cost: $ ______
___________________________________
Tobin Bridge
Cost: $ ______
Did you use an HOV lane?
Yes
No
Main activity (code): _______
Other activity (code): _______
pm
How did you pay for your fare?
Cash
Charlie Card
Weekly pass
Charlie Ticket
Monthly pass
Transfer
Student ID
Which household vehicle did you use?
H
am
Of those, how many were
household members? _______
F
If you GOT THERE by PERSONAL VEHICLE:
Did not pay
Zip
C
If you GOT THERE by PERSONAL VEHICLE:
$ ________ per ________
Another
place
What is the NAME and ADDRESS of this PLACE?
Name of place (if any) OR Transit stop
City
My home
My work
Did not pay
H
What ACTIVITIES did you do there?
(Use LIST 2-ACTIVITIES on flap)
I
What TIME did you LEAVE?
(Please record exact time)
Did you use an HOV lane?
Yes
No
Main activity (code): _______
Other activity (code): _______
______ : ______
am
pm
Did not leave
Next PLACE
DONE
PLACE
5
B
A
What is this
PLACE?
My home
My work
My school
Transit stop
Another
place
What is the NAME and ADDRESS of this PLACE?
PLACE
6
B
A
What is this
PLACE?
Name of place (if any) OR Transit stop
Street address OR nearest cross-streets
Street address OR nearest cross-streets
State
Zip
C
What TIME did you ARRIVE? (Exact time) ______ : ______
D
HOW did you GET there? (Use LIST 1-MEANS OF TRAVEL on flap)
E
How many people traveled with you?
(DON’T include yourself) _______
G
If you GOT THERE by PUBLIC TRANSIT:
Which type of transit
Local bus
Express bus
Shuttle bus
did you take?
Subway
Commuter rail
Ferry/Boat
am
City
pm
Code: ____
Of those, how many were
household members? _______
F
My school
Transit stop
State
What TIME did you ARRIVE? (Exact time) ______ : ______
D
HOW did you GET there? (Use LIST 1-MEANS OF TRAVEL on flap)
E
How many people traveled with you?
(DON’T include yourself) _______
G
If you GOT THERE by PUBLIC TRANSIT:
Which type of transit
Local bus
Express bus
Shuttle bus
How did you pay for your fare?
Cash
Charlie Card
Weekly pass
Charlie Ticket
Monthly pass
Transfer
Student ID
did you take?
Subway
Commuter rail
Ferry/Boat
How did you pay for parking?
Cash/Credit/Debit card
Year/Make/Model: _____________________
Pre-paid parking pass
Did not use a household vehicle
Employer-provided parking pass
Why not? ___________________________
How much did you pay "out-of-pocket"
Where did you park?
to park that was not reimbursed by
Did not park
Street
your employer? $ ______________
Parking lot
Parking garage
Which toll road did you use?
Personal garage/driveway
Did not use a toll road
Other: __________________________
Turnpike
Cost: $ ______
What are the nearest cross-streets to
Ted Williams Tunnel
Cost: $ ______
At location
this parking location?
Sumner Tunnel
Cost: $ ______
___________________________________
Tobin Bridge
Cost: $ ______
Which household vehicle did you use?
How much did you pay to park?
How much did you pay to park?
What ACTIVITIES did you do there?
(Use LIST 2-ACTIVITIES on flap)
I
What TIME did you LEAVE?
(Please record exact time)
______ : ______
am
pm
$ ________ per ________
Did not leave
Next PLACE
DONE
Code: ____
How did you pay for parking?
Cash/Credit/Debit card
Year/Make/Model: _____________________
Pre-paid parking pass
Did not use a household vehicle
Employer-provided parking pass
Why not? ___________________________
How much did you pay "out-of-pocket"
Where did you park?
to park that was not reimbursed by
Did not park
Street
your employer? $ ______________
Parking lot
Parking garage
Which toll road did you use?
Personal garage/driveway
Did not use a toll road
Other: __________________________
Turnpike
Cost: $ ______
What are the nearest cross-streets to
Ted Williams Tunnel
Cost: $ ______
At location
this parking location?
Sumner Tunnel
Cost: $ ______
___________________________________
Tobin Bridge
Cost: $ ______
Did you use an HOV lane?
Yes
No
Main activity (code): _______
Other activity (code): _______
pm
How did you pay for your fare?
Cash
Charlie Card
Weekly pass
Charlie Ticket
Monthly pass
Transfer
Student ID
Which household vehicle did you use?
H
am
Of those, how many were
household members? _______
F
If you GOT THERE by PERSONAL VEHICLE:
Did not pay
Zip
C
If you GOT THERE by PERSONAL VEHICLE:
$ ________ per ________
Another
place
What is the NAME and ADDRESS of this PLACE?
Name of place (if any) OR Transit stop
City
My home
My work
Did not pay
H
What ACTIVITIES did you do there?
(Use LIST 2-ACTIVITIES on flap)
I
What TIME did you LEAVE?
(Please record exact time)
Did you use an HOV lane?
Yes
No
Main activity (code): _______
Other activity (code): _______
______ : ______
am
pm
Did not leave
Next PLACE
DONE
PLACE
7
B
A
What is this
PLACE?
My home
My work
My school
Transit stop
Another
place
What is the NAME and ADDRESS of this PLACE?
PLACE
8
B
A
What is this
PLACE?
Name of place (if any) OR Transit stop
Street address OR nearest cross-streets
Street address OR nearest cross-streets
State
Zip
C
What TIME did you ARRIVE? (Exact time) ______ : ______
D
HOW did you GET there? (Use LIST 1-MEANS OF TRAVEL on flap)
E
How many people traveled with you?
(DON’T include yourself) _______
G
If you GOT THERE by PUBLIC TRANSIT:
Which type of transit
Local bus
Express bus
Shuttle bus
did you take?
Subway
Commuter rail
Ferry/Boat
am
City
pm
Code: ____
Of those, how many were
household members? _______
F
My school
Transit stop
State
What TIME did you ARRIVE? (Exact time) ______ : ______
D
HOW did you GET there? (Use LIST 1-MEANS OF TRAVEL on flap)
E
How many people traveled with you?
(DON’T include yourself) _______
G
If you GOT THERE by PUBLIC TRANSIT:
Which type of transit
Local bus
Express bus
Shuttle bus
How did you pay for your fare?
Cash
Charlie Card
Weekly pass
Charlie Ticket
Monthly pass
Transfer
Student ID
did you take?
Subway
Commuter rail
Ferry/Boat
How did you pay for parking?
Cash/Credit/Debit card
Year/Make/Model: _____________________
Pre-paid parking pass
Did not use a household vehicle
Employer-provided parking pass
Why not? ___________________________
How much did you pay "out-of-pocket"
Where did you park?
to park that was not reimbursed by
Did not park
Street
your employer? $ ______________
Parking lot
Parking garage
Which toll road did you use?
Personal garage/driveway
Did not use a toll road
Other: __________________________
Turnpike
Cost: $ ______
What are the nearest cross-streets to
Ted Williams Tunnel
Cost: $ ______
At location
this parking location?
Sumner Tunnel
Cost: $ ______
___________________________________
Tobin Bridge
Cost: $ ______
Which household vehicle did you use?
How much did you pay to park?
How much did you pay to park?
What ACTIVITIES did you do there?
(Use LIST 2-ACTIVITIES on flap)
I
What TIME did you LEAVE?
(Please record exact time)
______ : ______
am
pm
$ ________ per ________
Did not leave
Next PLACE
DONE
Code: ____
How did you pay for parking?
Cash/Credit/Debit card
Year/Make/Model: _____________________
Pre-paid parking pass
Did not use a household vehicle
Employer-provided parking pass
Why not? ___________________________
How much did you pay "out-of-pocket"
Where did you park?
to park that was not reimbursed by
Did not park
Street
your employer? $ ______________
Parking lot
Parking garage
Which toll road did you use?
Personal garage/driveway
Did not use a toll road
Other: __________________________
Turnpike
Cost: $ ______
What are the nearest cross-streets to
Ted Williams Tunnel
Cost: $ ______
At location
this parking location?
Sumner Tunnel
Cost: $ ______
___________________________________
Tobin Bridge
Cost: $ ______
Did you use an HOV lane?
Yes
No
Main activity (code): _______
Other activity (code): _______
pm
How did you pay for your fare?
Cash
Charlie Card
Weekly pass
Charlie Ticket
Monthly pass
Transfer
Student ID
Which household vehicle did you use?
H
am
Of those, how many were
household members? _______
F
If you GOT THERE by PERSONAL VEHICLE:
Did not pay
Zip
C
If you GOT THERE by PERSONAL VEHICLE:
$ ________ per ________
Another
place
What is the NAME and ADDRESS of this PLACE?
Name of place (if any) OR Transit stop
City
My home
My work
Did not pay
H
What ACTIVITIES did you do there?
(Use LIST 2-ACTIVITIES on flap)
I
What TIME did you LEAVE?
(Please record exact time)
Did you use an HOV lane?
Yes
No
Main activity (code): _______
Other activity (code): _______
______ : ______
am
pm
Did not leave
Next PLACE
DONE
PLACE
9
B
A
What is this
PLACE?
My home
My work
My school
Transit stop
Another
place
What is the NAME and ADDRESS of this PLACE?
PLACE
10
B
A
What is this
PLACE?
Name of place (if any) OR Transit stop
Street address OR nearest cross-streets
Street address OR nearest cross-streets
State
Zip
C
What TIME did you ARRIVE? (Exact time) ______ : ______
D
HOW did you GET there? (Use LIST 1-MEANS OF TRAVEL on flap)
E
How many people traveled with you?
(DON’T include yourself) _______
G
If you GOT THERE by PUBLIC TRANSIT:
Which type of transit
Local bus
Express bus
Shuttle bus
did you take?
Subway
Commuter rail
Ferry/Boat
am
City
pm
Code: ____
Of those, how many were
household members? _______
F
My school
Transit stop
State
What TIME did you ARRIVE? (Exact time) ______ : ______
D
HOW did you GET there? (Use LIST 1-MEANS OF TRAVEL on flap)
E
How many people traveled with you?
(DON’T include yourself) _______
G
If you GOT THERE by PUBLIC TRANSIT:
Which type of transit
Local bus
Express bus
Shuttle bus
How did you pay for your fare?
Cash
Charlie Card
Weekly pass
Charlie Ticket
Monthly pass
Transfer
Student ID
did you take?
Subway
Commuter rail
Ferry/Boat
How did you pay for parking?
Cash/Credit/Debit card
Year/Make/Model: _____________________
Pre-paid parking pass
Did not use a household vehicle
Employer-provided parking pass
Why not? ___________________________
How much did you pay "out-of-pocket"
Where did you park?
to park that was not reimbursed by
Did not park
Street
your employer? $ ______________
Parking lot
Parking garage
Which toll road did you use?
Personal garage/driveway
Did not use a toll road
Other: __________________________
Turnpike
Cost: $ ______
What are the nearest cross-streets to
Ted Williams Tunnel
Cost: $ ______
At location
this parking location?
Sumner Tunnel
Cost: $ ______
___________________________________
Tobin Bridge
Cost: $ ______
Which household vehicle did you use?
How much did you pay to park?
How much did you pay to park?
What ACTIVITIES did you do there?
(Use LIST 2-ACTIVITIES on flap)
I
What TIME did you LEAVE?
(Please record exact time)
______ : ______
am
pm
$ ________ per ________
Did not leave
Next PLACE
DONE
Code: ____
How did you pay for parking?
Cash/Credit/Debit card
Year/Make/Model: _____________________
Pre-paid parking pass
Did not use a household vehicle
Employer-provided parking pass
Why not? ___________________________
How much did you pay "out-of-pocket"
Where did you park?
to park that was not reimbursed by
Did not park
Street
your employer? $ ______________
Parking lot
Parking garage
Which toll road did you use?
Personal garage/driveway
Did not use a toll road
Other: __________________________
Turnpike
Cost: $ ______
What are the nearest cross-streets to
Ted Williams Tunnel
Cost: $ ______
At location
this parking location?
Sumner Tunnel
Cost: $ ______
___________________________________
Tobin Bridge
Cost: $ ______
Did you use an HOV lane?
Yes
No
Main activity (code): _______
Other activity (code): _______
pm
How did you pay for your fare?
Cash
Charlie Card
Weekly pass
Charlie Ticket
Monthly pass
Transfer
Student ID
Which household vehicle did you use?
H
am
Of those, how many were
household members? _______
F
If you GOT THERE by PERSONAL VEHICLE:
Did not pay
Zip
C
If you GOT THERE by PERSONAL VEHICLE:
$ ________ per ________
Another
place
What is the NAME and ADDRESS of this PLACE?
Name of place (if any) OR Transit stop
City
My home
My work
Did not pay
H
What ACTIVITIES did you do there?
(Use LIST 2-ACTIVITIES on flap)
I
What TIME did you LEAVE?
(Please record exact time)
Did you use an HOV lane?
Yes
No
Main activity (code): _______
Other activity (code): _______
______ : ______
am
pm
Did not leave
Next PLACE
DONE
Did not leave
am/pm
:
am/pm
:
am/pm
:
am/pm
:
am/pm
:
am/pm
:
am/pm
:
am/pm
:
am/pm
am/pm
:
21
am/pm
am/pm
am/pm
am/pm
am/pm
am/pm
am/pm
:
Next PLACE
DONE
20
pm
:
am
19
______ : ______
:
What TIME did you LEAVE?
(Please record exact time)
18
I
Main activity (code): _______
Other activity (code): _______
:
What ACTIVITIES did you do there?
(Use LIST 2-ACTIVITIES on flap)
17
H
Did you use an HOV lane?
Yes
No
:
Did not pay
16
$ ________ per ________
:
How much did you pay to park?
15
How did you pay for parking?
Cash/Credit/Debit card
Year/Make/Model: _____________________
Pre-paid parking pass
Did not use a household vehicle
Employer-provided parking pass
Why not? ___________________________
How much did you pay "out-of-pocket"
Where did you park?
to park that was not reimbursed by
Did not park
Street
your employer? $ ______________
Parking lot
Parking garage
Which toll road did you use?
Personal garage/driveway
Did not use a toll road
Other: __________________________
Turnpike
Cost: $ ______
What are the nearest cross-streets to
Ted Williams Tunnel
Cost: $ ______
At location
this parking location?
Sumner Tunnel
Cost: $ ______
___________________________________
Tobin Bridge
Cost: $ ______
EXTRA PLACES
Which household vehicle did you use?
:
If you GOT THERE by PERSONAL VEHICLE:
14
How did you pay for your fare?
Cash
Charlie Card
Weekly pass
Charlie Ticket
Monthly pass
Transfer
Student ID
am/pm
did you take?
Subway
Commuter rail
Ferry/Boat
:
Which type of transit
Local bus
Express bus
Shuttle bus
13
If you GOT THERE by PUBLIC TRANSIT:
am/pm
G
Of those, how many were
household members? _______
F
:
How many people traveled with you?
(DON’T include yourself) _______
12
E
Code: ____
WHAT is the NAME and ADDRESS?
HOW did you GET there? (Use LIST 1-MEANS OF TRAVEL on flap)
pm
B
D
am
What
ACTIVITIES?
(use LIST 2)
What TIME did you ARRIVE? (Exact time) ______ : ______
H
C
HOW did you
GET there?
(use LIST 1)
Zip
D
State
What TIME
did you ARRIVE?
(record exact times)
City
C
Street address OR nearest cross-streets
If you used all of the previous pages, use the chart below to write information on the other places you went.
Don’t forget to record your exact times!
I
Name of place (if any) OR Transit stop
:
What is the NAME and ADDRESS of this PLACE?
am/pm
Another
place
:
My school
Transit stop
What TIME
did you LEAVE?
(record exact times)
My home
My work
WHAT is this PLACE?
B
What is this
PLACE?
A
11
A
PLACE
#
PLACE