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Questionnaire Name - A questionnaire on Mobility Transport for Special Needs in Urban Community

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1	Your age
	A- 29 and below (0)  B- 30 – 39 (0)  C- 40 – 49 (0)  D- 50 – 59 (0)  E- 60 and above (1)
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2	Your gender
	A- Male (0)  B- Female (1)
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3	Please specify your mobility classification
	A- I am independent chair-bound (1)  B- I am accompanied chair-bound (0)  C- I am non-wheelchair or any chair-bound user (0)  D- I am non wheelchair user, but need mobility scooter to go out (0)
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4	Do you need someone to assist you to move in your daily routine?
	A- Yes (1)  B- No (0)
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5	What type of transport that you had available in your household?
	A- Own a car (0)  B- Electric scooter (0)  C- Electric wheelchair (1)  D- Hand-propelled tricycle (0)  E- Hand-propelled wheelchair (0)  F- Others, (0)
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6	What type of transport do you use when you go outside your home?
	A- Drive own vehicle (0)  B- Driven by nominated driver (0)  C- Own a car, but not driven by owner (0)  D- Use public transport (buses/taxis/etc.) (0)  E- Powered wheelchair (1)  F- Hand-propelled wheelchair (0)  G- Walking using walking aid (0)  H- Powered scooter (0)  I- Others, (0)
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7	How frequent you go outside your home in a week.
	A- more than 5 times a week (0)  B- 2 to 3 times a week (0)  C- once a week (1)  D- never (0)
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8	Do you feel that driving own transport is much more convenient rather than using public transport?
	A- Yes (1)  B- No (0)
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9	Do you have any health illness?
	A- No (0)  B- Yes (1)
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10	Do you have any physical disability?
	A- Yes (1)  B- No (0)
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11	What is the cause of the disability
	A- double lower limb amputation (0)  B- single lower limb amputation (0)  C- parapeglia (0)  D- hemiplegia (0)  E- cerebral palsy (0)  F- arthritis (0)  G- polio (0)  H- muscle weakness (1)  I- bone weakness (0)  J- bone fracture (0)  K- congenital (0)  L- Others, (0)
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12	What type of difficulty/ies you are facing when you want to go outside?
	A- Problems with public transport made me difficult to participate in activities (0)  B- Difficult to drive own car. Car need conversion (0)  C- Depend on others to take me out (0)  D- Pavement is not accessible (0)  E- My wheelchair/scooter cannot access doors (1)  F- It is too hard to walk even though the point is just a walking distance (0)  G- Feel not safe. There is a possibility to be a crime victim (0)  H- There is no mobility transport that really can support me to go out (0)  I- Others, (0)
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13	If there is a special design transport that can convenient you to go out by yourself which is safe, affordable, easy to use and trendy; would you love to have one?
	A- Yes (1)  B- No (0)
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14	Please state what is your opinion about mobility transport when you want to go outside your house in your routine
	A- Better drive own car (0)  B- Better if there is a transport that can conveyance me easily to high street (1)  C- I like to use public transport, much more convenient (0)  D- If there got a special design of mobility transport that safe, affordable, good features to support me; then it will be good (0)  E- Others, (0)
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