All templates
Sample Templates

Resident Impact Assessment: Micro-Fulfillment Centers

Measures how nearby micro-fulfillment center operations affect residents' quality of life, local environment, and policy preferences. Designed for city planners and community boards seeking structured resident input to guide zoning and operational decisions.

Sample questions

A preview of what’s in the template. Every question is editable before you launch.

28 questions · ~12 min
Q01
Message

Welcome to this survey about micro-fulfillment centers (MFCs) and your neighborhood. A micro-fulfillment center is a small warehouse used to prepare and dispatch online delivery orders. Cities are exploring how these facilities affect nearby residents. This survey takes approximately 8–10 minutes. Your participation is entirely voluntary, and you may stop at any time. There are no right or wrong answers—we are interested in your honest opinions and observations. All responses are anonymous and will be reported only in aggregate to inform city planning decisions. Please click 'Next' to begin.

Q02
Multiple Choice

A micro-fulfillment center (MFC) is a small warehouse used to prepare and dispatch online delivery orders. To the best of your knowledge, is there an MFC operating within about 1 mile of your home?

  • Yes
  • No
  • Not sure
Q03
Dropdown

When, if at all, did you first notice activity that seems related to an MFC near you?

  • In the last month
  • 1 to 3 months ago
  • 4 to 12 months ago
  • Over a year ago
  • I have not noticed any such activity
Q04
Message

The next questions ask how conditions in your immediate area have changed over the last 3 months. For each item, please indicate whether things have gotten worse, stayed about the same, or improved.

Q05
Ranking

Please rank the following city priorities related to MFCs from most to least important to you.

  1. Faster, reliable deliveries
  2. Fewer trucks on local streets
  3. Jobs and local hiring
  4. Lower noise levels
  5. Lower emissions and cleaner air
  6. Support for local retail
  7. Keeping prices affordable
Drag to rank
Q06
Long Text

Based on your responses in this survey, what else, if anything, should the city know about MFC impacts on your block or nearby streets?

Q07
Message

Finally, a few questions about you and your household. These help us understand how MFC impacts may differ across community members.

Q08
Message

Thank you for completing this survey. Your input will help inform city planning and policy decisions regarding micro-fulfillment centers in your area. If you have urgent concerns, please contact your local council representative.

Q09
Dropdown

Approximately how far is the nearest MFC from your home?

  • Less than ¼ mile
  • ¼ to ½ mile
  • ½ mile to 1 mile
  • 1 to 2 miles
  • More than 2 miles
  • Not sure
Q10
Opinion Scale

Compared with 3 months ago, how has traffic volume on your nearby streets changed?

Scale: 17
Min:Much worseMax:Much better
Q11
Multiple Choice

Which of the following measures, if any, would you support to address impacts from MFC operations? Select up to 3.

  • Time-of-day delivery windows
  • Electric-only delivery zones
  • Off-street loading requirements
  • Caps on van trips per day
  • Camera enforcement of loading zones
  • Safer bike and scooter lanes
  • Community hotline for reporting issues
  • Regular city inspections
  • None of the above
Q12
AI Interview

We'd like to understand your experiences in a bit more depth. An AI moderator will ask you a couple of brief follow-up questions based on your earlier answers.

Q13
Dropdown

How long have you lived in your current neighborhood?

  • Less than 6 months
  • 6–12 months
  • 1–3 years
  • 3–5 years
  • More than 5 years
Q14
Multiple Choice

In the last 30 days, which of the following, if any, have you noticed in your area? Select all that apply.

  • More delivery vans on local streets
  • Nighttime truck arrivals
  • Curbside loading/unloading
  • Noticeable noise from vehicles or loading
  • Traffic congestion near intersections
  • Blocked sidewalks or bike lanes
  • None of the above
Q15
Opinion Scale

Compared with 3 months ago, how have noise levels in your area changed?

Scale: 17
Min:Much worseMax:Much better
Q16
Multiple Choice

What type of home do you currently live in?

  • Apartment or condo
  • Townhouse or rowhouse
  • Single-family house
  • Multi-family building (3+ units)
  • Other (please specify)
Q17
Opinion Scale

Compared with 3 months ago, how has air quality in your area changed?

Scale: 17
Min:Much worseMax:Much better
Q18
Multiple Choice

What is your current housing situation?

  • Rent
  • Own
  • Other arrangement
  • Prefer not to say
Q19
Opinion Scale

Compared with 3 months ago, how has pedestrian and cyclist safety in your area changed?

Scale: 17
Min:Much worseMax:Much better
Q20
Dropdown

What is your age?

  • Under 18
  • 18–24
  • 25–34
  • 35–44
  • 45–54
  • 55–64
  • 65 or older
  • Prefer not to say
Q21
Opinion Scale

Compared with 3 months ago, how has parking availability in your area changed?

Scale: 17
Min:Much worseMax:Much better
Q22
Multiple Choice

What is your gender?

  • Woman
  • Man
  • Non-binary
  • Prefer to self-describe
  • Prefer not to say
Q23
Opinion Scale

Compared with 3 months ago, how has local business activity (e.g., foot traffic to nearby shops) in your area changed?

Scale: 17
Min:Much worseMax:Much better
Q24
Multiple Choice

What is your current employment status?

  • Employed full-time
  • Employed part-time
  • Self-employed
  • Unemployed and looking
  • Student
  • Homemaker or caregiver
  • Retired
  • Unable to work
  • Prefer not to say
Q25
Opinion Scale

Overall, how have MFC-related activities affected your quality of life in the last 3 months?

Scale: 17
Min:Much worseMax:Much better
Q26
Dropdown

What is the highest level of education you have completed?

  • Some high school or less
  • High school diploma or equivalent
  • Some college or associate degree
  • Bachelor's degree
  • Graduate or professional degree
  • Prefer not to say
Q27
Opinion Scale

Based on what you know today, to what extent do you support or oppose having an MFC operating within 1 mile of your home?

Scale: 17
Min:Strongly opposeMax:Strongly support
Q28
Long Text

What is your ZIP or postal code? (Optional)

What’s included

  • AI follow-ups

    Adaptive probes on open-ended answers that pull out detail a static form would miss.

  • Attention checks

    Built-in safeguards against rushed answers and low-quality respondents.

  • AI-drafted copy

    Wording, ordering, and branching written by the AI — tuned to your research goal.

  • Auto report

    Themes, quotes, and a plain-English summary write themselves once responses come in.

Ready to launch?

Open this template in the editor. Every part is yours to change before the first respondent sees it.

Related templates

More studies from the same category.

See all
Sample Templates

Mobile App UX & Performance Evaluation Survey

Evaluates user perceptions of mobile app navigation, gesture interactions, speed, and stability to identify priority areas for UX improvement. Designed for active and lapsed app users across iOS and Android.

View template
Sample Templates

API & SDK Developer Experience (DX) Survey

Captures developer feedback on API documentation, SDK setup, and integration friction to identify pain points and prioritize developer experience improvements.

View template
Sample Templates

Circular Retail Program Demand & Attitudes Survey

Measures shopper awareness, behavioral intent, and preferences for retailer-led circular programs—including trade-ins, take-back, repair, and refurbished resale—to inform program design and go-to-market strategy.

View template
Sample Templates

Developer Integration Experience Survey

Captures developer feedback on API, SDK, and documentation experiences to identify friction points, measure satisfaction, and prioritize improvements post-onboarding or post-release.

View template
Sample Templates

RAG System Quality & Grounding Assessment (Developer Survey)

Evaluates developer experiences with Retrieval-Augmented Generation systems across retrieval quality, grounding accuracy, evaluation practices, and infrastructure. Designed for ML engineers, backend engineers, and data scientists actively building or maintaining RAG pipelines.

View template
Sample Templates

Leisure Travel Behavior & Preferences Survey

Measures leisure travelers' trip frequency, destination decision drivers, transportation preferences, satisfaction, and likelihood to recommend — providing actionable segmentation and experience insights for travel brands, tourism boards, or academic research.

View template