Buckle Up Video Evaluation

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Buckle Up Video Evaluation

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Name:

Name of school, organization or agency

City

Do you have your license?

Yes

No

Clear selection

How likely were you to wear your seat belt on every trip BEFORE viewing the video?

Very unlikely

Somewhat likely

Very likely

Clear selection

How likely are you to wear your seat belt on every trip AFTER viewing the video?

Very unlikely

Somewhat likely

Very likely

Clear selection

Will you pass on the information you learned today to your friends and others?

Yes

No

Clear selection

Did you find the presenter knowledgeable?

No

Somewhat

Very knowledgeable

Clear selection

Was viewing this video a useful experience for you?

Yes

No

Clear selection

What was the most important thing learned from this video?

Submit

Clear form

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