Driving Survey

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Driving Survey

Directions: complete the following choose the answer that best fits you.

Do you text and drive? *

yes

Have you been in a car with a driver who texts while driving?

yes

Clear selection

When driving, do you use a cell phone?

yes

yes, but i use a hand free device

Clear selection

Do you eat while driving?

yes

Clear selection

Do you play the radio or iPod while driving?

yes

Clear selection

Have you been in a car with a driver who plays the radio or iPod while Driving?

yes

Clear selection

Do you wear a seat-belt when riding in a car?

always

most often

sometimes

never

Clear selection

Do you follow posted speed limit or drive over posted speed limit?

always

drive 5 over

drive 10 over

drive more than 10 over

Clear selection

do you speed if running late?

yes

Clear selection

do you feel alert and obey traffic laws when driving?

yes

Clear selection

do you or have you been with someone under the influence (drugs or alcohol) withing the last 6 months

yes

Clear selection

Submit

Clear form

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