Driving Survey

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Driving Survey

Please carefully read each of the following and choose the answer that best applies to you.

Do you text and drive?

Yes

Clear selection

Have you ever been in a car with someone who texts and drives?

Yes

Clear selection

While driving do you use your cell phone?

Yes

Yes but I have a hands free device

Clear selection

Do you eat while driving?

All Day

Yes

Clear selection

Do you play with the radio or iPod when driving?

Yes

Clear selection

Have you ever been in a car with a driver that plays with radio and or iPod when 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 most posted speed limit or drive over posted speed limit?

Always

Drive over 5

Drive over 10

More then 10

Clear selection

Do you speed when running late?

Clear selection

Submit

Clear form

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