JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Driving Survey
Directions: Please read the following and please select the answer that best fits you.
Sign in to Google
to save your progress.
Learn more
* Indicates required question
1.
Do you text and drive?
*
Yes
No
2.
Have you been in a car with a driver who texts while driving
*
Yes
No
3.
When driving, do you use a cell phone?
*
Yes, but I have a freehand device
No
4.
Do you eat while driving?
*
Yes
No
5.
Do you play with radio and/or Ipod while driving?
*
Yes
No
6.
Have you been in a car with a driver who plays with radio and/or Ipod while driving?
*
Yes
No
7.
Do you wear a seatbelt when riding in a car?
*
Always
Most Often
Sometimes
Never
8.
Do you follow posted speed limit or drive over posted limit?
*
Always
Drive 5 over
Driver 10 over
Drive more than 10 over
9.
Do you speed if running late?
*
Yes
No
10.
Do you feel you are alert and obey traffic laws when driving?
*
Yes
No
11.
Do you or have you been with someone under the influence (drugs or alcohol) within the last 6 months?
*
Yes
No
Submit
Clear form
Forms
This content is neither created nor endorsed by Google.
Report Abuse
Terms of Service
Privacy Policy
Help and feedback
Contact form owner
Help Forms improve
Report