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Driving Survey
Directions: Please read each of the following carefully and choose the answer that best applies to you.
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* Indicates required question
Do you text and drive?
*
Yes
No
Have you been in a car with a driver who texts while driving?
*
Yes
No
when driving, do you use a cell phone?
*
Yes
Yes but i have a hand free device
No
Do you eat while driving?
*
Yes
No
Do you play with the radio and/or ipod while driving?
*
Yes
No
Have you ever been in a car with a driver who plays with the radio and/or iPod while driving?
*
Yes
No
Do you wear a seatbelt when riding in a car?
*
Always
Most often
Sometimes
Never
Do you follow posted speed limit or drive over posted limit?
*
Always
Drive 5 over
Drive 10 over
Drive more then 10 over
Do you speed if running late?
*
Yes
No
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