Driver Post-Survey

Name


A red asterisk (*) indicates required questions.


  1. Which of the following statements best describes your experience with driving? Mark only one.*
    I do not drive yet
    I am learning to drive
    I drive on my own


  1. In the past 4 months, how many crashes have you been in as a driver?*
    0
    1
    2 or more


  1. In your lifetime, how many crashes have you been in as a driver where someone needed medical attention?*
    0
    1
    2 or more


  1. In the past 4 months, how many crashes have you been in as a passenger?*
    0
    1
    2 or more


  1. In your lifetime, how many crashes have you been in as a passenger where someone needed medical attention?*
    0
    1
    2 or more


  1. Please mark how often each of the following statements is true for you in the last 3 months.
    I wear my seat belt when I drive.*
    Never
    Seldom
    Neutral (Not Sure)
    Occasionally
    Often


  1. I have had a helpful conversation about driving safely.*
    Never
    Seldom
    Neutral (Not Sure)
    Occasionally
    Often


  1. I drive when I feel Angry.*
    Never
    Seldom
    Neutral (Not Sure)
    Occasionally
    Often


  1. I talk on a cell phone when I drive.*
    Never
    Seldom
    Neutral (Not Sure)
    Occasionally
    Often


  1. I drive more than 10miles per hour over the speed limit.*
    Never
    Seldom
    Neutral (Not Sure)
    Occasionally
    Often


  1. I have been scared by an event while I was driving.*
    Never
    Seldom
    Neutral (Not Sure)
    Occasionally
    Often


  1. I will read texts while driving.*
    Never
    Seldom
    Neutral (Not Sure)
    Occasionally
    Often


  1. I will eat food while driving.*
    Never
    Seldom
    Neutral (Not Sure)
    Occasionally
    Often


  1. My focus on driving gets distracted.*
    Never
    Seldom
    Neutral (Not Sure)
    Occasionally
    Often


  1. When I drive I have at least 4 other passengers in the car.*
    Never
    Seldom
    Neutral (Not Sure)
    Occasionally
    Often


  1. I have received a ticket or a warning from police while driving.*
    Never
    Seldom
    Neutral (Not Sure)
    Occasionally
    Often


  1. Other drivers honk at me in irritation or to warn me.*
    Never
    Seldom
    Neutral (Not Sure)
    Occasionally
    Often


  1. I think I am a better driver than my peers.*
    Never
    Seldom
    Neutral (Not Sure)
    Occasionally
    Often


  1. Please mark how often each of the following statements is true for you in the last 3 months.
    Worn a seatbelt while I am in a motor vehicle (passenger or driver)*
    Never
    Seldom
    Sometimes
    Often
    Always


  1. Been in a motor vehicle (passenger or driver) when the driver has been drinking or otherwise under the influence of drugs or chemicals.*
    Never
    Seldom
    Sometimes
    Often
    Always


  1. Been in a motor vehicle (passenger or driver) when the driving was using a cell phone.*
    Never
    Seldom
    Sometimes
    Often
    Always


  1. Been in a motor vehicle (passenger or driver) when the driving was texting.*
    Never
    Seldom
    Sometimes
    Often
    Always


  1. While a passenger, asked the driver to stop doing something I understood as unsafe (ex: on cell phone, texting, not wearing seatbelt, under the influence).*
    Never
    Seldom
    Sometimes
    Often
    Always


  1. As the driver in a motor vehicle asked one or more of my passengers to buckle up, stop being distracting, or stop other unsafe behaviors.*
    Never
    Seldom
    Sometimes
    Often
    Always


  1. The local Project Ignition program's message is clear to me.*
    Strongly Disagree
    Disagree
    Neutral (neither agree nor disagree)
    Agree
    Strongly Agree


  1. The people involved in the Project Ignition program are generally respected in our school/community.*
    Strongly Disagree
    Disagree
    Neutral (neither agree nor disagree)
    Agree
    Strongly Agree