The purpose of this survey is to assess student habits while walking and crossing the street. This survey is confidential. Please indicate your best response to each statement. Your honest responses are greatly appreciated. 

Thank you so much for your time and participation in completing this survey.

Question Title

* 1. I can text on my phone/tablet and safely cross the street at the same time.

Question Title

* 2. I can listen to music on my headphones and safely cross the street at the same time. 

Question Title

* 3. I can talk on my phone and safely cross the street at the same time.

Question Title

* 4. Did you notice the stencils and signs saying "Heads Up, Phone Down" around the school in the last few weeks?

Question Title

* 5. If YES, have you changed or do you plan to change your street crossing behavior as a result of the message?

Question Title

* 6. If YES, how? (check all that apply)

T