2023 Arrive Alive Pre-Seat belt Check Results

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* 1. Please Complete:

Name of School or Youth Group:

Date Seat Belt Check was Conducted:

Survey Time (must be approximately the same time for pre and post check):

Survey Location (must be the same location for pre and post check):

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* 2. Seat Belt Check Results:
*Please ONLY give numerical data, no words or explanation.

How many vehicles were checked during the pre- campaign survey?

Total number of vehicles with ALL passengers belted during the pre- campaign survey:

Percent of people buckled up during the pre- campaign survey:

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* 3. Adult Sponsor Verifying the Results: