Maryland Highway Safety Office Traffic Survey

 
1. What is today's date?
MM DD YYYY
Date
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2. What was the name of the program you attended or where did you get this survey?
3. Indicate the COUNTY where you LIVE:
4. What is your HOME zip code?
5. What is your AGE?
6. What is your SEX?
7. Are you Hispanic or Latino?
8. Select one or more of the following:
9. Indicate your WEEKLY driving mileage (car/van/SUV/pick-up):
10. Indicate your level of agreement:
Strongly AgreeSomewhat AgreeSomewhat DisagreeStrongly DisagreeUndecided
I often act on the spur of the moment.
I like to drive more than 10 MPH over the posted speed limit.
Most of my family and friends think it's ok to talk on a cell phone without using a hands-free device while driving.
Most of my family and friends think that it is ok to text while driving.
I am likely to text the next time I drive.
I am likely to talk on a cell phone without using a hands free device the next time I drive.
Most of my family and friends routinely drive at least 10 MPH over the posted speed limit.
In the past 30 days, I have driven more than 10 MPH over the posted speed limit.
If I am stopped for drinking and driving, the punishment will be severe.
I am likely to be stopped by police if I drive more than 10 MPH over the speed limit
11. Indicate the likeliness of each:
Very LikelySomewhat LikelyNot Very LikelyNot LikelyDon't Know
How likely is it that something bad would happen if you don't wear your seat belt?
How likely are you, as a PEDESTRIAN, to be stopped for a cross walk violation?
How likely are you to be stopped by police if you drive within two hours of drinking alcoholic beverages?
How likely are you to get a ticket if you don't wear your seat belt?
How likely are you, WHILE DRIVING A MOTOR VEHICLE, to be stopped for a crosswalk/pedestrian violation?
12. Indicate how often:
5 or More Times3-4 Times1-2 TimesNever
During the past 30 days, how many times did you RIDE in a car or other vehicle driven by someone who had been drinking alcoholic beverages?
In the past week, how often have you used your cell phone without a hands-free device while driving?
In the past 30 days, how many times have YOU DRIVEN a car or other vehicle within 2 hours of drinking alcoholic beverages?
In the past week, how often have you texted while driving?
13. Think of the last time you did not use a crosswalk - what was your reason for not using the crosswalk? (Mark all that apply)
14. Indicate how often:
All of the timeMost of the timeOccasionallyRarelyNever
How often do you use a seat belt when you drive or ride in the FRONT seat of a car, van, SUV or pick-up truck?
When driving with child passenger(s) under 13 years, how often do you make them sit in a back seat?
How often do you use a seat belt when you ride in a BACK seat of a car, van, SUV or pick-up truck?
15. Do you transport children under the age of 10 in a car, van, sports utility, or pick-up truck?
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