I agree to take part in this research by completing this CONFIDENTIAL survey. I also agree to take an additional survey in the future and am supplying my e-mail and cell phone number below where I can be reached.

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* 1. Do you have a driver’s license?

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* 2. If so, for how long?

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* 3. Age:

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* 4. Grade:

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* 5. What school do you attend?

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* 6. Gender:     

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* 7. Email (non-school):

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* 8. Cell #

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* 9. Do you drive with two hands on the wheel?

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* 10. Do you leave one car length between you and the car in front of you for every 10mph of speed? Example: 4 car lengths between you and the person in front of you if driving 40mph

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* 11. Do you wear your seat belt?

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* 12. Do all passengers (front and back) in your vehicle wear seat belts?

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* 13. Do you text while driving?

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* 14. Do you Snapchat while driving?

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* 15. Do you check notifications while driving?

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* 16. Have you ever raced a friend while driving?

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* 17. When you encounter a yellow light do you speed up to beat the light?

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* 18. Have you ever driven under the influence of either alcohol or drugs (legal or prescription)?

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* 19. Have you ever experienced (acted on or was a victim to) road rage?

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* 20. As a passenger do you distract the driver? (i.e. change radio, argue…)

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* 21. For winter driving, do you allow more stopping distance?

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* 22. For winter driving, do you come to a complete stop before you attempt to turn?

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* 23. Have you ever driven while drowsy or fatigued?

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* 24. Do you limit the number of teen passengers while you are driving?

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* 25. Do you speak to your parents about driving distractions?

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* 26. Have you ever been in a car accident where you were the driver?

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* 27. Have you ever received a traffic ticket?

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* 28. Have you ever been stopped but not ticketed?

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* 29. What is an acceptable speed to operate?

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* 30. Which of the following are distractions you have witnessed from other teen drivers?

  Never Rarely Sometimes Most of the Time Always
30. Teen  driver speeding
31. Teen driver on cell phone
32. Teen driver texting
33. Teen driver with multiple teens in the car
34. Passengers who get teen driver to speed
35. Teen driver playing loud music in car
36. Teen driver with passengers acting wild in car
37. Teen driver with passengers who have been drinking alcohol
38. Teen driver with passengers who have been smoking pot
0 of 30 answered
 

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