* 1. Please Complete:

* 2. How many vehicles did you check? (Check at least 100 vehicles, if possible. Check approximately same number vehicles for pre and post checks for more accurate results.)

* 3. Of the drivers you checked, how many were...

* 4. How many vehicles had any of the above listed distractions?

* 5. Results

Provide the percent of drivers distracted:
(Please ONLY give a percentage)

* 6. Sponsor or SRO verifying the results: