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* 1. Please Complete:

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* 2. How many vehicles did you check? (Check at least 100 vehicles, if possible. To obtain the most accurate results, be sure to check the SAME number or approximately the same number of vehicles for pre and post checks.)

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

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

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* 5. Results

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

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

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* 7. Sponsor or SRO verifying the results:

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