Driving Survey

Gathers information about respondents' driving habits and behaviors for analysis or research purposes.

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Please indicate your gender

Male Female Other

Please indicate your age

What city do you currently live in?

What kind of vehicle do you currently drive?

How often do you drive (days per week)?

Where do you drive to most often?

Do you usually leave early, on time, or late?

Early On time Late

What is the average speed you drive on main roads?

Regardless of the speed limit, I drive according to road conditions

Not likely

1 2 3 4 5 6 7 8 9 10

Very likely

In the last 30 days, have you talked on the phone while driving?

Yes No

In the last 30 days, have you smoked while driving?

Yes No

In the last 30 days, have you eaten or drunk while driving?

Yes No

Have you ever gotten a ticket from a police officer?

Yes No

If so, what for? Please explain.

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