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ECHO - Impaired Driving Survey - General Population
Please answer the following questions. The survey results will be used in a community assessment to determine the level of driving after drinking alcoholic beverages.
1.
In the past 30 days, have you read, seen, or heard anything about alcohol impaired driving (or drunk driving) enforcement by police?
Yes
No
2.
What do you think the chances are of someone getting arrested if they drive after drinking?
(1 is not likely & 5 is most likely)
1
2
3
4
5
3.
In the past 30 days, how many times have you driven a motor vehicle within 2 hours after drinking alcoholic beverages?
None
1 time
2-5 times
6-10 times
11 or more times
4.
Have you ever been charged with a DUI (Driving under the Influence)?
Yes
No
# of Charges
5.
If you answered yes to question # 4, where did you consume your alcoholic beverages?
At Home
At a Friend's Home
At a Bar/Restaurant
At the River/Beach
Other (please specify)
6.
What is your gender?
Male
Female
7.
What is your race?
White
Black/African American
Hispanic
Other _____________________
Other (please specify)
8.
How old are you?
Under 17
18 -20
21 - 25
26 - 30
31 - 35
36 or older
9.
What is your zipcode?
29936
29916
29927
29922
29934
Other (please specify)
10.
What is the number of alcoholic drinks you have had in the last two weeks?
None
1 - 2
3 - 5
6 -8
9 or more
11.
In the past 30 days, have you ridden in a car with someone who had been drinking alcohol?
Yes
No
12.
If you answered yes to question # 11, what was the age range of the person you were riding with?
15 - 17
18 - 20
21 - 25
26 - 30
31 - 35
36 or older