Exit Drivers Ages 35+ Question Title * 1. Please Enter your Zip Code: Question Title * 2. How many years have you held a driver's license? Question Title * 3. Have you personally known someone who has been killed in a vehicle crash? Yes No If yes, what is your relationship to that individual(s)? Question Title * 4. What percentage of the time do you wear a seatbelt? 0 100 Clear i We adjusted the number you entered based on the slider’s scale. Question Title * 5. Why do you wear/not wear a seatbelt? Question Title * 6. How many traffic tickets (moving violation) have you received? 0 1-2 3 or more Question Title * 7. As a driver, how many crashes have you been involved in? 0 1-2 3 or more Question Title * 8. How long after obtaining your license did each crash occur? N/A if 0: Crash #1: Crash #2: Crash #3: Question Title * 9. Please describe what you learned from each crash and/or how you could have prevented it? Question Title * 10. Do you text while driving? Yes No Question Title * 11. In your opinion, do you believe Driver's Ed. is providing adequate training for teen drivers today? Yes No Why? Question Title * 12. Do you believe the license renewal process should be more than a vision and rules of the road test? Yes No Question Title * 13. What frequency do you insist on passengers in your car wearing their seat belt? Never Sometimes Always Why? Question Title * 14. Please rate the following driver behavior in terms of risk. Use 1 for the item that YOU feel is the most dangerous and 4 for the least. Question Title * 15. Are you interested in participating in additional surveys or interviews for our research? Yes No Question Title * 16. If yes, Please provide your name and select your prefered method of communication: First Name Email Address Phone Number Done
