Love Your Self, BTB Seatbelt Survey

Presented by: C.A.R.E.S ClubTN

Our mission is to establish and assist teen-managed advocacy programs in high schools throughout the Mid-South that focuses on traffic safety education, unsafe driving practices and emphasizes on preventive ways to decrease crashes, injuries, and fatalities amongst teen drivers.

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* 1. Full Name

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* 2. Age

19+

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* 3. Gender

Female

Male

Non-Gender Specific

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* 4. Email

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* 5. School/Organization

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* 6. Zip Code

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* 7. What is your race or ethnicity?

Asian

Black or African American

Hispanic or Latino

Middle Eastern or North African

Multiracial or Multiethnic

Native American or Alaska Native

Native Hawaiian or other Pacific Islander

White

Prefer not to answer

Self-describe below:

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* 8. How often do you drive a motor vehicle

Every day

A few times a week

About once a week

A few times a month

Once a month

Less than once a month

Not Applicable/I Don't Drive

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* 9. When DRIVING a vehicle, how often do you wear your seat belt?)

Always

Often

Sometimes

Rarely

None at all

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* 10. As a PASSENGER, how often do you wear your seat belt?

Always

Often

Sometimes

Rarely

None at all

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* 11. Which one of the following encourages you to wear your seatbelt (click all that apply)?

It's the law

Fear of getting a ticket

You were in a car crash

A social media/marketing advertisment

A PSA video

Someone you know was in a car crash

Increase seatbelt awareness campaigns

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* 12. Did you know that Tennessee has a law requiring the wearing of seat belts by drivers and passengers?

Yes

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* 13. How likely is it that you will wear your seatbelt after learning about seatbelt awareness through the C.A.R.E.S Program?


Very Likely	Very Likely	Very Likely	Very Likely	Very Likely	Very Likely
Likely	Likely	Likely	Likely	Likely	Likely
Somewhat Likely	Somewhat Likely	Somewhat Likely	Somewhat Likely	Somewhat Likely	Somewhat Likely
Not Likely	Not Likely	Not Likely	Not Likely	Not Likely	Not Likely