Texting & Driving Survey
Answers marked with a * are required.
 
1. Are you male or female?

      

 
 
 
2.

Do you hold a current drivers license?


      

 
 
 
3.

Is driving a part of your job?                


      

 
 
 
4.

Do you own a cell phone?


      

 
 
 
5.

Do you think people should be allowed to use their cell phones while driving?    


      

 
 
 
6.

Do you use hands-free calling or a headset to talk on the phone while driving?   


      

 
 
 
7.

Do you think people should be allowed to text while driving?


      

 
 
 
8.

In the past six months, have you been involved in any near crashes as a result of using your cell phone?


      

 
 
 
9.

In the past six months, have you been involved in any collisions as a result of using your cell phone?
(If NO, skip to question 12.)


      

 
 
 
10. Q9 A: Did you sustain any injuries?

      

 
 
 
11. Q9 B: Did you seek medical treatment?

      

 
 
 
12.

In the past six months, have you been involved in any near misses as a result of texting?


      

 
 
 
13.

In the past six months, have you been involved in any collisions as a result of texting?
(If NO, skip to question16.)


      

 
 
 
14. Q13 A: Did you sustain any injuries?

      

 
 
 
15. Q13 B: Did you seek medical treatment?

      

 
 
 
16.

Do you feel texting while driving impairs your driving performance?


      

 
 
 
17.

As a passenger, do you feel safe if the driver is text messaging?


      

 
 
 
18.

Do you think talking on your cell phone while driving should be illegal?


      

 
 
 
19.

Do you think texting while driving should be illegal?


      

 
 
 
20. Has texting and driving impacted your life? We’d love to hear your story. Tell us your opinions and experience here.
 
 
           
 

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