Driving Survey
Please indicate your gender
Female
Male
Other
Please indicate your age
What is the current city you live in?
What kind of vehicle do you currently drive?
How often do you drive (days in a week)?
Please Select
0
1
2
3
4
5
6
7
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 the road conditions
Strongly Disagree
1
2
3
4
Strongly Agree
5
1 is Strongly Disagree, 5 is Strongly Agree
In the last 30 days, have you spoken in 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/drink while driving?
Yes
No
Have you ever gotten a ticket from a cop before?
Yes
No
If so, what for? Explain.
Submit
Should be Empty: