Traffic Crash Risk Assessment Form
Assess your risk factors related to traffic crashes by answering the following questions.
How many years of driving experience do you have?
*
Please Select
Less than 1 year
1-3 years
4-7 years
8-15 years
More than 15 years
How often do you drive over the speed limit?
*
Never
Rarely
Sometimes
Often
Always
In the past 12 months, how many traffic violations have you received?
*
None
1
2
3 or more
How frequently do you drive while feeling fatigued or drowsy?
*
Never
Rarely
Sometimes
Often
How would you rate your adherence to seatbelt use?
*
1
2
3
4
5
In the past 3 years, have you been involved in any traffic crashes?
*
No
Yes, once
Yes, more than once
How regularly do you maintain your vehicle (oil, brakes, tires, etc.)?
*
Always on schedule
Mostly on schedule
Occasionally
Rarely
How confident are you in navigating adverse weather conditions (rain, snow, fog, etc.)?
*
1
2
3
4
5
How often do you use a mobile phone or other devices while driving?
*
Never
Rarely
Sometimes
Often
How would you rate your awareness of road signs and traffic regulations?
*
1
2
3
4
5
Submit Assessment
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