Roadside Emergency Kit Survey Form
Help us understand the preparedness and needs of vehicle owners regarding roadside emergency kits. Please answer the following questions about your kit and experience.
First Name and Last Initial
*
First Name
Last Name
Email Address
*
example@example.com
City or Region
*
Vehicle Type
*
Please Select
Car
Truck
SUV
Van
Motorcycle
Other
Do you currently have a roadside emergency kit in your vehicle?
*
Yes
No
Which items are included in your kit? (Select all that apply)
*
Jumper cables
First aid supplies
Flashlight
Reflective triangles/flares
Basic tools
Blanket
Water/snacks
Tire repair kit
Other
How would you rate the current condition and readiness of your kit?
*
1
2
3
4
5
When did you last check or update your kit?
*
Please Select
Within the past month
Within the past 6 months
Within the past year
Over a year ago
Never
Where is your kit stored in your vehicle?
*
Please Select
Trunk/Cargo area
Under seat
Glove compartment
Other
Do you need to replace or add any items to your kit?
*
Yes
No
Not sure
How useful do you consider your roadside emergency kit?
*
Not useful
1
2
3
4
Extremely useful
5
1 is Not useful, 5 is Extremely useful
Additional notes or suggestions (optional)
Submit Survey
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