LA Rapid Assessment of Activities While Driving

We are doing a short survey on the type of activities people do while driving motor vehicles.  This survey will take less than 5 minutes to complete.  Your responses to our questions will be kept strictly confidential, and we will not ask for your name, address, or telephone number.  Your participation in this survey is voluntary and you can refuse to participate.  Once you complete this survey, no one will contact you regarding your answers. Your answers will be kept confidential. They will be reported only as aggregate (combined) information and will not identify you. We thank you in advance for your participation.
Rapid Assessment of Activities While Driving
Age*
Age*
Gender Identity*
Gender Identity*
Which County do you live in?*
Which County do you live in?*
Which race/ethnicity do you identify as?*
Which race/ethnicity do you identify as?*
What grade are you in?
What grade are you in?
Rapid Assessment of Activities While Driving
In the past 30 days have you driven a motor vehicle like a car, truck, SUV, or motorcycle?*
In the past 30 days have you driven a motor vehicle like a car, truck, SUV, or motorcycle?*
Rapid Assessment of Activities While Driving
What stage of licensing are you currently in?*
What stage of licensing are you currently in?*
Rapid Assessment of Activities While Driving
 If you are fully licensed, were you in a Driver’s Ed program?*
 If you are fully licensed, were you in a Driver’s Ed program?*
Rapid Assessment of Activities While Driving
Are you driving a vehicle or using an app that has a monitoring device that your (parents/guardians) use to check your driving?*
Are you driving a vehicle or using an app that has a monitoring device that your (parents/guardians) use to check your driving?*
How long have you been driving a motor vehicle?
How long have you been driving a motor vehicle?
Rapid Assessment of Activities While Driving
In the past 30 days, how often did you do these activities WHILE YOU WERE DRIVING?  (Check only one)*
In the past 30 days, how often did you do these activities WHILE YOU WERE DRIVING?  (Check only one)*
Never (0 days)
Rarely (1-5 days)
Some days (6-14 days
Most days (15-29 days)
Every-time (30 days)
Wear a seatbelt?
Eat and/or drink non-alcoholic beverages?
Use a GPS or navigation system?
Listen to a podcast, radio or other entertainment device?
Use hands-free vehicle voice commands to make/answer calls, send/receive messages?
Use phone to make/answer calls, send or receive emails/text messages?
Play games on a cell phone or an electronic gaming system?
Attend to personal grooming (e.g., apply makeup, shave, pluck eyebrows or brush hair)?
Smoke or vape (e.g., cigarettes, e-cigarettes)?
Drive high? (e.g. marijuana or other drugs)
Sing?
Dance?
Studying or doing homework?
Watch movies or videos?
Physically hold and talk on your cell phone?
Talk on your cell phone with a hands-free device (e.g. ear buds, speaker phone)?
Drive while drunk or buzzed?
Have conversations with passengers in the car?
Drive under the influence of prescription drugs?
Rapid Assessment of Activities While Driving
Now, please tell us about your experiences with a motor vehicle. (Check only one)*
Now, please tell us about your experiences with a motor vehicle. (Check only one)*
Yes
No
Have you ever been involved in a motor vehicle crash as a driver?
Have you ever been injured because of a motor vehicle crash as a driver?
Have you injured others in a motor vehicle crash?
Have you ever received a warning or a traffic ticket for talking or texting on your cell phone while you were driving?
As a driver have you ever been in a crash while you were texting and/or talking on a cell phone?
Rapid Assessment of Activities While Driving

Now, please tell us about your experiences with a motor vehicle. (Check only one)*

Now, please tell us about your experiences with a motor vehicle. (Check only one)*

Yes
No
Have you ever been involved in a motor vehicle crash as a passenger?
Have you ever been injured because of a motor vehicle crash as a passenger?
Rapid Assessment of Activities While Driving

Overall, I feel…*

Overall, I feel…*

N/A
Never
Sometimes
Most of the time
Always
that I’m a safe driver.
Rapid Assessment of Activities While Driving

Overall, I feel…*

Overall, I feel…*

N/A
Never
Sometimes
Most of the time
Always
that I’m a safe passenger.
Rapid Assessment of Activities While Driving

If you have any comments on the survey or the project, please leave a comment below

If you have any comments on the survey or the project, please leave a comment below