Questionnaires for Drivers
A. Demographic Information
Instruction: Please fill in the blanks with the specific answers.
Name: _______________________ Civil Status: ____________________
Address: _______________________________________________________
Occupation: _______________________ Sex: ______ Age: __________
B. Perception of the Respondents
Instruction: Please indicate your answer on the blank or encircle your answer on some questions that have choices.
1. How long do you have your cellphone?
2 months ______
3 months ______
4 months and above ______
1 year ______
More than a year ______
2. Do you use cellphones while driving your vehicles? __________________________________________________________
3. How often do use your cellphone while driving?
1 (Very Frequent) 2 (Frequent) 3 (Average) 4 (Rare) 5(Very Rare)
4. Are you aware that it is dangerous to use cellphone while driving?
1 (Definitely) 2 (Yes) 3 (Undecided) 4 (No) 5 (Never)
5. What are the reasons you use cellphone for, even though you are driving (you can check more than 1)
Emergency __________
Concern for the caller _________
Personal interest ________
Call from family members ________
For business purpose ________
Others, please specify: __________________________________
6. Do you feel uncomfortable using mobile phones while driving?
1 (Definitely) 2 (Yes) 3 (Undecided) 4 (No) 5 (Never)
7. Is it rewarding using mobile phones while driving in a sense that it fulfils objectives of some sort?
1 (Definitely) 2 (Yes) 3 (Undecided) 4 (No) 5 (Never)
8. Are you distracted when your mobile phone rings while you are driving?
1 (Definitely) 2 (Yes) 3 (Undecided) 4 (No) 5 (Never)
9. What hand do you use when you pick up your phone while driving?
Left __________ Right __________
10. Do you have difficulty steering the wheel with your other hand while you pick up the mobile phone with the other?
1 (Definitely) 2 (Yes) 3 (Undecided) 4 (No) 5 (Never)
11. Do you take your eye of the road when you pick up the mobile phone?
1 (Very Frequent) 2 (Frequent) 3 (Average) 4 (Rare) 5(Very Rare)
12. Do you experience missing a signal in the stoplight because of answering a ringing phone or dialling a number to the phone?
1 (Very Frequent) 2 (Frequent) 3 (Average) 4 (Rare) 5(Very Rare)
13. When dialling a phone while driving, do you take your eye off the road?
1 (Very Frequent) 2 (Frequent) 3 (Average) 4 (Rare) 5(Very Rare)
14. Are you aware that it is a crime to use mobile phone while driving?
1 (Definitely) 2 (Yes) 3 (Undecided) 4 (No) 5 (Never)
15. Have you been in a minor or major accident, or just an error in driving because of using mobile phone? If yes, please elaborate your experience on the blank below.
________________________________________________________________________________________________________________________________
16. Do you believe that using mobile phone while driving is dangerous? Please share your opinion about the matter.
________________________________________________________________________________________________________________________________________________________________________________________________
17. What are the other disadvantages of using mobile phones while driving based on your experiences as a driver?
________________________________________________________________________________________________________________________________________________________________________________________________
-Thank you for your cooperation! -
0 comments:
Post a Comment