Example Survey Questionaire (Self-Administered)

NAME OF AGENCY
ADDRESS OF AGENCY
CITY, STATE, ZIP

This survey of licensed drivers is being conducted for (insert name of agency or community) and will take only a few minutes of your time. Since a good response rate is essential for trustworthy results, we would very much appreciate your completing the questionnaire and returning it to the address above. To insure anonymity, do NOT put your name on the form.

  1. When you are driving, what traffic violations do you see other drivers committing? Check as many as you recall.

    • Drunk or drugged driving
    • Speeding
    • Not stopping completely at stop signs
    • Illegal turns
    • Tailgating/following too closely
    • Failure to signal a turn
    • Reckless (careless) driving
    • Not stopping for a red light
    • Failure to yield right-of-way
    • Failure to stop at light when making right turn on red
    • Passing illegally (on hill or curve, across double yellow line, etc.)
    • Driving too slow
    • Other:

  2. How do YOU define running a red light?

    • Entering an intersection on yellow but the light turns red while the car is still in the intersection
    • Entering an intersection on red
    • Other:

  3. How often do you see others run red lights?

    • Every day
    • A few times a week
    • A few times a month
    • Less than once a month

  4. Have you ever seen the police ticket someone who has run a red light?

    • Yes
    • No
    • Not sure – I have seen someone ticketed near an intersection but I’m not sure why they were stopped

  5. Have you ever run a red light as you described it?

    • Yes, once
    • Yes, more than once
    • No (skip to question 7)

  6. How did it happen? (check any factors involved in your running a red light)

    • Couldn’t stop in time
    • Afraid car behind would hit me
    • In a hurry
    • No other cars around
    • Not paying close enough attention
    • Unfamiliar with area, didn’t see light
    • Distracted by someone in the car
    • Other:

  7. Out of 100 drivers who run a red light in (insert name of community), how many do you think will actually be stopped and ticketed by the police?

    • None
    • 1-2
    • 3-5
    • 6-10
    • 11-20
    • More (specify):

  8. Out of 100 instances where someone runs a red light in (insert name of community), how many do you think will result in a collision, with the car hitting another car, a pedestrian, or a cyclist?

    • None
    • 1-2
    • 3-5
    • 6-10
    • 11-20
    • More (specify):

  9. In how many of these cases do you think someone will be hurt?

    • None
    • 1-2
    • 3-5
    • 6-10
    • 11-20
    • More (specify):

  10. Do you recall seeing or hearing any advertising about safe driving in the last three months? The advertising might have been on the radio, on television, in a newspaper, on a billboard, or somewhere else.

    • Yes
    • No
    • Not sure

  11. (If Yes) Please describe what you saw or heard.

[MODIFY QUESTIONS 12-18 TO REFLECT ANY LOCAL ADS RUNNING IN YOUR AREA]

  1. Three ads or public service announcements are described briefly below. Please indicate whether you recall seeing or hearing any of them.

    1. “Stop at Red” – This ad shows two impatient drivers who crash at an intersection because they were both trying to jump the light. It uses the line “So does she.”

      • Yes, I remember this
      • No, I don’t
      • I’m not sure

    2. “We’re Putting a Stop to Red-Light Runners for Good – Your Good” – This ad shows a police officer talking about the crashes he has seen. He says they are going to be watching out for red-light runners.

      • Yes, I remember this
      • No, I don’t
      • I’m not sure

    3. “He Took a Chance” – This ad shows an ordinary, responsible man who took a chance that he shouldn’t have at an intersection and got in a crash because someone else was taking a chance, too. The slogan is “The light is red for a reason. So stop.”
      • Yes, I remember this
      • No, I don’t
      • I’m not sure

[IF YOU ANSWERED “NO” OR “NOT SURE” TO ALL THREE PARTS OF QUESTION 12, SKIP TO QUESTION 19.]

  1. Do you recall seeing or hearing ads or information on red-light running anywhere else in the last three months?

    • Yes
    • No (skip to Question 16)
    • Not sure (skip to Question 16)

  2. (If Yes) Please indicate where the ads or information appeared. Check all that apply.

    • Magazine ad
    • Radio ad
    • Billboard
    • Newspaper article
    • Magazine article
    • Newspaper ad
    • Flier or direct mail insert
    • Other (specify):

  3. Please note anything you happen to remember about any of these ads or information:

  4. Have you changed your driving in any way as a result of seeing or hearing any of these ads?

    • Yes, definitely
    • Probably (skip to Question 19)
    • Probably not (skip to Question 19)
    • No (skip to Question 19)
  5. (If Yes) In what particular way have you changed something about your driving?

    • I stop for red lights now
    • I stop for yellow lights now
    • Other (specify): (skip to Question 19)

  6. Which ad, if any, made you change your driving?

    • “Stop at Red”
    • “We’re Putting a Stop to Red-Light Runners”
    • “He Took a Chance”
    • Other ads
    • None in particular

  7. Have you ever heard of the Federal Highway Administration?

    • Yes
    • No (skip to Question 22)
    • Not sure (skip to Question 22)

  8. (If Yes) Do you happen to know what this agency does?

    • Yes
    • No (skip to Question 22)
    • Not sure (skip to Question 22)

  9. (If Yes) Please write here anything you remember about what this agency does:

Finally, we need some background information for analysis purposes. A reminder: since your name does not appear on the questionnaire, the answers cannot be identified as yours.

  1. Your age group:

    • 16-25
    • 26-45
    • 45-60
    • over 60

  2. Your sex:

    • Male
    • Female

  3. Your occupation:

  4. Last grade you completed in school:

    • Less than high school
    • Some high school
    • High school graduate
    • Some college
    • College degree
    • Post-graduate

  5. How often do you wear a seat belt when you drive?

    • Always
    • Most of the time
    • Less than half the time
    • Never

  6. About how many miles per year do you drive?

    • Less than 10,000
    • 10,000 to 15,000
    • 15,000 to 20,000
    • More than 20,000

  7. Have you ever gotten a ticket for a moving violation?

    • No
    • Yes, once
    • A few times
    • Many times

  8. Have you ever taken a driver education course?

    • No
    • Yes

Thank you very much! Please put this completed questionnaire in the return envelope and mail it as soon as possible.

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Program Contact

Jeffrey Shaw

708-283-3524

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