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Road Safety Questionnaire

Please complete the questionnaire below which will help develop road safety initiatives in Staffordshire in the future. As well,
once competed you will be entered into a draw to win a £25 iTunes voucher!

1. Do you use your mobile phone whilst walking in the street?

All the Very
Often Sometimes Never
time rarely

2. Why do you use your mobile phone whilst walking in the street? Tick all that apply
To check my
To make To listen to
To text social
calls music
networks

Other, please specify

3. Do you listen to music whilst walking in the street?

All the time Often Sometimes Never

4. Do you take your earphones out when crossing the road?

I don't
All the
Often Sometimes Never use
time
earphones

5. Have you ever nearly been hit by a moving vehicle due to lack of concentration?
Yes No

6. Do you think pedestrian safety is the responsibility of:

Pedestrian

Other, please specify

7. As a pedestrian, cyclist, learner driver or driver, what would be your preferred place to get online general road safety
information?
Website Facebook Twitter Mobile App

8. If there was a Road Safety Guide available for you to read, what format would you prefer it to be in? TICK ONE OPTION ONLY
Paper Downloadable E- Mobile
Website Video
booklet PDF magazine App

9. What would make you go and visit a road safety website/Facebook page/Twitter page for young drivers?
 Access Look at Read/write Interactive Take Enter Shared
information photos/videos a blog animation part competitions by a
and in a to win prizes friend
cartoons quiz

10. What sort of prizes would be of interest to you? Number in order of preference 1 being your preferred choice
Driving lessons

Car accessories

Halfords vouchers

Festival/concert tickets

Tyres

Ipod

Advanced driving course

Ipad

ITunes vouchers

High street shopping vouchers

Other, please specify

ABOUT YOU:

11. Respondent Name:

12. Respondent Age:

13. Are you male or female?

Male

Female

14. Mobile Number:

15. Email Address:

16. Are you a?

Driver

Learner Driver

Cyclist

Pedestrian

17. Do you drive mostly in:

Urban Areas

Rural Areas

N/A

18. Do you own your own car?

Yes
No