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What is your sex?
 
Male
 
Female
 
 
 
What is your age?
 
18-24
 
25-34
 
35-44
 
45-54
 
55+
 
 
 
Do you own a mobile (cell) phone?
 
Yes
 
No
 
 
 
Do you have a valid driver's license?
 
Yes
 
No
 
 
 
Have you driven at least once in the past year?
 
Yes
 
No
 
 
 
While operating (driving) a motor vehicle, have you ever used your mobile phone for any purpose?
 
Yes
 
No
 
 
 
If you answered "yes" to question 6, what did you specifically use your mobile phone for (Select all that apply)?
 
Phone call
 
Text message
 
E-mail
 
Directions
 
Social media (Facebook, Twitter)
 
N/A
 
Other
 

 
 
 
Are you aware of Virginia state law regarding mobile phone usage while operating (driving) a motor vehicle? (i.e. As a secondary offense, novice drivers less than 18 years old are prohibited from all cell phone usage while operating a motor vehicle and as a primary offense, all drivers are prohibited from texting while driving which can result in a $125 fine for the first violation and a $250 fine for the second violation.)
 
Yes
 
No
 
 
 
Which, if any, have you experienced while using a mobile phone while driving? (Select all that apply)
 
Traffic citation (ticket)
 
Accident
 
Slow Driving
 
Swerving
 
Sudden braking
 
Failure to obey traffic signals
 
Failure to use turn signals
 
N/A
 
Other
 

 
 
 
Do you believe that using a mobile phone while operating (driving) a motor vehicle is dangerous to yourself and others?
 
Yes
 
No