Motorcycle Safety Survey

Your rank/grade:

Military Branch:

Your Status:

Your time in current unit:

Have you recently returned from an overseas unit deployment?

Gender:

Age:

Your current marital status:

Select which best describes your use of motorcycles:

Number of motorcycles you have owned:

Type of motorcycle you primarily operate:

Engine size of the primary motorcycle you operate:

Dollar value of your primary motorcycle (when you first obtained it):

Primary reason you ride a motorcycle

How long have you been operating a motorcycle?

How long have you had your current motorcycle?

Did you purchase your motorcycle after returning from your last unit deployment?

How recently have you completed level I training (e.g., MSF’s BRC; Total Control Basic Rider Training, etc.)?

How recently have you completed the level II training (e.g., ARC, MSRC, CRC, Total Control Intermediate Rider Training, etc.)?

How recently have you completed level III training (e.g., CA SuperBike; YCRS; Track Day, etc.)?

How often do you operate your motorcycle off road?

Have you been denied motorcycle rider training due to a lack of available courses/quotas?

Has your unit denied you the opportunity to attend motorcycle rider training?

Do you have a motorcycle endorsement on your driver license?

Do you have motorcycle insurance?

Number of other motorcyclists you typically ride with:

How frequently do you carry a passenger?

Do you own an automobile?

Is a motorcycle your primary mode of transportation?

How often do you ride your motorcycle to/from work?

Distance from your residence to your work:

Travel time from your residence to your work:

Average number of miles per year that you operate or are a passenger on a motorcycle:

Number of road trips that exceed 150 miles total driving distance that you typically take on a motorcycle per year:

How often do you use the technique of "lane splitting" (passing between two vehicles in adjacent lanes)?

Type helmet you typically wear:

Does your installation/unit have a motorcycle mentorship club?

Total number of motorcycle-related moving traffic citations you have personally received:

Total number of motorcycle-related mishaps you have personally had:

How many times have you been injured while riding a motorcycle?



SUPERVISION

   
How often do your unit leaders show support for the motorcycle safety program?

       
 NeverRarelySometimesOftenAlways
N/A
Don't Know
 
Enter any comment here: 

   
How often have your unit leaders assisted you in identifying/reducing risks associated with your motorcycle?

       
 NeverRarelySometimesOftenAlways
N/A
Don't Know
 
Enter any comment here: 

   
Leaders/Supervisors know who the high-risk motorcyclists are in my unit.

       
 Strongly DisagreeDisagreeNeutralAgreeStrongly Agree
N/A
Don't Know
 
Enter any comment here: 



ACTS

   
How often do you wear your helmet off base when riding your motorcycle?

       
 NeverRarelySometimesOftenAlways
N/A
Don't Know
 
Enter any comment here: 

   
How often do you require passengers on your motorcycle to wear a helmet?

       
 NeverRarelySometimesOftenAlways
N/A
Don't Know
 
Enter any comment here: 

   
How often do you wear other Personal Protective Equipment when riding your motorcycle off base (jacket, riding pants, boots, etc.)?

       
 NeverRarelySometimesOftenAlways
N/A
Don't Know
 
Enter any comment here: 

   
How often do you require passengers on your motorcycle to wear Personal Protective Equipment?

       
 NeverRarelySometimesOftenAlways
N/A
Don't Know
 
Enter any comment here: 

   
How often do you operate your motorcycle in inclement weather (e.g., rain, sleet, snow, fog, etc.)?

       
 NeverRarelySometimesOftenAlways
N/A
Don't Know
 
Enter any comment here: 

   
How often do you check T-CLOCS (tire pressure, controls, lights, oil, chassis/chain, and stand) before you ride your motorcycle?

       
 NeverRarelySometimesOftenAlways
N/A
Don't Know
 
Enter any comment here: 

   
How often do you use portable music players when operating your motorcycle?

       
 NeverRarelySometimesOftenAlways
N/A
Don't Know
 
Enter any comment here: 

   
How often do you use a cell phone when operating your motorcycle?

       
 NeverRarelySometimesOftenAlways
N/A
Don't Know
 
Enter any comment here: 

   
Do you use a Bluetooth headset to listen to music or talk on the phone?

       
 NeverRarelySometimesOftenAlways
N/A
Don't Know
 
Enter any comment here: 

   
How often do you drive greater than 10 mph faster than the flow of traffic when operating your motorcycle?

       
 NeverRarelySometimesOftenAlways
N/A
Don't Know
 
Enter any comment here: 

   
How often does peer pressure influence you to take unnecessary risks when operating your motorcycle (e.g., speeding, a wheelie, no hands, no helmet, etc.)?

       
 NeverRarelySometimesOftenAlways
N/A
Don't Know
 
Enter any comment here: 

   
How often do you operate your motorcycle within one hour of consuming alcohol?

       
 NeverRarelySometimesOftenAlways
N/A
Don't Know
 
Enter any comment here: 

   
How often do you carry a first aid kit on your motorcycle?

       
 NeverRarelySometimesOftenAlways
N/A
Don't Know
 
Enter any comment here: 



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