Private Motor Vehicle Survey

Your grade/rank:

Your age

Your branch of the military

Your gender

Your current marital status

Have you recently returned from Unit Deployment

Have you received PMV training after return from deployment

Your distance from residence to work

Your travel time from residence to work

Your travel time from work to residence

Your usual mode of transportation to/from work

The usual number of people you travel with in a PMV to/from work

Do you typically use a PMV to conduct military business (e.g., MPF, medical, military events, etc.)

Your average hours actually at work on a workday

Are you currently employed at an additional job(s) outside the military



SUPERVISION

   
My command leadership provides me adequate information to identify and reduce risks associated with PMVs.

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

   
My supervisor assists me in identifying and reducing risks associated with PMVs.

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

   
My supervisor is genuinely concerned about my safety when it comes to PMVs.

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



PRECONDITIONS

   
My PMV is currently in good operating condition.

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

   
I would say something to the driver of a vehicle I was in if he/she was doing something unsafe.

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

   
I feel pressured by passengers to drive faster and/or bend traffic rules.

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

   
I feel pressured by other drivers on the road to drive faster and/or bend traffic rules.

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

   
My driving times or distances between home and work are excessive.

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



ACTS

How often do you:


   
Take long drives

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

   
Work long hours

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

   
Fail to get adequate rest

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

   
Over exercise

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



How often do the following describe your driving habits?

   
Excessive speed

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

   
Loss of vehicle control

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

   
Failure to use a seatbelt

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

   
Excessive alcohol consumption

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

   
Failure to yield right of way

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



How often do the following describe your driving habits (continued)?

   
Tailgating

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

   
Running a red traffic light

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

   
Accelerating through a yellow traffic light

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

   
Rolling through a stop sign

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

   
Making an illegal U-turn

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



How often do the following describe your driving habits (continued)?

   
Allowing a passenger in the front seat to not wear a seatbelt

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

   
Allowing a passenger in the back seat to not wear a seatbelt

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

   
Using a cell phone while driving

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

   
Wearing ear phones

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

   
Driving fatigued

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



How often do the following describe your driving habits (continued)?

   
Driving while distracted (reading a map, eating, loud music, etc.)

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

   
Driving while angry/upset/depressed/ill/etc.

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

   
Road rage (anger at other drivers)

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

   
Failure to take road conditions into account

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

   
Failure to take weather conditions into account

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

   
Failure to wear prescription glasses

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

   
Failure to use turn signals (including lane changes)

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

   
Failure to make adequate rest stops on long trips

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



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