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364 A p p e n d i x x Exit Survey
365 Exit Survey There are 17 questions in this survey questions 1 Please answer the following questions as accurately as possible. You may choose to take some time to think about each item. Remember, all responses are kept completely confidential. 2 On average, how much life stress did you feel during your participation in the study? Please choose only one of the following: Almost no stress Slight stress Moderate stress High stress Extremely high stress 3 How much is your driving affected by stress? Please choose only one of the following: Not affected Slightly affected Moderately affected Very affected Extremely affected
366 4 To what degree do you feel your participation in the study altered your driving behaviors? Please choose only one of the following: Not altered Slightly altered Moderately altered Very altered Extremely altered 5 You indicated that your driving was affected by your participation in the study - in what way was it affected? Only answer this question if the following conditions are met: ° Answer was 'Extremely altered' or 'Very altered' or 'Moderately altered' or 'Slightly altered' at question '4 [4]' (To what degree do you feel your participation in the study altered your driving behaviors?) Please write your answer here: 6 How would you rate how safely you drove in the past year compared to all of your previous years of driving? Please choose only one of the following: Much more safely Somewhat more safely About the same Somewhat less safely Much less safely
367 7 How would you rate your driving ability compared to the average driver? Please choose only one of the following: Much better Somewhat better About the same Somewhat worse Much worse 8 How do you restrict your driving? Please choose all that apply: Avoid driving at night Avoid highway or interstate travel Avoid left turns across traffic, where possible Avoid high traffic volumes Avoid driving in unfamiliar areas Other 9 Please Describe: Only answer this question if the following conditions are met: ° Answer was at question '8 [8]' (How do you restrict your driving?) Please write your answer here:
368 10 How likely are you to give up driving altogether within the next 12 months? Please choose only one of the following: Very unlikely Somewhat unlikely Neither likely nor unlikely Somewhat likely Very likely 11 Is there any event or incident that happened in the past year where you pushed the critical incident button that you would like to tell us about? Please choose only one of the following: Yes No 12 Approximate Date Only answer this question if the following conditions are met: ° Answer was 'Yes' at question '11 [11]' (Is there any event or incident that happened in the past year where you pushed the critical incident button that you would like to tell us about?) Please write your answer here: 13 Approximate time Only answer this question if the following conditions are met: ° Answer was 'Yes' at question '11 [11]' (Is there any event or incident that happened in the past year where you pushed the critical incident button that you would like to tell us about?) Please write your answer here:
369 14 Description Only answer this question if the following conditions are met: ° Answer was 'Yes' at question '11 [11]' (Is there any event or incident that happened in the past year where you pushed the critical incident button that you would like to tell us about?) Please write your answer here: 15 How would you rate your experiences participating in this study? Please choose only one of the following: Very favorable Somewhat favorable Neither favorable nor unfavorable Somewhat unfavorable Very unfavorable 16 Is there anything in particular that you would like to bring to our attention? Please write your answer here:
370 17 Thank you for your participation! Submit Your Survey. Thank you for completing this survey.
