INSTRUCTIONS:

For each of the following 15 questions, check one answer that most applies to you.

Introduction

Think about what tasks you do every time you get behind the wheel of a car. You must coordinate the actions of your hands, feet, eyes, ears, and body movements. At the same time, you must decide how to react to what you see, hear, and feel in relation to other cars and drivers, traffic signs and signals, conditions of the highway, and the performance of your car.

These decisions are usually made close to other vehicles and must be converted quickly into action - brake, steer, accelerate, or a combination of all - to maintain or adjust your position in traffic. And these decisions must be made frequently. About 20 major decisions are needed for each mile driven; drivers frequently have less than one-half second to act to avoid a collision.

The record of older drivers is good, when you consider the number of collisions per driver, but when you consider the number of collisions per miles driven, this record is surprisingly bad. Older drivers have fewer collisions, because they drive less and at less dangerous times. But when they are in a crash, it can be very serious. In a two-car fatal collision, where one driver is 65 or older, the older driver is 3.5 times more likely to be killed. Injuries that are seen as moderate to severe for most people are fatal to people aged 55 and older.

Purpose of this Quiz:

One of the purposes of this self-rating form is to help you become, if you are not already, an "activated driver." An activated driver is someone who assumes responsibility for his or her own driving skills and who self-examines and compares his or her ability with the requirements for safe driving. The premise of this booklet is that through knowledge and self-awareness, you will understand what a safe driver is and will assume the responsibility to be a safe driver or to decide to give up the driver's license and seek other forms of transportation.

The questionnaire you have just completed has helped you to locate those areas where your physical and mental abilities call for a change in your driving habits and skills. This section of the booklet offers suggestions to improve each driving skill highlighted in the questionnaire. Be sure to focus on those sections that correspond to the problem areas identified by the questionnaire.

Please enter your:

Age:

Gender: M F

1. I signal and check to the rear when I change lanes

Always or Almost Always Sometimes Never or Almost Never

2. I wear a seat belt

Always or Almost Always Sometimes Never or Almost Never

3. I try to stay informed on changes in driving and highway regulations

Always or Almost Always Sometimes Never or Almost Never

4. Intersections bother me because there is so much to watch from all directions

Always or Almost Always Sometimes Never or Almost Never

5. I find it difficult to decide when to join traffic on a busy interstate highway

Always or Almost Always Sometimes Never or Almost Never

6. I think I am slower than I used to be in reacting to dangerous driving situations

Always or Almost Always Sometimes Never or Almost Never

7. When I am really upset, I show it in my driving

Always or Almost Always Sometimes Never or Almost Never

8. My thoughts wander when I am driving

Always or Almost Always Sometimes Never or Almost Never

9. Traffic situations make me angry

Always or Almost Always Sometimes Never or Almost Never

10. I get regular eye checks to keep my vision at its sharpest

Always or Almost Always Sometimes Never or Almost Never

11. I check with my doctor or pharmacist about the effects of my medications on driving ability. (If you do not take any medication, skip this question.)

Always or Almost Always Sometimes Never or Almost Never

12. I try to stay abreast of current information on health practices and habits

Always or Almost Always Sometimes Never or Almost Never

13. My children, other family members or friends are concerned about my driving ability

Always or Almost Always Sometimes Never or Almost Never

14. How many traffic tickets, warnings, or "discussions" with officers have you had in the past two years?

None One or Two Three or More

15. How many accidents have you had during the past two years?

None One or Two Three or More