Mock Crash Survey – Huntingtown – Chesapeake Region Safety Council

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Mock Crash Survey

Huntingtown High School (Pre Mock Crash Survey) 2026

Impaired days Date

Grade

Date

Driver’s License Status

Learner’s Permit
Provisional Driver’s License (under 18)
Full Driver’s License (18 or older)
I am Unlicensed

In the last 30 days have you:

Impaired

	Very Often	Often	Not Often	Never
Consumed alcohol or used cannabis within 4 hours of driving?	Very OftenConsumed alcohol or used cannabis within 4 hours of driving? Very Often	OftenConsumed alcohol or used cannabis within 4 hours of driving? Often	Not OftenConsumed alcohol or used cannabis within 4 hours of driving? Not Often	NeverConsumed alcohol or used cannabis within 4 hours of driving? Never
Ridden in another young driver’s vehicle after they had consumed alcohol or cannabis in the previous 4 hours?	Very OftenRidden in another young driver’s vehicle after they had consumed alcohol or cannabis in the previous 4 hours? Very Often	OftenRidden in another young driver’s vehicle after they had consumed alcohol or cannabis in the previous 4 hours? Often	Not OftenRidden in another young driver’s vehicle after they had consumed alcohol or cannabis in the previous 4 hours? Not Often	NeverRidden in another young driver’s vehicle after they had consumed alcohol or cannabis in the previous 4 hours? Never

Occupant Protection

	Very Often	Often	Not Often	Never
Driven/ridden as a passenger in any seating position without wearing a seat belt?	Very OftenDriven/ridden as a passenger in any seating position without wearing a seat belt? Very Often	OftenDriven/ridden as a passenger in any seating position without wearing a seat belt? Often	Not OftenDriven/ridden as a passenger in any seating position without wearing a seat belt? Not Often	NeverDriven/ridden as a passenger in any seating position without wearing a seat belt? Never

Distracted

	Very Often	Often	Not Often	Never
Read or typed a message (through any platform) or e-mail while operating a moving vehicle?	Very OftenRead or typed a message (through any platform) or e-mail while operating a moving vehicle? Very Often	OftenRead or typed a message (through any platform) or e-mail while operating a moving vehicle? Often	Not OftenRead or typed a message (through any platform) or e-mail while operating a moving vehicle? Not Often	NeverRead or typed a message (through any platform) or e-mail while operating a moving vehicle? Never
Used a social media app while operating a moving vehicle?	Very OftenUsed a social media app while operating a moving vehicle? Very Often	OftenUsed a social media app while operating a moving vehicle? Often	Not OftenUsed a social media app while operating a moving vehicle? Not Often	NeverUsed a social media app while operating a moving vehicle? Never
Talked on a cell phone without a hands-free device used while operating a moving vehicle?	Very OftenTalked on a cell phone without a hands-free device used while operating a moving vehicle? Very Often	OftenTalked on a cell phone without a hands-free device used while operating a moving vehicle? Often	Not OftenTalked on a cell phone without a hands-free device used while operating a moving vehicle? Not Often	NeverTalked on a cell phone without a hands-free device used while operating a moving vehicle? Never

General

	Very Often	Often	Not Often	Never
Driven 20 MPH or more over the posted speed limit?	Very OftenDriven 20 MPH or more over the posted speed limit? Very Often	OftenDriven 20 MPH or more over the posted speed limit? Often	Not OftenDriven 20 MPH or more over the posted speed limit? Not Often	NeverDriven 20 MPH or more over the posted speed limit? Never

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