Name:

Course:

Sex:

Age:

Frequency of Motorcycle driving (days/week):

1-2 3-4 5-6 7

Do you have driver’s license?

Yes No

Duration of motorcycle driving experience

<1 1-5 6-10 more than 11

Motorcycle Injuries (Accident during previous year)

No Yes

1-2

3-4

>5 times

Behavior Never Rarely Sometimes Very Often Always

I have driven my motorcycle within two
hours of consuming 3 or more alcoholic
beverages
I have driven my motorcycle within two
hours of consuming 1-2 alcoholic beverages
I have been charged of drinking and driving
Racing out with other vehicles when I got
annoyed with them
Not considering my speed limit when I’m in
a hurry especially when rushing to class
Driving in more than 40 kph in streets
Letting the pedestrians to cross the lane
first.
Disregard traffic Signals
Overtaking vehicles
Making a U-turn
Driving between two lanes of moving traffic
Leave space distance
Practicing Counterflow
Reading or Sending a text while driving
Calling while driving
Adjusting or Listening to Mp3 player while
driving.
Not wearing helmet
Driving with more than one passenger
Adjusting your side mirror while driving
Checking the brakes first before driving
I’m using my headlights when driving at
night time
Checking the tires before driving
Driving while raining
 Strongly Disagree Somewhat Agree Strongly
Disagree Disagree Agree
I’m aware that wearing helmet is
safe.
I’m aware that it is not safe to drive
within 2 hours after drinking 3 or
more alcoholic.
I’m aware that 80 kph is the speed
limit when driving national and
provincial road and 40 kph is the
speed limit when driving through
streets.
I’m aware that driving with more
than one passenger could affect my
control in driving.
I’m aware of the traffic rules (leave
safe distance, overtaking, U-turn,
lane splitting, lane filtering etc.)
I’m aware that it is necessary to
check motorcycle parts before
driving.
I’m aware that using cellphone could
minimize my concentration and
attention while driving.
I’m aware that it is not advisable to
drive while raining.
I would likely to exceed my speed
limit if there is a clear traffic.
I don’t want to use my helmet
because it could impair my visual
field.
I don’t want to use my helmet
because it could impair my hearing.
It is okay to use my cellphone while
driving.
It is okay to use a handsfree device
(earphones) while talking on the
phone while driving.
It is not okay for me to have a
passenger.
I would not likely to drive under
poor environmental condition.
I’m not comfortable enough to drive
while my vehicle is not in a good
condition.
It is important for me to drive with
complete signal lights such as turn
signals.
It is okay to overtake vehicles when I
got intimidated with them.
It is okay for me to drive while drunk
since I have a good sense of balance.
I always checked my motorcycle if it
is in a good condition before driving.
It is okay to drive on the road at
night without traffic lights
My motorcycle has a complete and
functional signal lights, head lights,
etc.
My motorcycle has a complete parts
and accessories.
Driving at unclear and rough roads
with curve and uneven surface
Driving at road with inadequate
traffic lights
Driving at road with adequate road
lights
Driving at road with unclear and
inadequate traffic lights

Do you ever receive any amount of information about road safety?

No Yes

If yes,

1-3 sources

4-5 sources

6-8 sources