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Traffic crashes are the leading cause of injury and death. In its safety program AIS is launching "My Seat Belt; My Life!" campaign, with the objectives of raising the awareness of its students and encouraging them to buckle up; not just because seat belts are mandatory!
The survey between your hands will help the AIS campaign "My Seat Belt; My Life!" in a very effective way.
 Name :    Date :  
 Grade : Section :     
1.  Where do you sit in your car? Front Back
2.  Do you have seat belts in your car? Yes No
3.  Does your car beep or make any other signals if seat belt is not fastened? Yes No
4.  Does the driver, whether in the car or on the bus, fastens the seat belt? Yes No
5.  Does the driver remind you to fasten the seat belt? Yes No
6.  Do you listen to the driver and fasten the seat belt? Yes No
7.  Are you aware of the results of not fastening the seat belt in the unlikely events of car crashes? Yes No
8.  Do you know anyone who was injured or died in an accident for not fastening the seat belt? Yes No
9.  If you have a baby brother / sister, do you help them buckle up? Yes No
10.  If you have a pet, do you help it buckle up? Yes No
11.  Which of the following affects you more? 
          A program about set belts.
          A commercial about set belts.
          A song about set belts.
12.  Briefly tell us what your favorite amongst them was about. 
13.  If you buckle up, why do you do it? 
14.  If you don`t buckle up, why don`t you do it? 

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