1.

I signal and look over my shoulder when I change lanes.

2.

I wear my seat belt.

3.

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

4.

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

5.

I find it difficult to decide when to merge with traffic on a busy freeway.

6.

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

7.

When I am really upset, it shows up in my driving.

8.

My thoughts wander when I am driving.

9.

Traffic situations make me angry.

10.

I get regular vision exams to keep my vision at its sharpest.

11.

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

12.

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

13.

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

Notice the change in the column headings

14.

How many traffic tickets, warnings or “discussions” with officers have you had in the past two years?

15.

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