SIMPLE Driver Stewardship Program

	*A Note On Privacy* This survey is anonymous. The record kept of your survey responses does not contain any identifying information about you unless a specific question in the survey has asked for this. If you have responded to a survey that used an identifying token to allow you to access the survey, you can rest assured that the identifying token is not kept with your responses. It is managed in a separate database, and will only be updated to indicate that you have (or haven't) completed this survey. There is no way of matching identification tokens with survey responses in this survey.

Simple'09 Follow-up Survey
Thank you for taking part in the SIMPLE Driver Stewardship Program follow-up survey.
Please take a few minutes to complete the survey below.
Your name will be entered in a random draw for a Clean Air Day Prize Pack!
All information will be kept confidential.

Question 1

*What is your name?

Question 2

*What is your phone number?

Question 3

*What is your Email address?

Question 4

Since signing your pledge form, which of the following actions have you taken?
Check any that apply

S - Reducing driving Speed
I - Avoiding unnecessary Idling
M - Choose a vehicle to Match my needs
P - Maintain my tire Pressure monthly
L - Whenever possible, Leave my car at home
E - Keep my vehicle's Engine tuned-up

Question 5

Please indicate any other fuel saving actions you have taken.

Question 6

Did you know about the SIMPLE actions before you signed the pledge?

Yes
No
No answer

Question 7

If so, which SIMPLE actions did you know about?

Question 8

Were you already doing any of the SIMPLE actions before you signed the pledge?

Yes
No
No answer

Question 9

If so, which SIMPLE actions were you already doing?

Question 10

Do you drive?

Yes
No
No answer

Question 11

If no, do you share these tips with the people you get rides from?

Yes
No
No answer

Question 12

Do you have any comments about the program?

Thank you very much!

If you have any questions or concerns about this survey,

please contact the New Brunswick Lung Association

via email at todd.scott@nb.lung.ca 455-8961, ext 111 (Fredericton-area)

or toll-free at 1-800-565-5864.

Remember, "When you can't breathe, nothing else matters"

[Exit and Clear Survey]