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appendix ten

pre- and post-test

Pre and post-tests measure the immediate attitudinal effect of hearing a panel. They may be useful as a component of evaluation, but have no validity in measuring actual behavioral outcome. A variety of questions may be asked, but please limit to one page. Feel free to modify the forms to fit your needs.

PDF symbol Pre- and Post-test Questionnaire

questionnaire

(Pre-Test Only)   check box True   check box False    I am a first offender impaired driver.

If false, please state why you are here:

 

Please check the box in front of the ONE answer that best describes you.

How do you feel about impaired driving laws in this state?

check box a. Too lenient   check box b. Fair   check box c. Too tough

 

How likely are you to continue drinking and driving?

check box a. Very likely   check box b. Somewhat likely   check box c. Somewhat unlikely   check box d. Very unlikely

 

What is the single best reason to not drink and drive?

check box  a. My insurance goes up

check box  b. I could lose my license

check box  c. I could go to jail

check box  d. I could damage my vehicle

check box  e. I could hurt myself

check box  f. I could hurt or kill someone

 

In the future, I will:

check box  a. Never drink again

check box  b. Drink, but not drive afterward

check box  c. Drink and drive but know when I've had enough

check box  d. Drink as much as I want and drive

 

post-test

(Post-Test Only) Please check the reaction to tonight's Victim Impact Panel that most fits you.

check box  a. I heard nothing new and it made no difference to me.

check box  b. I heard things I had never thought of before.

check box  c. I knew these things happened, but I have more feeling about it now than before.

check box  d. It made a very strong impression on me, and I am reconsidering how I think about drinking and driving.

check box  e. It made me committed to never drink and drive again.

 

sample evaluation one

PDF symbol Sample Evaluation One

Please tell us your reaction to tonight's Victim Impact Panel.

1. What thoughts and feelings did you experience as you listened to the speakers?

 

 

2. As a result of hearing the speakers, do you plan to change your drinking and driving behavior? Why?

 

 

 

sample evaluation two

PDF symbol Sample Evaluation Two

1. How do you feel about impaired driving laws in this state?

check box  Too lenient    check box  Fair    check box  Too tough

Other comments: _______________________________________________________________________

 

2. Did you learn anything from the speakers?

check box  Yes    check box  No

If yes, what did you learn? _______________________________________________________________

 

3. Do you think others could benefit from hearing these speakers?

check box  Yes    check box  No

If yes, who should attend? _______________________________________________________________

 

4. Which speaker made the greatest impression on you and why?

_____________________________________________________________________________________

_____________________________________________________________________________________

 

5. Did you consider these consequences the last time you drank and drove?

check box  Yes    check box  No

 

6. What do you think now about people who drink and drive?

_____________________________________________________________________________________

_____________________________________________________________________________________

 

7. Anything else you'd like us to know?

_____________________________________________________________________________________

_____________________________________________________________________________________

 

Please contact me for follow-up.

check box  I would like to talk with someone about what I heard tonight.

check box  I would like to ask a panelist a question.

check box  I would like to join and/or volunteer for MADD.

check box  I would like more information about impaired driving.

check box  I need help with an alcohol or other drug problem and would like a referral for a self-help group or treatment program.

 

Name ___________________________________________________________________________

Phone Number _________________________ E-mail____________________________________

 

sample evaluation three

PDF symbol Sample Evaluation Three

1. How do you feel about the impaired driving laws and penalties in this state?

check box  Too Lenient    check box  Fair     check box  Too Tough

 

2. Did you deserve what you got for your offense?

check box  Yes     check box  No

 

3. Before your offense, did you consider the injuries or deaths that could result from your drinking and driving?

check box  No, never.

check box  Sometimes, but I wasn't concerned or didn't think it would happen to me.

check box  Yes, I was aware of the harm I could cause, and still chose to drink and drive.

 

4. How has this presentation changed your attitude about drinking and driving? (Check all that apply)

check box  I am now more aware of the injuries and deaths I could cause by drinking and driving.

check box  I don't think I will ever drink and drive again.

check box  I don't want to let my friends drink and drive.

check box  I have not changed my attitude about drinking and driving.

 

5. A changed attitude is only the first step to changed behavior.
(Please check behaviors you will promise as of tonight.)

check box  I will never again drink and drive.

check box  I will volunteer to be the designated driver and use no alcohol or other drugs when I am the designated driver.

check box  I will do everything I can to prevent my family members and friends from drinking and driving.

check box  I will stop drinking and, if needed, enter an alcohol treatment program.

check box  I do not plan to change any of my drinking or driving behaviors.

 

Additional Comments:

 

sample evaluation four: mailed follow-up survey

PDF symbol Sample Evaluation Four

(From Victim Impact Panels: A Reference Manual published by the University of Wisconsin Law School Resource Center on Impaired Driving in Cooperation with the Wisconsin Department of Transportation. Reprinted with permission)

You participated in a Victim Impact Panel program as a result of your intoxicated driving violation. Please take a few moments to answer the following questions about your panel experience.

1. Since your OWI arrest, has your attitude toward driving under the influence of alcohol or drugs changed?

check box  Yes    check box  No

If no, explain____________________________________________________________________

Skip the question 2.

 

2. If yes, go to the next question.

Rank the influence
(1 - 5) of each of the following in changing your attitude toward drinking and driving.
(1 = most influence; 5 = least influence)

Actual OWI arrest                                   ___

Assessment, Treatment, Education        ___

Victim Impact Panel                               ___

Cost of the OWI - fines, insurance, etc. ___

Embarrassment to self and family          ___

 

3. Within the past _____ months (list number of months since the VIP), how often have you driven while impaired by alcohol or drugs?

check box  Daily

check box  2-6 times per week

check box  Once per week

check box  Once every two weeks

check box  Once a month

check box  4-6 times per year

check box  About once or twice per year

check box  Never

 

4. Most of the time, if I do drive after drinking, I have consumed:

check box  1-3 drinks    check box  4 - 6 drinks    check box  7 - 10 drinks    check box  more than 10 drinks

 

5. I know that my ability to drive is impaired after I have consumed:

check box  1-3 drinks    check box  4 - 6 drinks    check box  7 - 10 drinks    check box  more than 10 drinks

 

6. Within the past _____ months (list the number of months since the VIP), have you been arrested for OWI or a related offense?

check box  Yes     check box  No

 

7. Check your level of agreement with the following.

The Victim Impact Panel presentation . . .

Convinced me of the importance of not driving after drinking.

check box  Strongly agree    check box  Agree    check box  Disagree    check box  Strongly disagree

Has made me consider stopping or decreasing the amount of alcohol I consume if I have to drive.

check box  Strongly agree    check box  Agree    check box  Disagree    check box  Strongly disagree

Made me realize the consequences of drinking and driving.

check box  Strongly agree    check box  Agree    check box  Disagree    check box  Strongly disagree

Convinced me to arrange for alternate transportation if I am going to drink.

check box  Strongly agree    check box  Agree    check box  Disagree    check box  Strongly disagree

Convinced me that the penalties for driving after drinking are not severe enough.

check box  Strongly agree    check box  Agree    check box  Disagree    check box  Strongly disagree

Made me realize that anyone who drives after drinking is taking a big risk.

check box  Strongly agree    check box  Agree    check box  Disagree    check box  Strongly disagree

 

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