VAI

Instructions
Answer each statement truthfully.
Your records may be reviewed to
verify the information you provide.
Read each statement carefully and
choose the answer that is accurate for
you. Do not skip any questions. All
items must be answered on your
answer sheet.

SECTION 1
Select the answer that describes you best.
Put an X on your answer sheet under the
number (1, 2, 3 or 4) that you select for your
answer. Use the following scale:
1. Rare or Never
2. Sometimes

3. Often
4. Very Often

Answer each statement as it applies to you

now. All statements must be answered on
your answer sheet.
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.

Exercise / Physical Activity

Positive Attitude / Outlook
Dissatisfied with Life
Good Sense of Humor / Laugh
Anxious / Worried / Fearful
Depressed / Discourage
Insomnia / Trouble Sleeping
Satisfied with Self / Like Self
Financially Stable / Responsible
Enthusiastic / Involved with Life
Tension / Stress

12.
13.
14.
15.

Fatigued / Tired / Sluggish

Directly Deal with Problems
Emotionally Upset / Crying
Angry / Hostile with Others

16.
17.
18.
19.
20.

Lonely / Unhappy
Able to Handle Lifes Problems
Nervous / Unable to Relax
Patient / Tolerant / Understanding
Cant Make Decisions / Indecisive

21.
22.
23.
24.
25.

Work / Job satisfaction

Admit My Errors / Mistakes
Fearful / Anxious
Accept Constructive Suggestions
Trust My Own Judgment

26.
27.
28.
29.
30.

Stomach Problems / Acidity

Difficulty with Others / Conflict
Adaptable / Adjustable
Marital / Family Problems
Self-Reliant / Independent

SECTION 2
If a statement is True, put an X under T for
True on your answer sheet. If a statement is
False, put an X under F for False on your
answer sheet.
All statements must be
answered.
31. There have been times when I have been
careless about my driving.
32. Driving is everybodys right -- not just a
privilege.
33. I do not speed, get tickets or have
accidents.
34. There are times when I get real
discouraged.
35. I often pawn items at pawn shops.

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36. I often do things suddenly or

impulsively, without a lot of thought.

50. I always use my turn signal lights before

turning.

37. I always drive within posted speed

limits.

51. People tell me I have a bad attitude.

38. I will manipulate or lie to get my way.

39. I often yell at other drivers.
40. Two or more of the following apply to me
(answer true or false on your answer sheet):
a. Unreliable and Untrustworthy
b. Negative, Hostile or Defiant
c. Persistent Lying or Thefts
d. Substance (Alcohol or Drugs) Abuse
e. Poor Work or Employment History
41. Sometimes I get angry or upset at other
drivers.
42. My insurance has been increased within
the last five years because of my poor
driving record.
43. I would rather not discuss some of the
things I have done.
44. Low speed limits often annoy or frustrate
me.
45. I have gotten more traffic tickets than
most people I know.
46. Two or more of the following apply to me
(answer true or false on your answer sheet):
a. Careless or Thoughtless
b. Impulsive or Unthinking
c. Hurried or Rushed
d. Irritable, Resentful or Angry
e. Impatient or Nervous
47. At times I worry about what people think
or say about me.
48. I cannot say it more clearly. I do not
want anybodys help.

52. I would like to drive faster on the

highways.
53. There have been times when I have
strongly disliked someone.
54. There are only a few people I care about
anymore.
55. I am often moody, irritable and
demanding.
56. I have been arrested for a DUI (Driving
Under the Influence).
57. I have wished I could go back in time
and do some things over -- but
differently.
58. Anything I do is OK, as long as I do not
get caught.
59. I am a defensive driver.
60. I know I shouldnt but I have been
jealous of others success.
61. People tell me I am insensitive or thick
skinned.
62. There have been times when I have
driven a vehicle without insurance.
63. There are times when I really worry
about myself.
64. Two or more of the following apply to me
(answer true or false on your answer sheet):
a. Impulsive or Aggressive
b. Hostile or Angry
c. Argumentative or Defiant
d. Irresponsible or Undependable
e. Quick Tempered

49. Other drivers often annoy or anger me.

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65. I think the speed limit (55 M.P.H.) is to

low.
66. There have been times when I knew I
should not drive but did.
67. I am very sensitive and my feelings are
easily hurt.
68. When asked, I do not always tell the
whole truth about my personal life.
69. I have little remorse, sorrow or regret for
the things I have done.
70. I have a right to choose not to wear a
safety belt because if I got hurt, the only
one I am hurting is myself.
71. I have broken some traffic laws and was
not caught or given a ticket.
72. I believe cops like to give out tickets.
73. To be honest there are times when I am
not a good driver.
74. There are times when I am really down.
75. Police have a quota and must give out a
minimum number of traffic tickets
(moving violations) each shift.
76. I often drive fast.
77. I have done things when angry that I
regret.
78. The real reason the State has this driving
program is to make more money.
79. Even though I was not caught, I have
made mistakes while driving.

81. When I get frustrated or annoyed I tend

to yell or argue a lot.
82. Sometimes I get annoyed or upset at
myself.
83. People tell me that I often lie or con
others.
84. I have gotten two or more traffic
(moving violation) tickets in the last two
years.
85. I have been embarrassed or worried
about mistakes I have made.
86. Two or more of the following apply to
me (answer true or false on your answer
sheet):
a. Cold or Indifferent
b. Manipulative, Conning or Lying
c. Argumentative or Violent Temper
d. Alcohol or Drug Abuse
e. Non-Payment of Bills, Debts or Loans
87. There have been times when I have had
to drive without a valid drivers license.
88. I have always gotten along well with
people at work or school.
89. Outside of my family, I do not trust
anybody anymore.
90. I speed a lot and get tickets.
91. It bothers me when I am over-looked or
ignored by people I know.
92. To be honest, I have a negative or
disagreeable attitude.

80. This driver improvement program is a

waste of my time.

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SECTION 3
Each of the following items consists of a pair of opposite terms that you are to rate yourself on. Rate yourself
on how you feel now, or how you felt in the last six months. For example, rate yourself on Careful and
Careless.

Careful

Very
Often

Often

Cant
Decide

Often

Very
Often

1_____

2_____

3_____

4_____

5_____

Careless

In this example, 1 means you are Very Often Careful and 2 means you are Often Careful. A self-rating of 3
means you cant decide if you are careful or careless. Similarly, 4 means you are Often Careless and 5 means
you are Very Often Careless. If you are usually careful, you would put an X under 1 for Very Often on the
left side of the scale. If you are usually careless you would put an X under 5 for Very Often on the right side of
the scale. Mark only one X for each item or pair of opposite terms on your answer sheet.
Very
Often

Often

Cant
Decide

Often

Very
Often

93. Unsuccessful 1_____

2_____

3_____

4_____

5_____

Successful

94. Adequate

1_____

2_____

3_____

4_____

5_____

Inadequate

95. Accepted

1_____

2_____

3_____

4_____

5_____

Rejected

96. Unattractive

1_____

2_____

3_____

4_____

5_____

Attractive

97. Discontented 1_____

2_____

3_____

4_____

5_____

Contented

98. Cooperative

1_____

2_____

3_____

4_____

5_____

Uncooperative

99. Strong

1_____

2_____

3_____

4_____

5_____

Weak

100. Friendly

1_____

2_____

3_____

4_____

5_____

Unfriendly

101. Unhappy

1_____

2_____

3_____

4_____

5_____

Happy

102. Intelligent

1_____

2_____

3_____

4_____

5_____

Dull

103. Boring

1_____

2_____

3_____

4_____

5_____

Interesting

104. Loved

1_____

2_____

3_____

4_____

5_____

Unloved

105. Disliked

1_____

2_____

3_____

4_____

5_____

Liked

106. Positive

1_____

2_____

3_____

4_____

5_____

Negative

107. Insecure

1_____

2_____

3_____

4_____

5_____

Secure

108. Withdrawn

1_____

2_____

3_____

4_____

5_____

Outgoing

109. Stable

1_____

2_____

3_____

4_____

5_____

Unstable

110. Dangerous

1_____

2_____

3_____

4_____

5_____

Harmless

111. Nervous

1_____

2_____

3_____

4_____

5_____

Calm

112. Hostile

1_____

2_____

3_____

4_____

5_____

Friendly

113. Worthy

1_____

2_____

3_____

4_____

5_____

Worthless

114. Hopeful

1_____

2_____

3_____

4_____

5_____

Hopeless

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SECTION 1

VAI

Put an X under the number (1, 2, 3, or 4) that describes you

best. Use the following scale to select your answers.

1. Rare or Never
2. Sometimes

ANSWER SHEET
ACCURATELY COMPLETE THIS
INFORMATION
NAME:
ID#
AGE:
DATE OF BIRTH:
SEX:

MALE FEMALE

EDUCATION: (HIGHEST GRADE COMPLETED)

ETHNICITY (RACE):
MARITAL STATUS:
In the following, give the total number including
the present violation.
1. Number of moving violations or tickets
you received in the last 5 years:
2. Number of times you have attended
traffic safety school in the last 5 years:
3. Number of times your license has been
suspended in your lifetime:
4. Number of times your license has been
revoked in your lifetime:

______

______

______

______

3. Often
4. Very Often

1.

1
_____

2
_____

3
_____

4
_____

2.

_____

_____

_____

_____

3.

_____

_____

_____

_____

4.

_____

_____

_____

_____

5.

_____

_____

_____

_____

6.

_____

_____

_____

_____

7.

_____

_____

_____

_____

8.

_____

_____

_____

_____

9.

_____

_____

_____

_____

10.

_____

_____

_____

_____

11.

_____

_____

_____

_____

12.

_____

_____

_____

_____

13.

_____

_____

_____

_____

14.

_____

_____

_____

_____

15.

_____

_____

_____

_____

16.

_____

_____

_____

_____

17.

_____

_____

_____

_____

18.

_____

_____

_____

_____

19.

_____

_____

_____

_____

20.

_____

_____

_____

_____

21.

_____

_____

_____

_____

22.

_____

_____

_____

_____

23.

_____

_____

_____

_____

24.

_____

_____

_____

_____

25.

_____

_____

_____

_____

26.

_____

_____

_____

_____

27.

_____

_____

_____

_____

28.

_____

_____

_____

_____

29.

_____

_____

_____

_____

30.

_____

_____

_____

_____

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SECTION 2
The statements in this section are to be answered true or false. If a statement is true, put an X under T
for True on your answer sheet. If a statement is false, put an X under F for False on your answer sheet.
31.
32.
33.
34.
35.
36.
37.
38.
39.
40.
41.
42.
43.
44.
45.

T
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____

F
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____

46.
47.
48.
49.
50.
51.
52.
53.
54.
55.
56.
57.
58.
59.
60.

T
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____

F
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____

61.
62.
63.
64.
65.
66.
67.
68.
69.
70.
71.
72.
73.
74.
75.
76.

T
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____

F
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____

77.
78.
79.
80.
81.
82.
83.
84.
85.
86.
87.
88.
89.
90.
91.
92.

T
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____

F
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____

SECTION 3
Compare the opposite terms. Select the term that is accurate for you, then put an X next to the number
that describes you best.

93.

Very
Often
1
____

Cant
Often Decide Often
2
3
4
____
____
____

Very
Often
5.
____

104.

Very
Often
1
____

Cant
Often Decide Often
2
3
4
____
____
____

Very
Often
5
____

94.

____

____

____

____

____

105.

____

____

____

____

____

95.

____

____

____

____

____

106.

____

____

____

____

____

96.

____

____

____

____

____

107.

____

____

____

____

____

97.

____

____

____

____

____

108.

____

____

____

____

____

98.

____

____

____

____

____

109.

____

____

____

____

____

99.

____

____

____

____

____

110.

____

____

____

____

____

100.

____

____

____

____

____

111.

____

____

____

____

____

101.

____

____

____

____

____

112.

____

____

____

____

____

102.

____

____

____

____

____

113.

____

____

____

____

____

103.

____

____

____

____

____

114.

____

____

____

____

____

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