MAD Assessment (Letter (US Letter)) (Social Media) (Letter (US Letter))

Mindfully Aware Drivers Needed ASAP

Mindfully Solving Driving Problems-Mindfully Aware Driving Solutions
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Instructions: How to score: 1 is Strongly Disagree, 2 is Disagree, 3 is Neutral, (You Disagree nor Agree, 4 you agree and 5 is Strongly Agree. Think about how you feel without your cellphone. Please make sure you answer honestly. Thank you.
Do you ever wake up out of a good sleep to check your smartphone?

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1 is Strongly disagree , 5 is Strongly agree
Do you ever find yourself sleepy in the afternoon because you were using your smartphone before you went to bed the night before?

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1 is Strongly disagree , 5 is Strongly agree
Is checking your smartphone the first thing you do when you wake up in the morning to do more than check the time or your alarm?

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1 is Strongly disagree , 5 is Strongly agree
Do you constantly check your phone while getting ready for school or work?

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1 is Strongly disagree , 5 is Strongly agree
Do you eat while scrolling through your phone on social media, news sites, or shopping sites?

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1 is Strongly disagree , 5 is Strongly agree
Do you use your smartphone while driving to talk, text, Zoom meeting with the camera on, Facebook live, Tic Toc, or any social media?

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1 is Strongly disagree , 5 is Strongly agree
Do you eat, put on makeup, change clothes or groom/shave while driving?

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1 is Strongly disagree , 5 is Strongly agree
Do you have a policy at work/school that prohibits you from using your smartphone, but you sneak and use it anyway?

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1 is Strongly disagree , 5 is Strongly agree
When at work/school do you sneak around trying to use your smartphone as you study/work? Do you just study or are you on social media?

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1 is Strongly disagree , 5 is Strongly agree
Do you spend every single break at work or school on your smartphone?

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1 is Strongly disagree , 5 is Strongly agree
Latasha (Tasha Hairston Springs) MAD Method 2019-2024. Print This Document for your reference, add your score, and email tasha.madsolutions@gmail.com with your results.
Mindfully Aware Drivers Needed

Mindfully Aware Driving Solutions
If you forgot your cellphone at home do you experience anxiety?

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1 is Strongly disagree , 5 is Strongly agree
Do you find yourself lying about your social media habits to your family, friends, or coworkers?

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1 is Strongly disagree , 5 is Strongly agree
When out with friends, family, or coworkers are you truly present or are you distracted by your smartphone?

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1 is Strongly disagree , 5 is Strongly agree
Do you feel that you have a bad habit of using your smartphone at times when you should be giving your complete attention to something important?

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1 is Strongly disagree , 5 is Strongly agree
Do you neglect important tasks because you are engaging with your smartphone? Tasks like cleaning up, homework, babysitting or watching your own child if you have children?

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1 is Strongly disagree , 5 is Strongly agree
Would you like help in breaking these bad smartphone habits especially while driving?

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1 is Strongly disagree , 5 is Strongly agree
Rate your score here add all the numbers You should come up with a score between 0-71+:

This survey was designed to help you, not judge you.

Circle your answers and add the score up top on the line provided. Thank you!

If you have a score of 0-30 you don't have a bad habit or an addiction to your cellphone or social media.

If you have a score of 31-50 you have a mild addiction/habit and you may want to participate in our social media 14-day detox.

If you have a score of 51-70 you have a moderate addiction/habit and you may want to participate in our 21-day social media detox.

If you have a score of 71 or higher, you have a severe addiction to social media and your cellphone and I highly recommend our 21-day social media detox.

After you score yourself, if you find that you have a bad habit using your cellphone; PLEASE register for my FREE program.

It's a 21-day challenge designed to help you break the habit and change the culture around cellphone and social media usage, especially while driving.

Thank you for your participation!!!

Tasha Hairston Springs MAD Method©2019-2025. Print This Document Add your score let's talk about it tasha.madsolutions@gmail.com
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Mindfully Aware Drivers Needed ASAP

Mindfully Aware Drivers Needed