Name: Date:

Click on the gray boxes to fill out the worksheet. Remember to save your answers.

Part I. Assessing Your Personal Risk

Reducing the risk of injury and violence involves reducing risky behaviors. Think about things you do, perhaps without even thinking about them, that may increase your risk of injury. What can you do to reduce your risk? 1. List all the behaviors you do that might increase the risk of injuries. Why do you participate in these risky behaviors? What could be the consequences of them? Risky Behavior consequences

Why do you do it?

Possible

2. Pick one of the behaviors above that you want to target. Ask yourself honestly: How ready am I to commit to a behavior change that will help me reduce that behavior? What stage of behavior change am I in? Target behavior:

Current stage of behavior change:

3. Keeping your current stage of behavior change in mind, describe what might be a next step to reduce or eliminate the risk of injury due to the risky behavior. Also list your timeline for making your next step. Next step:

Timeline for next step:

Copyright 2012 Pearson Education Inc.

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Behavior Change Worksheet

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Part II. Make Your Car a No Phone Zone

According to neuroscientists, the human brain is not capable of fully concentrating on two tasks simultaneously. And yet, millions of drivers in the U.S. attempt to divide their attention between texting or talking on the phone and the complex and dangerous task of driving a car. What about you? Do you risk becoming a casualty of distracted driving? Are you ready to take the pledge to stop this dangerous behavior? 1. Pick one of the behaviors above that you want to target. Ask yourself honestly: How ready am I to commit to a behavior change that will help me reduce that behavior? What stage of behavior change am I in? While driving, do you: (check the box next to each behavior you engage in)
talk on your cell phone? dial numbers on your cell phone? read text messages (or other mobile email messages)? type text messages?

Describe your current cell phone use while driving:

2. What are some strategies for avoiding talking on your phone or texting while driving?

3. If you dont think you will stop texting or talking on the phone while you drive, what are the
reasons?

Now, list three things that you can do to address these reasons.

Copyright 2012 Pearson Education Inc.

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Behavior Change Worksheet