Skip to contentUnited States Department of Transportation - Federal Highway Administration FHWA Home
Research Home
Report
This report is an archived publication and may contain dated technical, contact, and link information
Publication Number: FHWA-HRT-04-135
Date: December 2005

Enhanced Night Visibility, Volume IV: Phase II—Study 2: Visual Performance During Nighttime Driving in Rain

PDF Version (1.61 MB)

PDF files can be viewed with the Acrobat® Reader®

APPENDIX A—SCREENING QUESTIONNAIRE


Driver Screening and Demographic Questionnaire: ENV-Rain

Note to Screening Personnel:

Initial contact with the potential participants will take place over the phone. Read the following Introductory Statement, followed by the questionnaire (if they agree to participate). Regardless of how contact is made, this questionnaire must be administered before a decision is made regarding suitability for this study.

Introductory Statement (Use the following script as a guideline in the screening interview):

Good morning/afternoon! My name is _____ and I work at the Smart Road. I’m recruiting drivers for a study to evaluate new night vision enhancement systems for vehicles.

This study will involve you driving a car for three sessions. The first session will be a training session, and the other two will be on the Smart Road. The Smart Road is a test facility equipped with advanced data recording systems. It is equipped with technology that will allow us to create snow, fog, and rain. The first session should be less than an hour, and the other two sessions will take approximately 2-3 hours. We will pay you 20 dollars per hour. The total amount will be given to you at the end of the third session. Would you like to participate in this study?

If they agree:

Next, I would like to ask you several questions to see if you are eligible to participate.

If they do not agree:

Thanks for your time.


Questions


  1. Do you have a valid driver’s license?
           Yes _____ No _____

  2. How often do you drive each week?
           Every day ____     At least 2 times a week____     Less than 2 times a week_____

  3. How old are you? ______

  4. Have you previously participated in any experiments at the [contractor facility]? If so, can you briefly describe the study?
           Yes _____        Description:______________________________________________________
           No _____

  5. How long have you held your drivers’ license? _____________________________________

  6. What type of vehicle do you currently drive? _____________________________________

  7. Are you able to drive an automatic transmission without assistive devices or special equipment?
           Yes _____      No _____

  8. Have you had any moving violations in the past 3 years? If so, please explain.
           Yes _____      ___________________________________
           No _____

  9. Have you been involved in any accidents within the past 3 years? If so, please explain.
           Yes _____     ___________________________________
           No _____

  10. Do you have a history of any of the following? If yes, please explain.
           Heart condition     No____          Yes________________________________
           Heart attack     No____ Yes________________________________
           Stroke     No____ Yes________________________________
           Brain tumor     No____ Yes________________________________
           Head injury     No____ Yes________________________________
           Epileptic seizures     No____ Yes________________________________
           Respiratory disorders     No____ Yes________________________________
           Motion sickness     No____ Yes________________________________
           Inner ear problems     No____ Yes________________________________
           Dizziness, vertigo, or other
               balance problems
        No____ Yes________________________________
           Diabetes     No____ Yes________________________________
           Migraine, tension headaches     No____ Yes________________________________

  11. Have you ever had radial keratotomy, (laser eye surgery), or other eye surgeries? If so, please specify.
           Yes_____     __________________________________________________
           No_____

  12. (Females only, of course) Are you currently pregnant?
           Yes _____ No _____

  13. Are you currently taking any medications on a regular basis? If yes, please list them.
           Yes _____     ____________________________________
           No _____

  14. Do you have normal or corrected to normal hearing and vision? If no, please explain.
           Yes _____
           No _____     ____________________________________


I would like to confirm your full name, phone number(s) (home/work) where you can be reached, hours/days when it’s best to reach you, and preferred days to participate.

Name __________________________________________________________    Male / Female

Phone Numbers (Home)_________________________(Work)_________________________

Best Time to Call _________________________________________________

Best Days to Participate____________________


Criteria For Participation:

  1. Must hold a valid driver’s license.
  2. Must be 18-25, 40-50, or 65+ years of age.
  3. Must drive at least two times a week.
  4. Must have normal (or corrected to normal) hearing and vision.
  5. Must be able to drive an automatic transmission without special equipment.
  6. Must not have more than two driving violations in the past 3 years.
  7. Must not have caused an injurious accident in the past 2 years.
  8. Cannot have a history of heart condition or prior heart attack, lingering effects of brain damage from stroke, tumor, head injury, or infection, epileptic seizures within 12 months, respiratory disorders, motion sickness, inner ear problems, dizziness, vertigo, balance problems, diabetes for which insulin is required, chronic migraine or tension headaches.
  9. Must not be pregnant.
  10. Cannot currently be taking any substances that may interfere with driving ability (cause drowsiness or impair motor abilities).
  11. No history of radial keratotomy, (laser) eye surgery, or any other ophthalmic surgeries.

Accepted: ________                      Days that will attend study:
(T):_________(N1):_________(N2):________

Rejected: ________        Reason:__________________________________________

Screening Personnel (print name):______________________       (Date):________

Willing to drive in snow?   Y     N       Willing to come in 11 p.m. or later?   Y    N

 

Previous    Table of Contents    Next
ResearchFHWA
FHWA
United States Department of Transportation - Federal Highway Administration