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Publication Number: FHWA-HRT-04-137
Date: December 2005
Enhanced Night Visibility Series, Volume VI: Phase II—Study 4: Visual Performance During Nighttime Driving in Fog
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APPENDIX A—SCREENING QUESTIONNAIRE
Driver Screening and Demographic Questionnaire: ENV-Fog
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 in italics 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 different vehicles on the Smart Road at night. The Smart Road is a test facility equipped with advanced data recording systems here in Blacksburg, VA. It is equipped with technology that will allow us to create snow, fog, and rain. You will be driving in man-made fog. The session will take approximately 4 hours. We will pay you $20 per hour. The total amount will be given to you at the end of the night. 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.
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:
Accepted: ________ Days that will attend to Study: (T):_________(N1):_________
Rejected: ________ Reason:__________________________________________
Screening Personnel (print name):______________________ (Date):________
Topics: research, safety
Keywords: research, safety, Age, Detection, Fog, Halogen, Headlamp, High Intensity Discharge (HID), Infrared, Night Vision, Nighttime, Pedestrian, Recognition, Ultraviolet, Vision Enhancement System, Weather
TRT Terms: research, Safety and security, Safety, Transportation safety, Automobile driving at night, Automobile driving in fog, Automobiles--Lighting--Evaluation, Night visibility, Headlamps