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Federal Highway Administration Research and Technology
Coordinating, Developing, and Delivering Highway Transportation Innovations
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Publication Number: FHWA-HRT-04-145
Date: December 2005
Enhanced Night Visibility Series, Volume XIV: Phase III—Study 2: Comparison of Near Infrared, Far Infrared, and Halogen Headlamps on Object Detection in Nighttime Rain
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APPENDIX B—INFORMED CONSENT FORM
[NAME OF UNIVERSITY]
Informed Consent for Participants of Investigative Projects
Title of Project: Nighttime Driving Evaluation of the Effects of Disability and Discomfort Glare from Various Headlamp Designs under Low and High Light Adaptation Levels
Investigators: (List names of investigators here)
The Purpose of the Research
The purpose of this study is to objectively identify the levels of discomfort and disability glare produced by various oncoming headlamps under two levels of light adaptation.
During the course of this experiment you will be asked to perform the following tasks:
It is important for you to understand that we are evaluating the technology, not you. Any tasks you perform, mistakes you make, or opinions you have will only help us do a better job of designing these systems. Therefore, we ask that you perform to the best of your abilities. The information and feedback that you provide is very important to this project.
There are risks or discomforts to which you are exposed in volunteering for this research. They include the following:
The following precautions will be taken to ensure minimal risk to you.
In the event of an accident or injury in an automobile, the automobile liability coverage for property damage and personal injury is provided. The total policy amount per occurrence is 2,000,000 dollars. This coverage (unless the other party was at fault, which would mean all expense would go to the insurer of the other party’s vehicle) would apply in case of an accident for all volunteers and would cover medical expenses up to the policy limit.
Participants in a study are considered volunteers, regardless of whether they receive payment for their participation; under Commonwealth of Virginia law, worker’s compensation does not apply to volunteers; therefore, if not in an automobile, the participants are responsible for their own medical insurance for bodily injury. Appropriate health insurance is strongly recommended to cover these types of expenses.
There are no direct benefits to you from this research other than payment for participation. No promise or guarantee of benefits will be made to encourage you to participate. Subject participation may have a significant impact on future night vision systems.
Extent of Anonymity and Confidentiality
The data gathered in this experiment will be treated with confidentiality. Shortly after participation, your name will be separated from your data. A coding scheme will be employed to identify the data by participant number only (e.g., Participant No. 1). You will be allowed to see your data and withdraw the data from the study if you so desire, but you must inform the experimenters immediately of this decision so that the data may be promptly removed. At no time will the researchers release the results of this study to anyone other than the client and individuals working on the project without your written consent. The client has requested that the video, including your eye movement data and image, be given to them when the study is completed. They would only use the video for research purposes. Researchers will not turn over the video of your image to the client without your permission
You will receive 20 dollars per hour for your participation in this study. This payment will be made to you at the end of your voluntary participation in this study. If you choose to withdraw before completing all scheduled experimental conditions, you will be compensated for the portion of time of the study for which you participated.
Freedom to Withdraw
As a participant in this research, you are free to withdraw at any time for any reason. If you choose to withdraw, you will be compensated for the portion of time of the study for which you participated. Furthermore, you are free not to answer any questions or respond to any research situations without penalty.
Approval of Research
This research has been approved, as required, by the Institutional Review Board for Research Involving Human Subjects at (Name of University) and by the (Name of Research Institute).
If you voluntarily agree to participate in the study, you will have the following responsibilities: To be physically free from any substances (alcohol, drugs, etc.) that might impair your ability to drive for 24 hours prior to the experiment, and to conform to the laws and regulations of driving.
Check one of the following:
I have read and understand the Informed Consent and conditions of this project. I have had all my questions answered. I hereby acknowledge the above and give my voluntary consent for participation in this project.
If I participate, I understand that I may withdraw at any time without penalty. I agree to abide by the rules of this project.___________________________________________________ ____________________________
Participant’s Signature Date
Should I have any questions about this research or its conduct, I may contact: (List name and contact information of PI, IRB Chair, and Experimenter)