U.S. Department of Transportation
Federal Highway Administration
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Washington, DC 20590
Federal Highway Administration Research and Technology
Coordinating, Developing, and Delivering Highway Transportation Innovations
|This report is an archived publication and may contain dated technical, contact, and link information|
Publication Number: FHWA-HRT-04-134
Date: December 2005
Enhanced Night Visibility Series, Volume III: Phase II—Study 1: Visual Performance During Nighttime Driving in Clear Weather
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APPENDIX A—SCREENING QUESTIONNAIRE
Driver Screening and Demographic Questionnaire: ENV-Clear
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 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.
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:
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