Form NHTSA Form #1067 NHTSA Form #1067 Drivers' Survey
An In-Depth Examination of Pedestrian-Involved Hit-and-Run Crashes
Appendix B--Survey Form
An In-Depth Examination of Pedestrian-Involved Hit-and-Run Crashes
OMB: 2127-0668
Supporting Statement for An In-Depth Examination of
Paperwork Reduction Act Submission Pedestrian-Involved Hit-and-Run Crashes
United States Department of Transportation National Highway Traffic Safety Administration |
Survey Instrument
(5/28/09 Draft) |
Form Approved O.M.B. No. 2127-XXXX Expiration Date: XXXX
An In-Depth Examination of Pedestrian Involved Hit and Run Traffic Crashes |
INTERVIEWER
INSTRUCTIONS:
Read
out all of the questions and answers, except the “Don’t
know,” “Refused,” and “Other” options.
Do not read “YES” or “NO” answers to
questions, unless indicated.
QUOTA 1 drivers are those WHO RAN from scene of accident
QUOTA 2 drivers are those who DID NOT RUN from the scene
Both sets of drivers (QUOTA 1 and QUOTA 2) are asked questions Q 1 – Q 38
Only QUOTA 2 drivers are asked questions Q 39 – Q 40
Only QUOTA 1 drivers are asked questions Q 41 – Q 54.
FIRST SCREEN (prior to respondent contact, not read by interviewer)
1. PROCEED TO FIRST QUESTION
2. No Answer
3. Normal Busy
4. Answering Machine
5. Non-Working Number
6. Business Number
7. Fax/Modem/Data Line
8. Disconnected Number
(If QUOTA = 1 or 2)
SCREEN 1 (interview starts here)
Hi, my name is _________________________, and I am calling on behalf of the University of California, Berkeley. Can I please speak with (name of respondent)?
Yes, I am that person (skip to INTRO 2)
Yes, I will go get him/her (wait for respondent to come to phone then begin with INTRO 1)
What is this call about? (see response below)
No – Callback (collect information for contact – time, alternative number, etc.)
9. Refusal (skip to TERM 1)
If answer is 3 (“What is this call about?”), respond as follows:
We are conducting a confidential nationwide survey of drivers in order to better understand how to reduce injuries and fatalities due to traffic accidents involving pedestrians. This study is conducted solely for research purposes.
IDENTIFICATION OF RESPONDENT
INTRO 1
Hi,
my name is _________________________, and I am calling on behalf of
the University of California, Berkeley. Is this (name
of respondent)?
1. Yes (proceed to INTRO 2)
2. No (ask for respondent and set callback)
INTRO 2
The US Department of Transportation has asked UC Berkeley to conduct a brief but important nationwide survey of drivers in order to better understand how to reduce injuries and fatalities due to traffic accidents involving pedestrians.
Your participation is completely voluntary, and all information that you provide will be kept confidential. There is no direct benefit to you anticipated from participating in this study. However, the information gained from the study will help design programs to reduce pedestrian-related crashes, in particular, hit and run crashes.
This
study is conducted solely for research purposes, and all identifying
information will be removed from your responses. To help protect
your privacy, the researchers have obtained a Certificate of
Confidentiality from the National Center for Injury Prevention and
Control, part of the U. S. Department of Health and Human Services.
With this Certificate, the researchers cannot be forced to disclose
information that may identify you, even by a court subpoena, in any
federal, state, or local civil, criminal, administrative,
legislative, or other proceedings. We have this certificate because
some of the questions are about illegal activities. Also, we want you
to know that some questions may make you upset or uncomfortable. You
may skip any questions or stop participating at any point during the
survey. The survey will take about 20 minutes over the telephone. To
ensure that I am doing this correctly, this call may be monitored by
my supervisor. This survey is voluntary so you have the right to
decline to participate or to withdraw at any point in this study.
Additionally, this study has been reviewed and approved by the Office of Management and Budget under the OMB control number XXXX-XXXX. If you have any questions or concerns about your rights and treatment as a research subject, you may contact the office of UC Berkeley's Committee for the Protection of Human Subjects, at 510-642-7461 or [email protected].
(proceed to INTRO 3)
INTRO 3
Your name has been selected from local records of past traffic accidents and those records indicate your involvement in a pedestrian-related incident around <<insert month and year>> in <<insert city>>.
Do you recall that incident?
1. Yes (proceed to INTRO 4)
2. No – I do not recall that incident (skip to TERM 2)
3. No – I never had an accident/wrong person (skip to TERM 2)
(INTERVIEWER NOTE: Respondent indicates they are not the person we are looking for.)
9. Refused (skip to TERM 2)
CONSENT
INTRO 4
Great, please keep in mind that all of your answers are confidential and that this study is for research purposes only.
May I start the interview now?
1. Yes (proceed to INTRO 5)
2. No – When is a better time for you? (Schedule callback)
9. Refused (skip to TERM 2)
(INTERVIEWER NOTE: If respondent wants further information, offer the following:
“If you would first like to learn more about the survey, you can call [NHTSA provided 800 number] or go to [Web Site URL], which will explain more about the survey.”)
INTRO 5
Do you have any questions before we begin?
ELIGIBILITY
Q 1.
To the best of your knowledge, are you currently involved in any legal proceedings concerning the referenced pedestrian-related incident? This includes if you are being investigated for a crime related to the incident or have been charged with a crime or sued, and a judgment has not been reached or the judgment has been appealed.
1. Yes (skip to TERM 3)
2. No
8. Don’t know
9. Refused
DEMOGRAPHICS/DRIVING HISTORY
Q 2.
First, I am going to ask you some basics questions about yourself.
Can you please tell me your year of birth?
_____________ (enter year) (If answer <= 1991 and respondent’s age < 18, skip to TERM 4)
888. Don’t know
999. Refused
Q 3.
Do you consider yourself of Hispanic, Latino, or Spanish origin?
Yes
No
8. Don’t know
9. Refused
Q 4.
Which of the following best describes your race? (Select all that apply)
American Indian or Alaska Native (go to Q 6)
Asian (go to Q 6)
Black or African American (go to Q 6)
Native Hawaiian or other Pacific Islander (go to Q 6)
White (go to Q 6)
Other
8. Don’t know (go to Q 6)
9. Refused (go to Q 6)
Q 5.
Other race, please describe: _________________________________
888. Don’t know
999. Refused
(CONSISTENCY CHECK: If respondent says other race: Hispanic/ Latino, but said “no” to Q 3, pause and repeat Q 3.)
Q 6.
Okay, thank you. The next questions I would like to ask are about your driving history.
What is the total number of years that you have been a licensed driver?
(INTERVIEWER NOTE: Respondent can estimate to the closest number of years.)
_______________________ (Enter number of years)
888. Don’t know
999. Refused
(CONSISTENCY CHECK: Answer to Q 6 cannot be larger than age determined from Q 2.)
Q 7.
How many accidents have you been involved in as a driver in the last 10 years?
(INTERVIEWER NOTE: This includes accidents that involve pedestrians and those that do not.)
0 – none (skip to TERM 5)
1 (show “Did the accident on << month and year>> in << city>> involve pedestrians?”)
2
3
4
5
More than 5
8. Don’t know
9. Refused
Q 8.
How many of those accidents involved pedestrians?
Enter number: ______________________
777. None (0) (skip to TERM 5)
888. Don’t know
999. Refused
DETAILS OF ACCIDENT
The
next questions are about the accident that occurred around <<insert
month and year>>
in <<insert
city>>
Q 9.
Who was the registered owner of the vehicle you were driving?
Myself
Spouse/Significant Other
Other Family Member
Friend
Company/Work vehicle
Stolen
Other (specify):
8. Don’t know
9. Refused
Q 10.
Where were you coming from before the accident?
Bar
Restaurant
Home
Friend’s Home
Entertainment/Sports Venue
Work
School
Other (specify):
88. Don’t know
99. Refused
Q 11.
Where were you going to before the accident?
Bar
Restaurant
Home
Friend’s Home
Entertainment/Sports Venue
Work
School
Other (specify):
88. Don’t know
99. Refused
Q 12.
Were you carrying any passengers in your vehicle at the time of the accident?
Yes
No
8. Don’t know
9. Refused
Q 13.
Aside from any passengers in your vehicle, were there witnesses to the accident?
Yes
No (skip to Q 15)
8. Don’t know
9. Refused
Q 14.
Did you notice whether any of the witnesses helped the pedestrian(s)?
Yes
No
8. Don’t know
9. Refused
Now I am going to ask some questions about the pedestrian(s) involved in the accident.
Q 15.
When did you realize you had struck a pedestrian (or pedestrians)? Would you say…?
Immediately
Within a few minutes
When I arrived at my destination and got out of car
Did not realize until told
Other (specify):
8. Don’t know
9. Refused
Q 16.
How many pedestrians were hit by your vehicle in the accident that occurred in <<insert city>>?
1. 1 (skip to Q 20)
2. 2
3. 3 or more
8. Don’t know (go through loop Q 20 – Q 23 once)
9. Refused (skip to Q 24)
If answer to Q 16 was “2” or “3 or more” proceed to Q 17-19 and follow to loop for Q 20 – Q 23 for the first, second and third pedestrian.
Number of loops limited to three to account for impartial free recall in human memory and risk of confounding event details.
***** start for loop Q 20 – Q 23 if Q 16 > 1 *****
Q 17. 1st loop
Of those <<insert number from Q 16>> pedestrians that were impacted in that accident, please think of just one of them for now. (Proceed to Q 20)
***** start 2nd round for loop Q 20 – Q 23 only if Q 16 > 1 *****
Q 18. 2nd loop
Of those <<insert number from Q 16>> pedestrians that were impacted in that accident, please think of the second pedestrian now. (Proceed to Q 20)
***** start 3rd round for loop Q 20 – Q 23 only if Q 16 > 2 *****
Q 19. 3rd loop
Of those <<insert number from Q 16>> pedestrians that were impacted in that accident, please think of the third pedestrian now. (Proceed to Q 20)
[Programming instruction: Create loop from Q 20 through Q 23 depending on answer to Q 16. Create maximum of three loops (for three pedestrians)]
DECISION WHETHER OR NOT TO “RUN”: DETAILS ABOUT PEDESTRIAN
**** begin loop ****
Q 20.
Did you see the pedestrian that your vehicle struck at any time at the scene of the accident?
Yes
No (skip to Q 22)
8. Don’t know
9. Refused
Q 21.
Was the pedestrian doing any
of the following immediately before the accident?
(Select
all that apply)
Walking
Running
Weaving or falling
Lying in the roadway
Acting as if intoxicated
Acting disturbed
Other (specify):
8. Don’t know
9. Refused
Q 22.
Was the pedestrian involved harmed as a result of the accident?
Yes
No (skip to next loop Q 18 or Q 19 for additional pedestrian, or, if no other loop, to Q 24)
8. Don’t know
9. Refused
Q 23. How severe were the pedestrian’s injuries? Would you say…
Minor
Moderate
Severe
Fatal
Other (specify):
8. Don’t know
9. Refused
**** end loop ****
(Return to Q 17-19 and then repeat loop if multiple pedestrians were involved)
DECISION WHETHER OR NOT TO “RUN”: DETAILS ABOUT DRIVER
Q 24.
The next series of questions concern the events leading up to and the possible causes of the accident. I want to remind you again that all answers are kept confidential.
Immediately
prior to the accident, were you doing any of the following? Were
you…?
(Select
all that apply.)
Talking on a cell phone
Text messaging or using a PDA
Looking at the surrounding area (ads, retail storefronts, scenery, etc.)
Adjusting vehicle controls (radio, GPS locator, DVD player, etc.)
Attending to vehicle passengers
Distracted by something else – by what:_________________?
Falling asleep or asleep
Drinking alcoholic beverages
Other (specify):
I did not do any of the above
88. Don’t Know
99. Refused
Q 25.
Did you have a valid driver’s license at the time of the accident?
Yes
No
8. Don’t know
9. Refused
Q 26.
Did you have valid auto insurance at the time of the accident?
Yes
No
8. Don’t know
9. Refused
Q 27.
Had you ever been convicted of a serious traffic offense such as reckless driving or a DUI (aside from the current incident)?
Yes
No
8. Don’t know
9. Refused
Q 28.
Was there an active warrant for your arrest at the time of this accident?
Yes
No
8. Don’t know
9. Refused
Q 29.
What was your legal status in the United States at the time of this accident?
Citizen
Permanent Resident
Nonimmigrant (student, work visa, or tourist visa)
Undocumented
Other (specify):
8. Don’t know
9. Refused
Q 30.
Did you drink any alcohol during the 2 hours before this accident?
Yes
No (skip to Q 32)
8. Don’t know
9. Refused
Q 31.
How many drinks did you have in the 2 hours before this accident?
_________ (enter number of drinks)
88. Don’t know
99. Refused
Q 32.
Did you take any prescription or over-the-counter medication in the 24 hours preceding the accident?
Yes
No
8. Don’t know
9. Refused
Q 33.
Did you take any illegal drugs in the 24 hours preceding the accident?
Yes
No
8. Don’t know
9. Refused
Q 34.
Do you believe you were at fault in causing this accident?
Yes (skip to Q 36)
No
8. Don’t know
9. Refused
Q 35.
Who do you think was at fault? (A list of possible answers will be available)
Q 36.
Did you or someone else call 911 or the police after the accident?
Yes
No (skip to Q 39)
8. Don’t know
9. Refused
Q 37.
To the best of your knowledge, who made the 911 call or call to the police? (Check all that apply)
1. I did (the driver)
2. A passenger in my car
3. A bystander
4. A person in another vehicle
5. Other household member
6. Other (specify):
8. Don’t know
9. Refused
Q 38.
How long after the accident was the call made?
1. A few minutes after the accident/right away
2. 15 minutes or later after the accident
3. 30 minutes or later after the accident
4. An hour or later after the accident
5. Other (specify):
8. Don’t know
9. Refused
If QUOTA = 1 (Skip to Q 42)
Q 39.
Were there legal consequences of your involvement in the accident?
Yes
No (skip to TERM 6)
8. Don’t know
9. Refused
Q 40.
Were you…? (Select all that apply)
Arrested
Charged with a misdemeanor
Charged with a felony
Convicted of a misdemeanor
Convicted of a felony
Given a revoked or suspended license
Fined
Imprisoned
Other(specify):
Don’t Know
Refused
(Skip to final TERM)
QUESTIONS FOR DRIVERS WHO RAN: GENERAL
(These questions are ONLY for drivers WHO RAN)
Q 41.
According to the report on the incident, you left the scene of the accident before notifying authorities. How long after the accident occurred did you leave the scene?
Did not stop
Immediately
After a few minutes
After 30 minutes
After an hour or later
Other (specify):
8. Don’t know
9. Refused
Q 42.
How likely did you think you were to get caught when you left the scene? Would you say…?
Not likely
Somewhat likely
Very likely
8. Don’t know
9. Refused
Q 43.
What was the most important factor in your decision to leave the scene?
Record Detail: _______________________________________
888. Don’t know
999. Refused
Q 44.
Did you leave the scene on foot, in your vehicle, or another way?
On foot
In his/her vehicle
In another vehicle
Other (specify):
8. Don’t know
9. Refused
Q 45.
Did you consider returning to the scene?
Yes, I did return to the scene (skip to Q 47)
Yes, I considered it, but I did not
No, I did not consider and did not return
8. Don’t know
9. Refused
Q 46.
Do you recall why you decided not to return to the scene of the accident?
Record Detail: _______________________________________
888. Don’t know
999. Refused
Q 47.
Did you consider contacting the police after leaving the scene?
Yes
No
8. Don’t know
9. Refused
QUESTIONS FOR DRIVERS WHO RAN: CONSEQUENCES
(These questions are ONLY for drivers WHO RAN)
Q 48.
How were you eventually identified as involved in the accident?
Record Detail: _______________________________________
888. Don’t know
999. Refused
Q 49.
Were there legal consequences of your leaving the scene of the accident?
Yes
No (skip to Q 52)
8. Don’t know
9. Refused
Q 50.
Were you charged with leaving the scene of the accident?
Yes
No
8. Don’t know
9. Refused
Q 51.
Were you…? (Select all that apply)
Arrested
Charged with a misdemeanor
Charged with a felony
Convicted of a misdemeanor
Convicted of a felony
Given a revoked or suspended license
Fined
Imprisoned
Other(specify):
Don’t Know
Refused
Q 52.
Aside from any consequences of leaving the scene, were there any additional legal consequences of your involvement in the accident?
Yes
No (skip to TERM 6)
8. Don’t know
9. Refused
Q 53.
Were you…? (Select all that apply)
Arrested
Charged with a misdemeanor
Charged with a felony
Convicted of a misdemeanor
Convicted of a felony
Given a revoked or suspended license
Fined
Imprisoned
Other(specify):
Don’t Know
Refused
Q 54.
In your opinion, were the legal consequences more or less severe because you left the scene?
More severe
Less severe
Same
Other (specify):
8. Don’t know
9. Refused
(Skip to final TERM)
TERM 1
(refusal at beginning of interview)
Thank you for your time.
Those are all of the questions that I have. Goodbye.
TERM 2
(refusal after subject of interview introduced)
Thank you for
your time. Those are all of the questions that I have. If you have
found any of my questions upsetting, would you like the phone number
of someone to talk to in confidentiality? (If
yes, give them a local crisis hotline number)
TERM
3 (eligibility
termout – currently involved in legal proceedings)
Thank
you for being willing to partake in our research study, but it looks
like the quota for the respondent category you fall in is filled.
Those are all of the questions that I have; thank you very much for
your time. If you have found any of my questions upsetting, would you
like the phone number of someone to talk to in confidentiality? (If
yes, give them a local crisis hotline number)
TERM
4 (age termout)
Thank you for being willing to partake in our research study,
but it looks like the quota for the respondent category you fall in
is filled. Those are all of the questions that I have; thank you very
much for your time. If you have found any of my questions upsetting,
would you like the phone number of someone to talk to in
confidentiality? (If
yes, give them a local crisis hotline number)
TERM
5 (no accident
termout)
Great, and those are all of the questions that I have
for you. Thank you for your time. Goodbye. If you have found any of
my questions upsetting, would you like the phone number of someone to
talk to in confidentiality? (If
yes, give them a local crisis hotline number)
TERM 6 (legal consequences at Q 39 or Q 52)
All right, and those are all of the questions that I have for you. Thank you for your time. Would you like more information about the results of the survey and how they may be used to reduce injuries and fatalities? (If yes, give them email/weblink/800 number.) If you have found any of my questions upsetting, would you like the phone number of someone to talk to in confidentiality? (If yes, give them a local crisis hotline number)
TERM (Final)
And those are all of the questions that I have for you; thank you for participating in this survey. Would you like more information about the results of the survey and how they may be used to reduce injuries and fatalities? (If yes, give them email/weblink/800 number.) If you have found any of my questions upsetting, would you like the phone number of someone to talk to in confidentiality? (If yes, give them a local crisis hotline number)
OMB Control Number 2127-XXXX
| File Type | application/msword |
| File Title | Supporting Statement for Paperwork Reduction Act Submission |
| Author | Anissa Craghead |
| Last Modified By | charlene.doyle |
| File Modified | 2010-06-17 |
| File Created | 2010-06-17 |
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