CRASH
Motorcycle Rider Questionnaire
1. Case Number ____________ 2. Motorcycle Rider Number ____
BACKGROUND INFORMATION
3. How old are you? ___ ___ A.5.1.1.3
Code actual age in years
(99) unknown
4. Where did you get your current driver's license? _____ A.5.1.1.4
(1) no license
(2) California
(3) other State (list) ________
(4) Canada
(5) Mexico
(6) military
(8) other (describe) ____________
(9) unknown
5. What kind of operator's license is it? ___ ___ A.5.1.1.5.1
(Code up to 4; input "97" in remaining responses) ___ ___ A.5.1.1.5.2
(01) no license held ___ ___ A.5.1.1.5.3
(02) learner's permit, only ___ ___ A.5.1.1.5.4
(03) motorcycle license
(04) automobile license
(05) commercial license
(06) motorcycle driver and competition license
(07) license to transport people
(08) heavy truck license
(97) not applicable
(98) other (describe) ___________
(99) unknown
6. What year was/were the license(s) issued? __ __ __ __A.5.1.1.6.1
(Listed in same order as licenses above) __ __ __ __A.5.1.1.6.2
(9997) not applicable __ __ __ __A.5.1.1.6.3
(9999) unknown __ __ __ __A.5.1.1.6.4
7. How many times have you acquired a motorcycle learner’s permit? ___ ___
(00) never
(01-96) actual number of times
(98) other (specify) _________
(99) unknown
8. How long have you held a motorcyclist license? ___ ___ ___ Months
(000) less than two weeks
(001-995) actual number of months
(996) 996 months or greater
(997) Not applicable, no license held
(998) other (specify) _________
(999) unknown
9. Are you of Hispanic or Latino origin? ____
(0) refused to answer
(1) no
(2) yes
(8) other (describe) __________
(9) unknown
10. What is your race? ___
Please select one or more, code “7” in others ___
(0) refused to answer
(1) white ___
(2) black or African American ___
(3) Asian
(4) Native Hawaiian or other Pacific Islander
(5) American Indian or Alaska native
(7) not applicable
(8) other _________________________
(9) unknown
11. What is your height? ___ft. ___ ___ in. A.5.1.1.9
(9/99) unknown
12. What is your weight? ___ ___ ___lbs. A.5.1.1.10
(999) unknown
13. Gender ___ A.5.1.1.11
(1) male
(2) female
(9) unknown
14. How much formal education have you had? ___ ___ A.5.1.1.12
(01) no formal schooling
(02) less than high school diploma
(03) high school diploma or GED
(04) partial college/university
(05) college/university graduate
(06) graduate school, advanced degree, professional degree
(07) specialty/technical school
(97) not applicable
(98) other (specify) ___________
(99) unknown
15. What is your current occupation? ___ ___ A.5.1.1.13
(11) management occupations
(13) business and financial
(15) computer and mathematical
(17) architecture and engineering
(19) life, physical, and social science
(21) community and social services
(23) legal
(25) education, training or library
(27) arts, design, entertainment, sports or media
(29) healthcare practitioners and technical jobs
(31) healthcare support
(33) protective services
(35) food preparation and serving related
(37) building and grounds maintenance
(39) personal care and services
(41) sales and related occupations
(43) office and administrative support
(45) farming, fishing or forestry
(47) construction or extraction
(49) installation, maintenance or repair
(53) transportation and material moving
(55) military
(60) full time student
(97) not applicable, not in workforce at present
(98) other (specify) _____________
(99) unknown
16. Are you married? ___ D.5.2.1.1.4
(01) not married
(02) single
(03) married
(04) separated
(05) divorced
(06) widowed
(07) cohabitating
(98) other (specify) _______________________________
(99) unknown
17. How many children do you have? ___ D.5.2.1.1.5
(0) none
(1) one
(2) two
(3) three
(4) four
(5) five
(6) six
(7) more than six
(9) unknown
RIDING/DRIVING EXPERIENCE
18. Are you the owner of this motorcycle? ___
(1) no
(2) yes
(8) other __________________
(9) unknown
19. Where did you purchase this motorcycle? ____
(1) dealership (store front or internet)
(2) family, friend, or neighbor
(3) newspaper want ad or internet ad
(4) motorcycle was a gift
(7) not applicable, rider does not own this motorcycle
(8) other, specify_______________
(9) unknown
20. How long have you owned this motorcycle? ___ ___
(00) less than two weeks
(01) one year or less
(02-96) number of years
(97) not applicable, rider does not own this motorcycle
(98) other (specify) ________
(99) unknown
21. During the most recent period of riding regularly, how many MONTHS have you operated a street motorcycle? ___ ___ ___ A.5.1.1.16
(000) this is the first time
(001) less than or equal to one month
(002-095) actual number of months
(096) 96 months or more
(997) not applicable
(998) other (specify) __________
(999) unknown
22. How many MONTHS have you operated the crash-involved motorcycle? ___ ___ ___
(000) this is the first time A.5.1.1.16
(001) less than or equal to one month
(002-095) actual number of months
(096) 96 months or more
(998) other (specify) __________
(999) unknown
23. What is the average number of days per year you ride motorcycles? ___ ___ ___
(001-365) Actual number of days per year A.5.1.1.18
(997) not applicable, first time
(999) unknown
24. About how many miles per year do you ride motorcycles? ___ ___ ___ ___ ___
(00000) none A.5.1.1.19
(00001-99995) actual miles
(99996) 99996 or greater miles
(99998) other (specify) ____
(99999) unknown
25. What kind of motorcycle training have you had? ___ ___ A.5.1.1.20
(00) none
(01) self taught
(02) taught by family or friends
(03) special voluntary motorcycle training for road riding
(04) special compulsory motorcycle training for road riding
(05) professional training for competition license
(06) advanced training
(07) compulsory motorcycle training ordered by judge/police/etc.
(98) other (specify) __________________
(99) unknown
26. In what years have you taken any formal motorcycle training?
Code up to three ___ ___ ___ ___
(9997) not applicable ___ ___ ___ ___
(9999) unknown ___ ___ ___ ___
27. Please tell me the reason for not taking motorcycle safety training ____
(1) not offered
(2) enrolled for future date
(3) tried unsuccessfully to enroll
(4) not interested/don't need it
(5) cost
(7) not applicable, took training
(8) other (specify) ___________________________
(9) unknown
28. What year was your most recent motorcycle training class? ____ ____ ____ ____
Code actual year
(0000) no training class
(9998) other (specify) _____
(9999) unknown
29. How old were you when you first began to ride a street motorcycle? ____ ____
Code actual age
(00) never rode before, or rarely ever rides
(98) other (specify) _______
(99) unknown
30. Were there years in which you gave up riding a motorcycle before returning to
riding? ____
(1) no
(2) yes
(7) not applicable, never before rode
(8) other (specify) ______
(9) unknown
31. How many years before you started riding again? ____ ____
(00) never stopped riding
(01-96) actual number of years
(97) not applicable, never before rode
(98) other _____________
(99) unknown
32. When you ride a motorcycle, what is the percentage of time you use it for each of these categories? (indicate % of total riding/driving time for each of the three categories)
Recreation ___ ___ ___ % A.5.1.1.21.1
Basic transportation ___ ___ ___ % A.5.1.1.21.2
100%
(000) first time use
(997) not applicable
(999) unknown
33. How many YEARS have you been driving any kind of motor vehicle? ___ ___ years
(00) less than two weeks A.5.1.1.15
(01) one year or less
(02-96) actual number of years
(97) not applicable/no previous experience/first time
(99) unknown
34. How many miles per year do you drive a car or truck? ____ ____ ____ ____ ____
(00000) None, do not drive car or truck
(00001-99995) actual miles
(99996) 99996 or greater miles
(99998) other (specify) ____
(99999) unknown
35. Have you had any car or truck driver training? ___ ___
(01) no training
(02) self taught
(03) taught by friends or family
(03) official driver training class
(04) voluntary drivers education
(05) compulsory drivers education
(06) professional training for commercial license
(07) compulsory motor vehicle training ordered by judge/police/etc.
(98) other (specify) ___________
(99) unknown
36. How many moving traffic convictions have you had in the previous 5 years?
Code the total number of moving traffic convictions – any vehicle ___ ___
(00) none A.5.1.1.24
(99) unknown
37. Of those how many were motorcycle moving violation-related? ___ ___
Code the total number of previous motorcycle moving violations A.5.1.1.25
(00) none
(99) unknown
38. Of those how many were car or truck moving violation-related? ___ ___
Code the total number of previous car or truck moving violations A.5.1.1.26
(00) none
(99) unknown
39. How much experience do you have riding with passengers on a motorcycle? ___
(1) first time carrying passenger(s) A.5.1.1.22
(2) very little experience
(3) moderate experience
(4) extensive experience
(7) not applicable, never carry passengers
(9) unknown
40. How much experience do you have riding with cargo/luggage? ___
(1) first time A.5.1.1.23
(2) seldom carries similar cargo/luggage
(3) frequently carries similar cargo/luggage
(4) always carries similar cargo/luggage
(7) not applicable/no experience with cargo/luggage
(9) unknown
TRIP INFORMATION
41. At what kind of location did you begin your trip today? ___ ___
(01) home A.5.1.1.27
(02) work, business
(03) recreation/social
(04) school/religious activity
(05) errand, shopping
(06) family personal business/obligations
(07) meals, restaurant, etc.
(08) transport someone
(09) medical/dental
(10) bar, pub
(98) other (specify) _____________
(99) unknown
42. Did you do any safety or maintenance checks on your motorcycle before leaving for this trip? Code up to 4.
(0) none ___
(1) exterior, visual inspection, only ___
(2) checked fluids ___
(3) checked lights ___
(4) checked brakes
(5) checked tire pressure
(8) other, specify: __________________
(9) unknown
43. What was your trip destination? ___ ___ A.5.1.1.28
(01) home
(02) work, business
(03) recreation/social
(04) school/religious activity
(05) errand, shopping
(06) family personal business/obligations
(07) meals, restaurant, etc
(08) transport someone
(09) medical/dental
(10) bar, pub
(11) no destination, joy riding
(98) other (specify) _____________
(99) unknown
44. About how many miles would the trip have been one way? ___ ___ ___ A.5.1.1.29
(001) one mile or less
(002-995) actual number of miles
(996) 996 miles or greater
(997) not applicable
(999) unknown
45. How frequently do you travel this road on/in any vehicle? ___ ___
(01) first time
(02) daily use, i.e., once or more per day
(03) weekly use, i.e., once or more per week
(04) monthly use, i.e., once or more per month
(05) quarterly, i.e., once or more per quarter
(06) annually, i.e., once or more per year
(07) less than annually
(99) unknown
46. How many hours have you been riding today since your departure? ___ ___
(01) one hour or less A..5.1.1.31
(02-95) actual hours
(96) 96 or more
(97) not applicable, had not yet begun trip
(98) other (specify) ___________
(99) unknown
47. How many miles had you ridden before the crash occurred? ___ ___ ___
(001) one mile or less A..5.1.1.31
(002-095) actual hours
(096) 96 or more
(997) not applicable, had not yet begun trip
(998) other (specify) ___________
(999) unknown
SITUATION
48. What was your position on the motorcycle at time of collision?___ ___ A.5.1.1.42
(01) not on motorcycle, separated before collision
(02) normal seating position
(03) standing on footrests, foot pegs
(04) seated, head down
(05) shoulder check, left
(06) shoulder check, right
(07) dismounting, jumping to side
(08) dismounting, jumping upward
(09) dragging feet, foot down
(10) abnormal seating position
(11) standing on seat
(98) other (specify) _____________
(99) unknown
49. Were you distracted by any of the following? ___ ___ A.5.1.1.44
Prior to Recognition Of Critical Event
(01) Attentive or not distracted
(02) Looked but did not see
Distractions
(03) By other occupant(s), (specify):___
(04) By moving object in vehicle (specify): ________
(05) While talking or listening to cellular phone/intercom or short wave radio
(specify location and type of phone):_________
(06) While dialing cellular phone/intercom/short wave radio
(specify location and type of phone): ____________________
(07) While adjusting climate controls
(08) While adjusting radio, cassette, CD (specify): ___________________________________
(09) While using other device/controls integral to vehicle (specify):_____________________
(10) While using or reaching for device/object brought into vehicle (specify): _______________
(11) Sleepy or fell asleep
(12) Distracted by outside person, object, or event (specify): ___________________________
(13) Eating or drinking
(14) Smoking related
(15) While listening or adjusting GPS device
(96) Distracted/inattentive, details unknown
(98) Other, distraction (specify): __________________
(99) Unknown
RIDING HABITS
50. Are you a motorcycle-related club member? ___
(1) no
(2) yes
(9) unknown
51. Were you riding with other motorcyclists? ___
(1) no
(2) yes
(8) other (specify) ________
(9) unknown
52. How many other motorcycles were in the group? ___
(00) none, no group
(01 – 95) code number of motorcycles
(96) 96 motorcycles or more
(98) other (specify) __________
(99) unknown
53. Was the group riding in a specific formation? ___
(1) single file
(2) staggered
(3) side-by-side
(7) not applicable, no group
(8) other (specify)_____________
(9) unknown
54. If in a formation, where was your motorcycle placed in formation? ____
(0) not in formation
(1) front area
(2) middle area
(3) rear area
(7) not applicable, no group
(8) other (specify) _______
(9) unknown
PROTECTIVE CLOTHING/GEAR AT TIME OF CRASH
55. What kind of clothing was on your upper body? ___ A.5.3.1.1
(0) none
(1) light cloth garment, i.e., thin cotton
(2) medium cloth garment, i.e., denim, nylon
(3) heavy cloth garment, i.e., imitation leather
(4) leather garment
(5) Kevlar
(8) other (specify)
(9) unknown
56. Was this upper body clothing motorcycle-oriented? ___ A.5.3.1.2
(1) no
(2) yes
(7) not applicable/no clothing
(8) other (specify) ________
(9) unknown
57. What kind of clothing was on your lower body? ___ A.5.3.1.3
(0) none
(1) light cloth garment, i.e., thin cotton
(2) medium cloth garment, i.e., denim, nylon
(3) heavy cloth garment, i.e., imitation leather
(4) leather garment
(5) Kevlar
(8) other (specify)
(9) unknown
58. Was this lower body clothing motorcycle-oriented? ___ A.5.3.1.4
(1) no
(2) yes
(7) not applicable/no clothing
(8) other (specify) ________
(9) unknown
59. Were you wearing an inflatable safety vest? ____
(1) no
(2) yes
(8) other (specify) ___
(9) unknown
60. What kind of shoes or boots were you wearing? ___ A.5.3.1.5
(1) no shoes or boots, barefoot
(2) light sandal
(3) medium street shoe, loafer
(4) athletic, training shoe
(5) heavy shoe or boot
(6) reinforced work boot or motorcycle boot
(8) other (specify) _______
(9) unknown
61. Did this footwear go up over your ankle? ___
(1) no
(2) yes
(7) not applicable, no footwear worn
(8) other, specify __________________
(9) unknown
62. Was the footwear motorcycle-oriented? ___ A.5.3.1.6
(1) no
(2) yes
(7) not applicable, no footwear worn
(9) unknown
63. What kind of gloves were you wearing? ___ A.5.3.1.7
(0) none
(1) light cloth garment, i.e., thin cotton
(2) medium cloth garment, i.e., denim, nylon
(3) heavy cloth garment, i.e., imitation leather
(4) leather garment
(5) Kevlar
(8) other (specify)
(9) unknown
64. Are the gloves motorcycle-oriented? ___ A.5.3.1.8
(1) no
(2) yes, full fingered
(3) yes-shorties
(7) not applicable, no gloves worn
(8) other (specify) ______
(9) unknown
65. Is any of this clothing retroreflective? _____
Code up to 3 responses _____
(1) no retroreflective clothing or gloves _____
(2) upper body (shirt/jacket/vest)
(3) lower body (pants/ shorts)
(4) gloves
(5) special arm bands, or similar items
(7) not applicable, no clothing or gloves
(8) other (specify) _________
(9) unknown
66. What is the clothing color of the following?
Upper body clothing ___ ___ D.5.3.1.6.1
Lower body clothing ___ ___ D.5.3.1.6.2
Footwear ___ ___ D.5.3.1.6.3
Gloves ___ ___ D.5.3.1.6.4
(01) no dominating color, multi-colored
(02) white
(03) yellow
(04) black
(05) red
(06) blue
(07) green
(08) silver
(09) orange
(10) brown
(11) purple
(12) gold
(13) grey
(97) not applicable/no clothing
(98) other (specify) ________
(99) unknown
67. Do you think any of your clothing helped with your ability to safely operate your motorcycle? A.6.3.1.44 and A.6.3.1.45 combined
Upper body clothing ___ ___
Lower body clothing ___ ___
Footwear ___ ___
Gloves ___ ___
(01) apparel had no effect
(02) apparel protected or helped rider
(03) apparel uncomfortable or distracting
(97) not applicable, no apparel
(98) other, specify ________________
(99) unknown
68. What kind of eye protection were you wearing at the time of the crash? ___ ___
(01) none A.5.1.1.14
(02) non-prescription clear glasses
(03) prescription clear glasses
(04) non-prescription sunglasses
(05) prescription sunglasses
(06) goggles, non-prescription
(07) goggles, prescription
(08) industrial safety glasses
(98) other (specify) ____________
(99) unknown
69. Are you required to wear corrective lenses when riding/driving? ___
(1) no
(2) yes
(8) other specify____________________
(9) unknown
70. What color was the eye coverage lens? ___ A.5.3.1.10
(1) clear
(2) green
(3) grey, smoke
(4) amber, yellow
(5) blue
(6) reflective (any color)
(7) not applicable, not wearing eye coverage
(8) other (specify) __________________________
(9) unknown
HELMET DATA
71. Were you wearing a helmet? ___ A.5.3.1.11
(1) no
(2) yes
(3) helmet available but not used
(8) other (specify) ______
(9) unknown
72. What is your reason for not wearing a helmet? ___ ___ D.5.2.1.1.13
(01) not required by law
(02) no expectation of accident involvement
(03) helmets too expensive
(04) helmets are inconvenient and uncomfortable
(05) helmets reduce traffic awareness, limit hearing and vision
(06) helmets ineffective in reducing head injury
(07) helmets cause neck injury
(08) helmets can not be used, physical or religious reasons
(09) do not own a helmet
(10) forgot to bring helmet today
(97) not applicable, rider always wears a helmet
(98) other (*describe, 80 characters) ________________________
(99) unknown
IF NO HELMET WAS WORN, go to PRECRASH section
73. Was your helmet properly adjusted? ___ A.5.3.1.12
(1) no
(2) yes
(7) not applicable, no helmet
(8) other (specify) ______
(9) unknown
74. Was your helmet securely fastened? ___ A.5.3.1.13
(1) no
(2) yes
(7) not applicable, no helmet
(8) other (specify) ______
(9) unknown
75. What type of helmet is it? ___ A.5.3.1.14
(1) not a motorcycle helmet
(2) half/police motor vehicle, motorcycle helmet
(3) open face motor vehicle, motorcycle helmet
(4) full face motor vehicle, motorcycle helmet
(5) novelty helmet
(7) not applicable, not helmet
(8) other (specify)
(9) unknown
76. What is the type of helmet coverage? ___ ___ A.5.3.1.15
(11) partial coverage
(12) full coverage
(13) full facial, integral chin bar but no face shield
(14) full facial, removable chin bar
(15) full facial, retractable chin bar
(16) full facial coverage, integral chin bar and face shield
(17) wrap around face shield
(18) bubble type face shield
(19) visor/face shield combo
(97) not applicable/no helmet
(98) other (specify)
(99) unknown
77. What is the predominant color of your helmet? ___ ___ A.5.3.1.16
(01) no dominating color, multi-colored
(02) white
(03) yellow
(04) black
(05) red
(06) blue
(07) green
(08) silver, grey
(09) orange
(10) brown, tan
(11) purple
(12) gold
(13) chrome, metallic
(97) not applicable/no helmet
(98) other (specify) ________
(99) unknown
78. What is the color of the face shield? ___ A.5.3.1.17
(1) clear
(2) green
(3) grey, smoke
(4) amber, yellow
(5) blue
(6) reflective (any color)
(7) not applicable/no face shield
(8) other (specify) ________
(9) unknown
79. Do you own this helmet? ___ A.5.3.1.18
(1) no
(2) yes
(7) not applicable, no helmet
(8) other (specify) ______
(9) unknown
80. How well does this helmet fit? ___ A.5.3.1.19
(1) acceptable fit
(2) too large, too loose
(3) too small, too tight
(7) not applicable/no helmet
(8) other (specify) ____________________
(9) unknown
81. What percentage of time do you wear your helmet when riding? ___ ___ ___ %
Code from 001-100 percent A.5.3.1.20
(997) not applicable/no helmet
(999) unknown
82. Under what conditions do you usually wear your helmet? ___ A.5.3.1.21.1
(code up to four; input "0" for remaining responses) ___ A.5.3.1.21.2
(1) never uses helmet ___ A.5.3.1.21.3
(2) long trips ___ A.5.3.1.21.4
(3) highway traffic
(4) in adverse weather
(5) never in hot weather
(6) always
(7) not applicable/no helmet
(8) other (specify) __________
(9) unknown
83. Was the helmet retained in place on your head during crash? ___ A.5.3.1.30
(1) no, helmet ejected from head during pre-crash time period
(2) no, helmet ejected from head during crash
(3) no, helmet ejected from head after collision
(4) yes, helmet retained in place to completion of accident events
(5) yes, helmet moved on head but was retained
(7) not applicable/no helmet
(8) other (specify)
(9) unknown
PRECRASH DATA
84. How were you operating your motorcycle immediately prior to the crash?
(00) Stopped in traffic, speed is zero
(01) Moving in a straight line, constant speed
(02) Moving in a straight line, foot off accelerator
(03) Moving in a straight line, braking
(04) Moving in a straight line, accelerating
(05) Turning right, constant speed
(06) Turning right, foot off accelerator
(07) Turning right, braking
(08) Turning right, accelerating
(09) Turning left, constant speed
(10) Turning left, foot off accelerator
(11) Turning left, braking
(12) Turning left, accelerating
(13) Stopped at roadside, or parked
(14) Backing up, in a straight line
(15) Backing up, steering left
(16) Backing up, steering right
(17) Making U-turn right
(18) Making U-turn left
(19) Making Y-turn right
(20) Making Y-turn left
(21) Changing lanes to left
(22) Changing lanes to right
(23) Merging to left
(24) Merging to right
(25) Entering traffic from right shoulder, median, or parked
(26) Entering traffic from left shoulder, median, or parked
(27) Leaving traffic, turn out to right
(28) Leaving traffic, turn out to left
(29) Passing maneuver, passing on right
(30) Passing maneuver, passing on left
(31) Crossing opposing lanes of traffic
(32) Traveling wrong way, against opposing traffic
(36) Collision avoidance maneuver to avoid a different collision
(37) Negotiating a curve, constant speed
(38) Negotiating a curve, foot off accelerator
(39) Negotiating a curve, braking
(40) Negotiating a curve, accelerating
(97) Not applicable
(98) Other, specify: _________________________
(99) Unknown
85. Where were you looking at the start of the crash sequence? ___
(1) looking straight ahead
(2) looking right
(3) looking left
(4) looking rearward
(5) looking at own motorcycle
(8) other (specify)
(9) unknown
86. Were your motorcycle brakes functioning before the crash? ____ A.4.1.1.35
(1) no
(2) yes
(8) other (specify) ______
(9) unknown
87. Did you have your hands/fingers positioned on the front brake ___ A.6.3.1.17
prior to the crash event?
(1) no
(2) yes
(7) not applicable, no front brake or brake lever
(8) other (specify) ______
(9) unknown
88. In which lane were you traveling just before the precipitating event? ___
(1) lane 1 (right curb lane)
(2) lane two
(3) lane three
(4) lane four
(7) not applicable, not in a travel lane
(8) other (specify) _______
(9) unknown
89. What was your travel speed just before the precipitating event? ___ ___A.4.2.2.a
(00) stopped
(01-95) actual miles per hour
(96) 96 mph or more
(98) other (specify) ______
(99) unknown
90. What were the lateral movements of your motorcycle immediately ___ ___
before impact?
(01) no movement/avoidance maneuver
(02) lane departure-left side
(03) lane return-left side
(04) lane departure right side
(05) lane return-right side
(06) road departure-left side
(07) road return-left side
(08) road departure-right side
(09) road return-right side
(97) not applicable
(98) other (specify) _______
(99) unknown
91. What avoidance actions did you attempt (if any)? ___ ___ A.4.2.5.1
Code up to four ___ ___ A.4.2.5.2
(01) braking ___ ___ A.4.2.5.3
(02) downshifting ___ ___ A.4.2.5.4
(03) releasing brakes
(04) steering left
(05) steering right
(06) accelerating
(07) laid the bike down
(08) use of horn
(09) flashing headlamp
(10) drag feet
(11) jump or bail out
(97) not applicable/no avoidance actions
(98) other (specify) ________
(99) unknown
92. Did you lose control of the motorcycle? ___ ___ A.6.3.1.11
(01) capsized or fell over
(02) braking slide out-low side
(03) braking slide out-high side
(04) cornering slide out-low side
(05) cornering slide out-high side
(06) ran wide on turn, ran off road
(07) lost wheelie
(08) low speed wobble
(09) high speed wobble
(10) weave, no pitch
(11) pitch weave, low speed
(12) pitch weave, high speed cornering
(13) end over, flying W
(14) continuation, no control actions
(15) lost stoppie
(97) not applicable, no loss of control
(98) other (specify) _________
(99) unknown
93. Was there any control loss due to weather, roadway or mechanical
problems? ___
(01) no control loss due to weather, roadway or mechanical problems
(02) yes, control loss due to weather
(03) yes, control loss due to mechanical problems
(04) yes, control loss due to both weather and mechanical
(05) yes, control loss due to roadway
(06) yes, control loss due to roadway and weather
(07) yes, control loss due to roadway and mechanical
(08) yes, control loss due to all three
(98) other (specify) ____________
(99) unknown
RECOGNITION/DECISION
If not multi-vehicle crash,code not applicable to questions __ through __
94. Where was the other vehicle coming from in relation to you? ___ ___
(01) 180 degrees opposed (oncoming)
(02) from left front
(03) from left
(04) from left rear
(05) from right front
(06) from right
(07) from right rear
(08) from behind
(97) not applicable/no other vehicle
(98) other (specify) _______
(99) unknown
95. Was your line of sight to the other vehicle clear? ___ A.4.2.3
(1) yes, clear
(2) no, view obstructed by road curvature
(3) no, view obstructed by roadway grade
(4) no, view obstructed by roadside objects (shrubs, vehicles, buildings)
(5) other vehicle in blind spot of mirror
(7) not applicable, no other vehicle
(8) other (specify) ______
(9) unknown
96. Was your view of the other vehicle obscured? ___ ___
(01) no, not obscured
(02) yes, obscured by sun glare
(03) yes, obscured by headlight glare
(04) yes, obscured by other glare (specify) _____
(05) yes, obscured by darkness
(06) yes, obscured by nighttime and color of vehicle
(07) obscured by dust, smoke, smog, fog
(08) obscured by windscreen or eye wear condition (dirt, condensation, etc)
(97) not applicable
(98) yes, obscured by other (specify) _____
(99) unknown
IMPAIRMENT
97. Do you have any of the following permanent physical conditions?___ ___ A.5.1.1.39.1
(Code up to three; input "01" in remaining responses) ___ ___ A.5.1.1.39.2
(01) no ___ ___ A.5.1.1.39.3
(02) vision reduction or loss
(03) hearing reduction or loss
(04) respiratory, cardiovascular condition
(05) paraplegia
(06) amputee
(07) neurological, epilepsy, stroke
(08) endocrine system, diabetes, digestive system
(09) infirmity, arthritis, senility
(98) other (specify) ____________
(99) unknown
98. At the time of the crash, were you experiencing any of the following?
(Code up to three; input "01" in remaining responses) ___ ___ A.5.1.1.40.1
(01) no ___ ___ A.5.1.1.40.2
(02) fatigue ___ ___ A.5.1.1.40.3
(03) hunger
(04) thirst
(05) elimination urgency
(06) muscle spasm, cramp, itch
(07) headache, minor malaise, fever
(08) siesta syndrome (tired in afternoon)
(98) other (specify) _______________
(99) unknown
99. Were you concerned about any of the following issues on the day of the crash?
(Code up to three; input "01" in remaining responses) ___ ___ A.5.1.1.41.1
(01) no problems ___ ___ A.5.1.1.41.2
(02) conflict with friends, relatives, divorce, separation ___ ___ A.5.1.1.41.3
(03) work related problems
(04) financial distress
(05) school problems
(06) legal, police problems
(07) reward stress
(08) traffic conflict, road rage
(09) death of family, friend
(98) other (specify) ______________
(99) unknown
100. How many hours of sleep did you have in the past 24 hours? ____ ____
(00) no sleep
(01-24) number of hours slept
(98) other (specify) _______________
(99) unknown
101. Did you drink any alcohol or take any drugs or medications today? ___
(1) no A.5.1.1.32
(2) alcohol use, only
(3) drug/medication use, only
(4) combined alcohol and drug/medication use
(8) other, _________________________________
(9) unknown
Independently determine following questions
102. Alcohol/drug impairment? ___ A.5.1.1.33
(1) no impairment
(2) not legally impaired
(3) legally impaired
(8) other (specify) _________
(9) unknown
103. Blood alcohol concentration (BAC)? __ __ __ mg/100ml A.5.1.1.34
Code results
(000) negative BAC
(995) BAC tested, results not known
(996) BAC not tested
(998) other (specify) _______
(999) unknown
104. Source of BAC information? ___ ___ A.5.1.1.35
(01) not tested
(02) tested, results not available
(03) breath testing
(04) blood test
(05) urine test
(06) unknown if tested
(07) tested, results unknown
(98) other (specify) _________
(99) unknown source
105. Time span from crash to BAC collection? ___ ___ hours A.5.1.1.36
(or time of death in fatal cases)
(00) no test done
(01-96) actual hours
(98) other (specify) ______________
(99) unknown
106. Type of drugs other than alcohol? ___ A.5.1.1.37
(1) no drugs other than alcohol
(2) stimulant
(3) depressant
(4) drugs taken, type unknown
(5) multiple drugs taken
(7) not applicable, no drugs or alcohol
(8) other (specify)__________________
(9) unknown
107. Source of drugs other than alcohol? ___ A.5.1.1.38
(1) no drugs other than alcohol
(2) prescription
(3) non-prescription, over the counter
(4) illegal
(7) not applicable, no drugs or alcohol
(9) unknown
| File Type | application/msword |
| File Title | Case Number ____________ |
| Author | Louise Woodruff |
| File Modified | 2007-07-23 |
| File Created | 2007-07-23 |