NHTSA 1110 ATT C6 NCRUSS Inspection-Restraints

ATTACHMENT C6

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A federal agency may not conduct or sponsor, and a person is not required to respond to, nor shall a person be subject to a penalty for failure to comply with a collection of information subject to the requirements of the Paperwork Reduction Act unless that collection of information displays a current valid OMB Control Number. The OMB Control Number for this information collection is 2127-0642. Public reporting for this collection of information is estimated to be approximately 15 minutes per response, including the time for reviewing instructions, completing and reviewing the collection of information. All responses to this collection of information are voluntary. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to: Information Collection Clearance Officer, National Highway Traffic Safety Administration, 1200 New Jersey Ave, S.E., Washington, DC, 20590. NHTSA Form 1 110

United States Department of Transportation National Highway Traffic Safety Administration		Inspection Form Restraints (03/10/11 Draft)		Form Approved O.M.B. No. 2127-0642 Expiration Date: xxxx National Automotive Sampling System National Child Restraint Use – Special Study
Primary Sampling Unit Number: _____ _____			Site Number: _____ _____
Observation Number: _______/_______			Date of Observation: _______/_______/2011
Specific Seating Position – Randomly select one child <9 to observe
Seating position observed? (circle) __ 12 13 21 22 23 31 32 33 Other ____________	Front Seating Positions Only (i.e., 12, 13)
	Right frontal airbag?				1 O Yes 2 O No (Skip to Q8 )
	Air bag switch?				1 O On 2 O Off 3 O Not available
Location of child (or CRS, if used)	1 O Vehicle seat 2 O Floor 3 O Lap of occupant 4 O Other
Restraint type used?	1 O CRS/device 2 O Seat belt only (Skip to Q12) 3 O None (Skip to vehicle form)
CRS type/mode used?	1 O Infant seat with base 6 O Backless BP booster 2 O Infant seat with no base 7 O Shield booster 3 O RF convertible/all-in-one 8 O Car bed 4 O FF with harness/shield 9 O Vest 5 O Highback BP booster (no harness) 10 O Other device
Does the CRS have a harness?	1 O Yes (Skip to Q22) 2 O No (complete the following section)
Booster Seats or Adult Seat Belts – While Child Restrained
Booster: Is the seat belt routed through the belt-positioning guides/channels?	1 O Yes 2 O No 3 O NA/No booster 4 O Unknown
Is the seat belt buckled?	1 O Yes 2 O No 3 O Unknown
Is the child's head supported?	1 O Yes, CRS supports head 3 O No, head is above vehicle seat back 2 O Yes, vehicle supports head 4 O Unknown
Is the child sitting against seat back?	1 O Yes, against CRS 3 O No, child leaning forward/slouching 2 O Yes, against vehicle seat back 4 O Unknown
Is the shoulder belt loose/slack?	1 O Yes 2 O No 3 O NA/no shoulder belt 4 O Unknown
Shoulder belt position	1 O Over body--centered on shoulder 5 O Behind arm or back 2 O Over body--touching shoulder 6 O NA/no shoulder belt 3 O Over body--below shoulder/around arm 7 O Unknown 4 O Over body--above shoulder at neck/face
Adjustable D-ring on shoulder belt?	1 O Yes 2 O No 3 O NA/no shoulder belt 4 O Unknown
Is the lap belt loose/slack?	1 O Yes 2 O No 3 O NA/no shoulder belt 4 O Unknown
Lap belt position	1 O Across hips/thighs 3 O NA/lap belt not used 2 O Across abdomen/ribcage 4 O Unknown
Booster: Does the booster have a lower anchor connector?	1 O Yes (Skip to Q61) 3 O NA/no booster (Skip to Q68) 2 O No (Skip to Q68) 4 O Unknown (Skip to Q68)
All RF and FF harnessed CRSs – Harness Type and Use – While Child Restrained
Harness/shield type on CRS	1 O 3-point/V type 3 O T-shield 2 O 5-point 4 O Tray-shield
Is the harness or shield in use?	1 O Yes 2 O No 3 O Unknown
Is the harness strap buckled?	1 O Yes 2 O No, 1 or more unbuckled 3 O Unknown
Retainer/chest clip available?	1 O Yes 2 O No (Skip to Q27)
Is the harness retainer/chest clip used?	1 O Used, chest/armpit 4 O Not used 2 O Used, abdomen 5 O Unknown 3 O Used, neck level
Position of the harness straps	1 O Both straps over shoulders/body 3 O Unknown 2 O 1 or more straps behind arm/back/leg
Snugness of harness straps	1 Amount of slack when pinched ______ cm (Enter 0 if no slack)
Twisted harness strap(s)	1 O Yes 2 O No
Type of harness slots?	1 O Sliding adjustment – no slots 4 O Slots – lowest used 2 O Slots – uppermost used 5 O Slots – different levels used 3 O Slots – middle used
Where is the harness opening in relation to the child's left shoulder?	1 O At the left shoulder 3 O Below the left shoulder: ______cm 2 O Above the left shoulder: ______ cm 4 O Unknown
… right shoulder?	1 O At the right shoulder 3 O Below the right shoulder: _____ cm 2 O Above the right shoulder: _____ cm 4 O Unknown
Where is the top of the child's head in relation to the top of the CRS?	1 O At the top 3 O Below the top: ________ cm 2 O Above the top: _______ cm 4 O Unknown
Top of the ears above the shell of the CRS?	1 O Yes 2 O No 3 O Unknown

All RF and FF harnessed seats – Installation

Direction of CRS	1 O Rear-facing 4 O Side-facing 2 O Forward-facing 5 O Other 3 O Supine (facing up)
Does CRS base footprint hang over the vehicle seat?	1 O Yes (Take measurements) 2 O No Length of CRS base (front to back) _________ cm Length of CRS base that is off the vehicle seat _________ cm
What is the lower attachment of the CRS to the vehicle?	1 O Lower anchor strap(s) 4 O Other method of attachment 2 O Seat belt for this seating position 5 O Integrated 3 O Both LA and SB for this seating pos 6 O Not attached
How much does CRS move laterally when pushed or pulled at the belt path?	1 Amount of movement at base _______ cm (Note: do not move CRS more than 8 cm)
FF only: Is the CRS against the vehicle seat back? (All that apply)	1 Yes, most of CRS contacts vehicle seat 2 No, seat back contour 3 No, head restraint interference 4 NA/RF seat 5 No, other __________________
RF only: Is the back of the CRS touching the front seat?	1 O Yes 2 O No 3 O NA/FF seat
Amount of recline in child seat?	1 O upright – not reclined 4 O approx 45 degrees 2 O up to 30 degrees 5 O more than 45 degrees 3 O between 30-45
Method used to adjust angle?	1 None or not reclined 2 Rolled towel(s) 3 CR’s angle adjustor 4 Noodle(s) 5 Other method (not part of CRS) _________________
All RF and FF harnessed seats – CRS hardware and tether use
Lower attachment type available on the CRS	1 O Flexible strap 3 O Unknown 2 O Rigid 4 O None (Skip to Q46)
Lower connector type	1 O Hook-on 3 O Unknown 2 O Push-on 4 O None
Lower connector adjustment	1 O Latchplate 3 O Automatic (e.g., SureLATCH) 2 O Button-release 4 O Unknown
Top tether adjustment	1 O Latchplate 2 O Button-release 3 O Unknown
Top tether in use?	1 O Yes 2 O No (Skip to Q52)
Top tether tightness	1 Amount of slack in tether when pinched ___________ cm (Enter 0 if none)
What is the tether attached to?	1 O Tether anchor for this seating position 2 O Tether anchor for another SP 3 O Secure location in front (Swedish) 4 O Locked seat belt in back 5 O Not attached to anything 6 O Other attachment _______________
How is the top tether strap routed?	1 O Over integral/no head restraint 4 O Under adjustable head restraint 2 O Over raised adjustable head restraint 5 O Around headrest 3 O Over down adjustable head restraint 6 O Other routing ______________
Top tether strap twisted?	1 O Yes 2 O No
All Seat Belt Installed CRSs
Seat belt used to install?	1 O Yes (Complete this section) 2 O No (Skip to Q61)
Seat belt routing	1 O Forward-facing slots/channels 3 O Other unconventional routing 2 O Rear-facing slots/channels 4 O Unknown
Is the seat belt twisted?	1 O Yes 2 O No 3 O Unknown
Is the seat belt buckled?	1 O Yes 2 O No 3 O Unknown
Latch plate type on seat belt	1 O Sliding 4 O Locking or lightweight locking 2 O Switchable-locked 5 O Sewn-on 3 O Switchable-not locked 6 O Unknown
Use of locking clip	1 O None present 4 O Used only on lap 2 O Used on lap/shoulder, within 1 in 5 O Used only on shoulder 3 O Used on lap/shoulder, > 1 in 6 O Other use _______________
Seat belt retractor	1 O Locked (ALR mode) 2 O Not locked (ELR mode) 3 O Unknown
CRS lockoff available?	1 O Yes 2 O No (Skip to Q61) 3 O Unknown (Skip to Q61)
CRS lockoff in use?	1 O Yes 2 O No 3 O Unknown
All LATCH Installed CRSs
Lower anchor(s) used to install?	1 O Yes (Complete this section) 2 O No (Skip to 68)
LATCH strap routing	1 O Forward-facing slots/channels 4 O Unknown 2 O Rear-facing slots/channels 5 O NA – rigid with no strap 3 O Other unconventional routing
Is the LATCH strap twisted?	1 O Yes 3 O Unknown 2 O No 4 O NA – rigid with no strap
Left connector attached to?	1 O Left lower anchor for SP 3 O Something other than LA 2 O Other lower anchor 4 O Not attached to anything
Right connector attached to?	1 O Right lower anchor for SP 3 O Something other than LA 2 O Other lower anchor 4 O Not attached to anything
Are the connectors attached with the correct side up?	1 O Yes, correct side up 3 O No, not attached 2 O No, one or more upside-down 4 O Unknown
Are there multiple CRS attached to the lower anchors?	1 O Yes 2 O No 3 O Unknown
All RF seat, FF seat, or booster - CRS Labels and Other Issues
Is the child sitting in any type of CRS (harnessed or booster)?	1 O Yes (Complete this section) 2 O No (Skip to vehicle form)
Does the CRS have a label?	1 O Yes, visible (Complete this section) 2 O Yes, but not visible (Skip to Q77) 3 O No (Skip to Q77)
CRS Make or Manufacturer	1 __________________ 2 Not able to observe or missing
CRS Model	1 __________________ 2 Not able to observe or missing
CRS Model #	1 __________________ 2 Not able to observe or missing
Rear-facing limits	1 Lower height: _________ inches 3 Lower weight: _________ pounds 2 Upper height: _________ inches 4 Upper weight: _________ pounds
Forward-facing limits	1 Lower height: _________ inches 3 Lower weight: _________ pounds 2 Upper height: _________ inches 4 Upper weight: _________ pounds
Highback booster limits	1 Lower height: _________ inches 3 Lower weight: _________ pounds 2 Upper height: _________ inches 4 Upper weight: _________ pounds
Backless booster limits	1 Lower height: _________ inches 3 Lower weight: _________ pounds 2 Upper height: _________ inches 4 Upper weight: _________ pounds
Is there visible damage to the restraint? (All that apply)	1 Cracked/broken shell 2 Torn padding 3 Broken/frayed harness 4 No visible damage 5 Other visible damage _____________________________
Are there any aftermarket products used with the CRS? (All that apply)	1 Belt tightener/Mighty Tite 4 Aftermarket seat cover 2 Padding between child and CRS 5 Toys/items attached to CRS 3 Padding between CRS and vehicle seat 6 No aftermarket device (other than noodles/rolled towels) 7 Other aftermarket device _______