Form NHTSA Form 1117 NHTSA Form 1117 Debriefing Session Guidelines

OMB Control No. 2127-XXXX

Expiration Date XX, XX, XXXX

Speed Warning System

Contract No. DTNH22-09-R-00256, Westat Project No. 8427.03

Data Collection

Debriefing Form

Date: ______________________ Subject Number:_______________

Thank you for participating in this study. While we are removing the speed monitoring/warning device from your vehicle, I am going to ask you a few questions about your vehicle and your experiences driving with this system in your vehicle. This should only take a few minutes and you are free to refuse to answer any question.

Paperwork Reduction Act Burden Statement

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-XXXX. Public reporting for this collection of information is estimated to be approximately XX 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

Let’s begin.

(Read Aloud)

1. How would you rate your overall experience with the speed monitoring/warning device?

1. Very positive

2. Positive

3. Neither positive nor negative

4. Negative

5. Very negative

2. Do you believe the device was accurate, that is, only alerting you when you were traveling over the posted speed limit?

a. Yes b. No

Please Explain:

____________________________________________________________________________________________________________________________________________________________________

3. Did you experience any problems with the device?

a. Yes b. No

Please Explain:

_____________________________________________________________________________________________________________________________________________________________

4. Whenever the alert sounded, did you adjust your speed?

a. Yes b. No

Please Explain:

____________________________________________________________________________________________________________________________________________________________________

5. Did you find yourself tracking your driving speed more often during the study period when the device was active?

a. Yes b. No

Please Explain:

____________________________________________________________________________________________________________________________________________________________________

6. If you notice that you were traveling over the posted speed limit before the alert, did you lower your traveling speed?

a. Yes b. No

Please Explain:

____________________________________________________________________________________________________________________________________________________________________

7. Were there any negative effects of having the speed monitoring/warning device in your vehicle?

a. Yes b. No

Please Explain: _______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

8. Did you receive any speeding violations or warnings during the time when the speed monitoring/warning device was installed in your vehicle?

a. Yes b. No (Skip to Question 8)

8a. How many? (Read Aloud)

1. One

2. Two

3. Three

4. More than three

9. As a result of having the device in your vehicle, would you say that your driving speed has

1. Decreased

2. Stayed the same

3. Increased

4. Other____________________________________

10. Did anyone else drive the vehicle when the system sounded an alert during the course of this study?

a. Yes b. No

11. What was their overall opinion of the speed monitoring/warning device?

1. Very positive

2. Positive

3. Neither positive nor negative

4. Negative

5. Very negative

12. Did you have passengers in the vehicle when the system sounded an alert during the course of this study?

a. Yes b. No

13. What was their overall opinion of the speed monitoring/warning device?

1. Very positive

2. Positive

3. Neither positive nor negative

4. Negative

5. Very negative

14. Were you self conscious about having passengers in the vehicle while the device was installed?

a. Yes b. No (If Yes, please explain)

Please Explain

_____________________________________________________________________________________

__________________________________________________________________________________________________________________________________________________________________________

15. In your opinion, was the incentive provided for your participation in the study adequate?

a. Yes b. No

Please Explain: _______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

16. What is the likelihood that you would use a speed monitoring/warning device now that the study is over?

1. Very likely

2. Likely

3. Neither positive nor negative

4. Unlikely

5. Very unlikely

Please Explain: _______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

17. Based on your experiences during this study, would you be willing to participate in a larger scale speeding prevention program?

a. Yes b. No

Please Explain: _______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

18. Is there anything else you would like to say about the study or the device? Changes to the device or the study design?

19. Did you ever try to tamper with the device or disengage the system?

a. Yes b. No

Please Explain

_____________________________________________________________________________________

__________________________________________________________________________________________________________________________________________________________________________

20. I need to record your current mileage

________________________________________

NHTSA Form 1117 Page 9