University of Washington Consent Form

UNIVERSITY OF WASHINGTON

CONSENT FORM

Evaluating the safety benefits of an on-board monitoring system in commercial vehicle operations: independent evaluation and data analysis

Researchers:

Principal Investigator

Name

Linda Boyle

Title

Dr.

Position

Associate Professor

Department

Industrial and Systems Engineering

Mail box

Box 352650

Telephone

206 616 0245

Fax

206 685 3072

e-mail

[email protected]

Research staff

Name

Yiyun Peng

Title

Ms.

Position

Graduate student

Department

Industrial and Systems Engineering

Mail box

Box 352650

Telephone

206 616 0277

Toll Free

866 577 0848

e-mail

[email protected]

John D. Lee, Mahtab Ghazizadeh, Rebecca Olson, Kelly Stanley

*Please note we cannot guarantee the confidentiality of information sent via e-mail.

Researchers’ statement

We are asking you to be in a research study. The purpose of this consent form is to give you the information you will need to help you decide whether to be in the study or not. Please read the form carefully. You may ask questions about the purpose of the research, what we would ask you to do, the possible risks and benefits, your rights as a volunteer, and anything else about the research or this form that is not clear. When we have answered all your questions, you can decide if you want to be in the study or not. This process is called “informed consent.” We will give you a copy of this form for your records.

PURPOSE OF THE STUDY

The purpose of this study is to determine whether on-board monitoring system (OBMS) will reduce at-risk behavior among commercial drivers and improve driver safety performance. There is an OBMS installed in your vehicle as part of a study of naturalistic study lead by VTTI and Transecurity. You are randomly selected to be in the comparison group in the study, which means the OBMS passively records (through snippets of video and other performance/kinematic measures) unsafe driving behaviors. University of Washington (UW) is the independent evaluator of the system.

The role of the University of Washington (UW) is to evaluate the data collected by the OBMS, and to obtain drivers’ opinions through several questionnaires. Therefore, UW is asking for your permission to access the data from the OBMS in your truck (which can include videos of your face and audios from your cab) and to help us evaluate the effectiveness of the OBMS as part of a safety program. We are also asking for your voluntary permission to participate in questionnaires that assess your opinions of the OBMS.

STUDY PROCEDURES

As part of your company’s safety program, you will receive training in: (i) how the technology works, (ii) the benefits of using the technology, and (iii) what types of traffic events the technology captures.

If you decide to participate in the UW portion of the study we will ask you to do the following:

1. Read and sign this Informed Consent Form (if you agree to participate).

2. Complete one Pre-Study Questionnaire (20~25 minutes).

3. Complete four During- Study Questionnaires (15~20 minutes each).

4. Complete one End of Study Questionnaire (15~20 minutes).

5. Complete one in-person interview at the end of the study (20-30 minutes).

We will ask you to complete these six questionnaires over the course of 18 months. The questionnaire questions address your expectation, attitude, and perception of the OBMS, as well as demographic information. You can skip any question you do not want to answer.

The questionnaires will be administered on-line and you will receive a password to access the questionnaires. We can send you a paper version of the questionnaire at your choice. Please indicate your preferred method of receiving questionnaires at the end of this consent form. For administration purpose, we would also like to ask your contact information so we can send you the questionnaires. Your contact information will be kept confidential.

If you decide to participate, we will also access some of the OBMS data in your truck that is being collected. The data we will use are vehicle data, video data (including your face video), and audio data from approximately 30-second episodes of events during your regular drive. This data will be analyzed along with the questionnaire data for up to 500 drivers (up to 125 drivers in the comparison group).

RISKS, STRESS, OR DISCOMFORT

Some people feel that participating in research is an invasion of privacy. We have addressed issues related to confidentiality of your data in the Other Information section.

BENEFITS OF THE STUDY

You will not personally benefit from participation in this study. However, by participating, results of this study may help improve driving safety.

OTHER INFORMATION

Participation in this research study is voluntary. You are free to withdraw from participation in the study at any time. However, you will receive $10 for filling out each questionnaire (total $60 for all questionnaires) and $40 for participating in the interview at the end of the study. As required by UW policy, we will need to collect your Social Security number (SSN) for tax purpose. Your SSN will be kept confidential and will not be disclosed to anyone beyond the UW project team. We will destroy all your personal information, including contact information and SSN, once you have completed or withdrawal the study and received all the payment.

Non-participation or withdrawal from this study does not have any influence on your employment status. Please note that whether or not you choose to allow UW access to your data, your employer will still view videos obtained from the OBMS and conduct coaching sessions as part of the participation in safety program that your employer is involved in. Whether you allow UW to access your data will have no effect on what may happen if you violate your company’s safety policies or rules. Please notice that participating in UW’s study does NOT necessarily mean that you are also in the VTTI’s naturalistic study.

The data collected for this study will be kept confidential. Shortly after participating, your name will be separated from the data and replaced with a number. That is, your data will not be attached to your name, but rather to a number (e.g., Driver No.1). We will keep the data linked to your name until six months after the study is complete (Feb 2014).

Printed name of study staff obtaining consent Signature Date

Subject’s statement

This study has been explained to me. I volunteer to take part in this research. I have had a chance to ask questions. If I have questions later about the research, I can ask one of the researchers listed above. If I have questions about my rights as a research subject, I can call the Human Subjects Division at (206) 543-0098. I will receive a copy of this consent form.

I would prefer to receive the questionnaire announcements and reminders via (check only one):

□ E-mail □ Postal Mail

Contact Information:

E-mail address ________________________

Mailing address (required) ________________________

Phone number _______________ Best time to call_______________________

Social Security Number (required, for tax purpose only) _______________

Printed name of subject Signature of subject Date

UNIVERSITY OF WASHINGTON

CONSENT FORM

Evaluating the safety benefits of an on-board monitoring system in commercial vehicle operations: independent evaluation and data analysis

Researchers:

Principal Investigator

Name

Linda Boyle

Title

Dr.

Position

Associate Professor

Department

Industrial and Systems Engineering

Mail box

Box 352650

Telephone

206 616 0245

Fax

206 685 3072

e-mail

[email protected]

Research staff

Name

Yiyun Peng

Title

Ms.

Position

Graduate student

Department

Industrial and Systems Engineering

Mail box

Box 352650

Telephone

206 616 0277

Fax

N/A

e-mail

[email protected]

John D. Lee, Mahtab Ghazizadeh, Rebecca Olson, Kelly Stanley

*Please note we cannot guarantee the confidentiality of information sent via e-mail.

Researchers’ statement

We are asking you to be in a research study. The purpose of this consent form is to give you the information you will need to help you decide whether to be in the study or not. Please read the form carefully. You may ask questions about the purpose of the research, what we would ask you to do, the possible risks and benefits, your rights as a volunteer, and anything else about the research or this form that is not clear. When we have answered all your questions, you can decide if you want to be in the study or not. This process is called “informed consent.” We will give you a copy of this form for your records.

PURPOSE OF THE STUDY

The purpose of this study is to determine whether on-board monitoring system (OBMS) will reduce at-risk behavior among commercial drivers and improve driver safety performance. There is an OBMS installed in your vehicle as part of a study of naturalistic study lead by VTTI and Transecurity. The OBMS records (through snippets of video and other performance/kinematic measures) unsafe driving behaviors and provide real-time feedback to you. More specifically, the project will determine if recording and reporting of safety critical events, followed by coaching drivers (by safety supervisors) using these safety events as feedback, will enhance safe driving behavior. University of Washington (UW) is the independent evaluator of the system.

The role of the University of Washington (UW) is to evaluate the data collected by the OBMS, and to obtain drivers’ opinions through several questionnaires. Therefore, UW is asking for your permission to access the data from the OBMS in your truck (which can include videos of your face and audios from your cab) and to help us evaluate the effectiveness of the OBMS as part of a safety program. We are also asking for your voluntary permission to participate in questionnaires that assess your opinions of the OBMS.

STUDY PROCEDURES

As part of your company’s safety program, you will receive training in: (i) how the technology works, (ii) the benefits of using the technology, and (iii) what types of traffic events the technology captures.

If you decide to participate in the UW portion of the study we will ask you to do the following:

1. Read and sign this Informed Consent Form (if you agree to participate).

2. Complete one Pre-Study Questionnaire (20~25 minutes).

3. Complete four During- Study Questionnaires (15~20 minutes each).

4. Complete one End of Study Questionnaire (15~20 minutes).

5. Complete one in-person interview at the end of the study (20-30 minutes)

We will ask you to complete these six questionnaires over the course of 18 months. The questionnaire questions address your expectation, attitude, and perception of the OBMS, as well as demographic information. You can skip any question you do not want to answer.

The questionnaires will be administered on-line and you will receive a password to access the questionnaires. We can send you a paper version of the questionnaire at your choice. Please indicate your preferred method of receiving questionnaires at the end of this consent form. For administration purpose, we would also like to ask your contact information so we can send you the questionnaires. Your contact information will be kept confidential.

If you decide to participate, we will also access some of the OBMS data in your truck that is being collected. The data we will use are vehicle data, video data (including your face video), and audio data from approximately 30-second episodes of events during your regular drive. This data will be analyzed along with the questionnaire data for up to 500 drivers.

RISKS, STRESS, OR DISCOMFORT

Some people feel that participating in research is an invasion of privacy. We have addressed issues related to confidentiality of your data in the Other Information section.

BENEFITS OF THE STUDY

You will not personally benefit from participation in this study. However, by participating, results of this study may help improve driving safety.

OTHER INFORMATION

Participation in this research study is voluntary. You are free to withdraw from participation in the study at any time. However, you will receive $10 for filling out each questionnaire (total $60 for all questionnaires) and $40 for participating in the interview at the end of the study. As required by UW policy, we will need to collect your Social Security number (SSN) for tax purpose. Your SSN will be kept confidential and will not be disclosed to anyone beyond the UW project team. We will destroy all your personal information, including contact information and SSN, once you have completed or withdrawal the study and received all the payment.

Non-participation or withdrawal from this study does not have any influence on your employment status. Please note that whether or not you choose to allow UW access to your data, your employer will still view videos obtained from the OBMS and conduct coaching sessions as part of the participation in safety program that your employer is involved in. Whether you allow UW to access your data will have no effect on what may happen if you violate your company’s safety policies or rules. Please notice that participating in UW’s study does NOT necessarily mean that you are also in the VTTI’s naturalistic study.

The data collected for this study will be kept confidential. Shortly after participating, your name will be separated from the data and replaced with a number. That is, your data will not be attached to your name, but rather to a number (e.g., Driver No.1). We will keep the data linked to your name until six months after the study is complete (Feb 2014).

Printed name of study staff obtaining consent Signature Date

Subject’s statement

This study has been explained to me. I volunteer to take part in this research. I have had a chance to ask questions. If I have questions later about the research, I can ask one of the researchers listed above. If I have questions about my rights as a research subject, I can call the Human Subjects Division at (206) 543-0098. I will receive a copy of this consent form.

I would prefer to receive the questionnaire announcements and reminders via (check only one):

□ E-mail □ Postal Mail

Contact Information:

E-mail address ________________________

Mailing address (required) ________________________

Phone number _______________ Best time to call_______________________

Social Security Number (required, for tax purpose only) _______________

Printed name of subject Signature of subject Date

Comparison Group (Group 1) Driver ICF 10/22/2010 3