This collection of information is voluntary, and will be used to better understand the causes of motorcycle crashes. Public reporting burden is estimated to average 25 minutes per response, including the time for reviewing instructions searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Please note that an agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. The OMB control number for this collection is 2125-0619. This collection expires on 11/31/2013. 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, Federal Highway Administration, 1200 New Jersey Avenue, SE, Washington, DC 20590.
CONTROL
MOTORCYCLE PASSENGER QUESTIONNAIRE
1. Control Case Number ____________ 2. Control Passenger Number____
BACKGROUND INFORMATION
3. How old are you? ___ ___
Code actual age in years
(99) unknown
4. Where did you get your current driver's license? _____
(1) no license
(2) California
(3) other State (list) ________
(4) Canada
(5) Mexico
(6) military
(7) not applicable
(8) other (describe) ____________
(9) unknown
5. What kind of operator's license is it? ___ ___
(Code up to 4; input "00" in remaining responses) ___ ___
(01) no license held ___ ___
(02) learner's permit, only ___ ___
(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, have no license
(98) other (describe) ___________
(99) unknown
6. What year was/were the license(s) issued? ___ ___ ___ ___
(Listed in same order as licenses above ___ ___ ___ ___
(7777) not applicable ___ ___ ___ ___
(9999) unknown ___ ___ ___ ___
7. Are you of Hispanic or Latino origin? ____
(0) refused to answer
(1) no
(2) yes
(8) other (describe) __________
(9) unknown
8. 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
(9) unknown
9. What is your height? ___ft. ___ ___ in.
(9/99) unknown
10. What is your weight? ___ ___ ___lbs.
(999) unknown
11. Gender ___
(1) male
(2) female
(9) unknown
12. How much formal education have you had? ___ ___
(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
13. What is your current occupation? ___ ___
(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
RIDING/DRIVING EXPERIENCE
14. How many YEARS have you been driving any kind of motor vehicle? ___ ___
(00) less than two weeks
(01) one year or less
(02-96) actual number of years
(97) not applicable/no previous experience/first time
(99) unknown
15. How many MONTHS have you operated a street motorcycle? ___ ___ ___
(000) never
(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
16. What is the average number of days per year you ride as a passenger
on motorcycles? ___ ___ ___
(000) this is the first time
(001-365) Actual number of days per year
(997) not applicable, never or first time
(999) unknown
17. About how many miles per year do you ride as a passenger on
motorcycles? ___ ___ ___ ___ ___
00000 – this is the first time
00001-99995 - actual miles
99996 – 99996 or greater miles
99998- other (specify) ____
99999- unknown
18. What kind of motorcycle training have you had? ___
(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
19. When you ride a motorcycle as a passenger, what is the percentage of time you use it for each of these categories? (indicate % of total riding/driving time for each category)
Recreation ___ ___ ___ %
Basic transportation ___ ___ ___ %
100%
(000) first time use
(999) unknown
20. How much experience would you say you have riding as a passenger on motorcycles? ___
(0) first time
(1) very little experience
(2) moderate experience
(3) extensive experience
(8) other, specify: ___________________________
(9) unknown
21. How many moving traffic violations have you had in the previous 5 years?
Code the total number of moving traffic convictions – any vehicle ___ ___
(00) none
(99) unknown
22. Of those how many were motorcycle moving violations crashes? ___ ___
Code the total number of previous motorcycle moving violation crashes
(00) none
(99) unknown
23. Of those how many were car or truck moving violation crashes? ___ ___
Code the total number of previous car or truck moving violation crashes
(00) none
(99) unknown
PROTECTIVE CLOTHING/GEAR WHEN RIDING
24. What kind of clothing do you usually wear on your upper body? ___
(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
25. Is this upper body clothing motorcycle-oriented? ___
(1) no
(2) yes
(7) not applicable/no clothing
(8) other (specify) ________
(9) unknown
26. What kind of clothing do you usually wear on your lower body? ___
(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
27. Is this lower body clothing motorcycle-oriented? ___
(1) no
(2) yes
(7) not applicable/no clothing
(8) other (specify) ________
(9) unknown
28. Do you usually wearing an inflatable safety vest? ____
(1) no
(2) yes
(8) other (specify) ___
(9) unknown
29. What kind of shoes or boots do you usually wear? ___
(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
30. Does this footwear go up over your ankle? ___
(1) no
(2) yes
(7) not applicable, no footwear worn
(8) other, specify __________________
(9) unknown
31. Is the footwear motorcycle-oriented? ___
(1) no
(2) yes
(7) not applicable, no footwear worn
(9) unknown
32. What kind of gloves do you usually wear? ___
(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
33. Are the gloves motorcycle-oriented? ___
(1) no
(2) yes, full fingered
(3) yes-shorties
(7) not applicable, no gloves worn
(8) other (specify) ______
(9) unknown
34. 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
35. What is the clothing color of the following?
Upper body clothing ___ ___
Lower body clothing ___ ___
Footwear ___ ___
Gloves ___ ___
(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
36. What kind of eye protection do you usually wear? ___ ___
(01) none
(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
37. Are you required to wear corrective lenses when riding/driving? ___
(1) no
(2) yes
(8) other specify____________________
(9) unknown
38. What color is the eye coverage lens? ___
(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
39. Do you usually wear a helmet? ___
(1) no
(2) yes
(3) helmet available but not used
(8) other (specify) ______
(9) unknown
40. What is your reason for not wearing a helmet? ___ ___
(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 IMPAIRMENT SECTION.
41. Is your helmet properly adjusted? ___
(1) no
(2) yes
(7) not applicable, no helmet
(8) other (specify) ______
(9) unknown
42. Is your helmet securely fastened? ___
(1) no
(2) yes
(7) not applicable, no helmet
(8) other (specify) ______
(9) unknown
43. What type of helmet is it? ___
(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
44. What is the type of helmet coverage? ___ ___
(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
45. What is the predominant color of your helmet? ___ ___
(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
46. What is the color of the face shield? ___
(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
47. Do you own this helmet? ___
(1) no
(2) yes
(7) not applicable, no helmet
(8) other (specify) ______
(9) unknown
48. How well does this helmet fit? ___
(1) acceptable fit
(2) too large, too loose
(3) too small, too tight
(7) not applicable/no helmet
(8) other (specify) ____________________
(9) unknown
49. What percentage of time do you wear your helmet (when riding)? ___ ___ ___ %
(001-100) Code actual percentage
(997) not applicable/no helmet
(999) unknown
50. Under what conditions do you usually wear your helmet? ___
(code up to four; input "0" for remaining responses) ___
(1) never uses helmet ___
(2) long trips ___
(3) highway traffic
(4) in adverse weather
(5) never in hot weather
(6) always
(7) not applicable/no helmet
(8) other (specify) __________
(9) unknown
IMPAIRMENT
51. Do you have any of the following permanent physical conditions?
(indicate all that apply; input "01" in remaining responses) ___ ___
(Code up to three; input "01" in remaining responses) ___ ___
(01) no ___ ___
(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
52. Are you concerned about any of the following issues today?
(indicate all that apply; input "01" in remaining responses) ___ ___
(01) no problems ___ ___
(02) conflict with friends, relatives, divorce, separation ___ ___
(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
53. 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
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| File Title | Motorcycle Passenger Control Group Questionnaire |
| File Modified | 0000-00-00 |
| File Created | 2021-01-26 |