NHTSA Form 1326 Post-Install Questionnaire

OMB Control No. 2127-XXXX

Expiration Date XX/XX/XXXX

Appendix G

Post Installation Questionnaire Form

This collection of information is voluntary and will be used to assist in the development of programs designed to reduce misuse of child restraint systems and subsequently reduce the number of traffic-related injuries and deaths. 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 8 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

Child Safety Seat Study: Post-Install Questionnaire

(Interviewer-administered)

Participant ID: ______ Trial # ______ Vehicle # ______ CRS # Used ______

Section 1:

[Read to participant] I will be reading you a series of statements. I want you to think back to your experience with the most recent installation you completed today, and respond to each statement accordingly. I will provide you with a range of responses, please select the one that best reflects your thoughts.

For these statements your response options are: Strongly Disagree, Somewhat Disagree, Neutral, Somewhat Agree, and Strongly Agree.

[Participant observed using a CRS, ask Questions 1 and 2. If not, observed using a CRS skip to Question 3.]

1. I attached the child seat to the vehicle correctly. Do you…. [Please read all answer responses to the participant and circle the number that reflects their response.]

1	2	3	4	5
Strongly Disagree	Somewhat Disagree	Neutral	Somewhat Agree	Strongly Agree

2. I secured the doll in the seat properly. Do you …. [Please read all answer responses to the participant and circle the number that reflects their response.]

1	2	3	4	5
Strongly Disagree	Somewhat Disagree	Neutral	Somewhat Agree	Strongly Agree

3. I chose an appropriate restraint for the doll’s height, weight, and age. Do you…. [Please read all answer responses to the participant and circle the number that reflects their response.]

1	2	3	4	5
Strongly Disagree	Somewhat Disagree	Neutral	Somewhat Agree	Strongly Agree

[Participant observed using the child safety seat manual, ask Question 4. If not, skip to Question 5.]

4. The labels on the child seat conflicted with the instructions in child seat manual. Do you… [Please read all answer responses to the participant]

1	2	3	4	5
Strongly Disagree	Somewhat Disagree	Neutral	Somewhat Agree	Strongly Agree

[Participant observed using the vehicle owner’s manual, ask Question 5. If not, skip to Section 2.]

5. The vehicle manual provided enough information with respect to installing the child seat. Do you…[Please read all answer responses to the participant]

1	2	3	4	5
Strongly Disagree	Somewhat Disagree	Neutral	Somewhat Agree	Strongly Agree

[Participant observed using the vehicle owner’s manual & the Child seat manuel, ask Question 6. If not, skip to Section 2.]

6. The information in the vehicle manual conflicted with the child seat manual. Do you…[Please read all answer responses to the participant]

   1	2	3	4	5
   Strongly Disagree	Somewhat Disagree	Neutral	Somewhat Agree	Strongly Agree

Section 2:

[Read to participant] Again, I will be reading you a series of statements or questions. I want you to think back to your experience with the most recent installation you completed today, and respond to each statement accordingly. I will provide you with a series of responses, please select the one that best reflects you thoughts.

For these statements your response options are: Very Hard, Somewhat Hard, Neutral, Somewhat Easy, and Very Easy.

Ease of Use: CRS Manual, Labels, and Vehicle Manual

1. How hard or easy was it to understand labels on child seat? Was it…[Please read all answer responses to the participant]

1	2	3	4	5	6
Very Hard	Somewhat Hard	Neutral	Somewhat Easy	Very Easy	Not Applicable

[Participant observed using the child safety seat manual, ask Questions 2 and 3. If not, observed using the manual skip to Question 4.]

2. How hard or easy was it to understand the product manual instructions for installing child seat? Was it… [Please read all answer responses to the participant]

1	2	3	4	5	6
Very Hard	Somewhat Hard	Neutral	Somewhat Easy	Very Easy	Not Applicable

3. How hard or easy was it to understand the product manual instructions for securing child? Was it… [Please read all answer responses to the participant]

1	2	3	4	5	6
Very Hard	Somewhat Hard	Neutral	Somewhat Easy	Very Easy	Not Applicable

[Participant observed using the vehicle owner’s manual, ask Question 4. If not, skip to Question 5]

1. How hard or easy was it to understand the vehicle manual instructions for installing child seat? Was it [Please read all answer responses to the participant]

1	2	3	4	5	6
Very Hard	Somewhat Hard	Neutral	Somewhat Easy	Very Easy	Not Applicable

Installations using a CRS with a harness

[Participant observed installing a CRS with a harness system, ask Questions 5- 10. If not, skip to Question 11.]

1. Participant observed adjusting the shoulder harness, ask this question. If not, mark Not Applicable and skip to Question 6. How hard or easy was it to move shoulder harness between slots (make adjustments)? Was it…. [Please read all answer responses to the participant]

1	2	3	4	5	6
Very Hard	Somewhat Hard	Neutral	Somewhat Easy	Very Easy	Not Applicable

Participant was observed adjusting the crotch strap ask this question. If not, mark Not Applicable and skip to Question 7.

5. How hard or easy was it to adjust the crotch strap? Was it… [Please read all answer responses to the participant]

1	2	3	4	5	6
Very Hard	Somewhat Hard	Neutral	Somewhat Easy	Very Easy	Not Applicable

5. How hard or easy was it to tighten the harness around the doll? Was it… [Please read all answer responses to the participant]

1	2	3	4	5	6
Very Hard	Somewhat Hard	Neutral	Somewhat Easy	Very Easy	Not Applicable

5. How hard or easy was it to buckle the harness straps? Was it… [Please read all answer responses to the participant]

1	2	3	4	5	6
Very Hard	Somewhat Hard	Neutral	Somewhat Easy	Very Easy	Not Applicable

5. How hard or easy was it to adjust the harness clip height? Was it… [Please read all answer responses to the participant]

1	2	3	4	5	6
Very Hard	Somewhat Hard	Neutral	Somewhat Easy	Very Easy	Not Applicable

5. How hard or easy was it to fasten the two parts of the harness clip together? Was it… [Please read all answer responses to the participant]

1	2	3	4	5	6
Very Hard	Somewhat Hard	Neutral	Somewhat Easy	Very Easy	Not Applicable

Installations using the vehicle seat belt to secure the CRS:

[For installs where the vehicle’s seat belt was used, ask questions 11 and 12. Otherwise, skip to Question 13]

5. How hard or easy was it to figure out where to route the seat belt? Was it…. [Please read all answer responses to the participant]

1	2	3	4	5	6
Very Hard	Somewhat Hard	Neutral	Somewhat Easy	Very Easy	Not Applicable

5. How hard or easy was it to tighten the seat belt? Was it…. [Please read all answer responses to the participant]

1	2	3	4	5	6
Very Hard	Somewhat Hard	Neutral	Somewhat Easy	Very Easy	Not Applicable

Installations using the lower anchors (LATCH system):

[If the participant chose to install the CRS using lower anchors, ask question 15. Otherwise skip to Question 16].

5. How hard or easy was it to find the lower anchors? Was it… [Please read all answer responses to the participant]

1	2	3	4	5	6
Very Hard	Somewhat Hard	Neutral	Somewhat Easy	Very Easy	Not Applicable

Installations using the top tether:

[If the participant chose to install the CRS using the tether anchor, ask questions 16 and 17. Otherwise, skip to question 18]

5. How hard or easy was it to find the tether anchor? Was it….[Please read all answer responses to the participant]

1	2	3	4	5	6
Very Hard	Somewhat Hard	Neutral	Somewhat Easy	Very Easy	Not Applicable

5. How hard or easy was it to attach and adjust the tether strap? Was it…. [Please read all answer responses to the participant]

1	2	3	4	5	6
Very Hard	Somewhat Hard	Neutral	Somewhat Easy	Very Easy	Not Applicable

Installations of the CRS in the rear facing position:

[For rear facing seat installs only, ask questions 13 and 14, otherwise skip to Question 15]

5. How hard or easy was it to adjust the angle of the child seat? Was it… [Please read all answer responses to the participant]

1	2	3	4	5	6
Very Hard	Somewhat Hard	Neutral	Somewhat Easy	Very Easy	Not Applicable

5. How hard or easy was it to determine what angle the child seat should be? Was it…. [Please read all answer responses to the participant]

1	2	3	4	5	6
Very Hard	Somewhat Hard	Neutral	Somewhat Easy	Very Easy	Not Applicable

Installations using a booster seat:

[If the participant chose to use a booster seat, ask questions 18 and 19. Otherwise, end the questionnaire]

5. How hard or easy was it to install the booster seat? Was it… [Please read all answer responses to the participant]

1	2	3	4	5	6
Very Hard	Somewhat Hard	Neutral	Somewhat Easy	Very Easy	Not Applicable

5. How hard or easy was it to secure the doll in the booster seat? [Please read all answer responses to the participant]

1	2	3	4	5	6
Very Hard	Somewhat Hard	Neutral	Somewhat Easy	Very Easy	Not Applicable

10

NHTSA Form 1326