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Questionnaire # ________ (1-4)
Q.1 Enter the task number.
[REQUIRE ANSWER]
__________________________
(5-17)
Q.2 Instructions for the interviewer:
(1) Do not read the "Don't know" or the "Refused" options. Only mark these based on the
respondent's answer.
(2) Be ready to reassure confidentiality when asked/necessary.
(3) Instructions for the interviewer are in bold throughout the survey.
Age of injured person:
Less than 12 years old, interview a parent or guardian
Between 12 and 17 years old, ask a parent or guardian for permission to interview the injured
person. If permission not obtained, then interview the parent or guardian
More than 17 years old, interview the injured person
Q.3 Contact questions
Hello. May I speak with ______________? (OR: Hello. May I speak with the parent or guardian of
_______?)
Hello. I am calling for the U.S. Consumer Product Safety Commission. We are currently conducting a
study on off-road vehicles. I understand that you were/your child was treated at _________ (Insert
hospital name) on ________ (Insert treatment date).
May I ask some questions about the incident?
(OR if the respondent is between 12 and 17: May I ask _____ some questions about the
incident?
If "yes", then continue. If "no", then ask May I ask you some questions about the incident? )
Be prepared to answer/assure:
(1) Identity will be kept confidential.
(2) This study is to understand how accidents happen on off-road and off-highway vehicles to
help prevent future injuries.
[REQUIRE ANSWER]
(18)
1 Agreed
2 Refused
[S - IF THE ANSWER IS 2, THEN SKIP TO QUESTION 126]
Q.4 And just to clarify, are you the...
[REQUIRE ANSWER]
(19)
1 Injured person
2 Parent/guardian of the injured person
3 Other
[S - IF THE ANSWER IS 2, THEN SKIP TO QUESTION 6]
[S - IF THE ANSWER IS 1, THEN SKIP TO QUESTION 7]
-2-
Q.5 Specify.
Enter DK for don't know.
[REQUIRE ANSWER]
__________________________________________________________________________________
(20-119)
Q.6 Did you witness the accident?
[REQUIRE ANSWER]
(120)
1
2
3
4
Yes
No
Don't know
Refused
Q.7 The following race and ethnicity questions will help us better focus our outreach and education efforts
related to consumer product safety.
Are you/your child Hispanic or Latino?
For the Interviewer: Due to the cultural diversity in the United States, we sometimes have
difficulty communicating important information to consumers.
[REQUIRE ANSWER]
(121)
1
2
3
4
Yes
No
Don't know
Refused
-3-
Q.8 Please read race choices aloud and ask the respondent to select ALL categories that apply. If
the respondent replies with anything other than the first 5 categories, select "Other" and in the
next question, enter the answer verbatim.
What race or races do you/your child consider yourself to be?
[REQUIRE ANSWER]
(122-127)
1
2
3
4
5
6
7
8
White
Black or African American
American Indian or Alaska Native
Native Hawaiian or Pacific Islander
Asian
Other
Don't know
Refused
[S - IF THE ANSWER IS NOT 6, THEN SKIP TO QUESTION 10]
Q.9 Please specify "other" race.
If respondent states "biracial" or "multiracial", please prompt for specifics (country of origin,
nationality, etc.). Otherwise, simply state "biracial" or "multiracial".
Enter DK for don't know.
[REQUIRE ANSWER]
_________________________________________________________________________________
-4-
(128-219)
Q.10 As part of this study, we are trying to determine the types of vehicles involved in these accidents.
An ATV is a three- or four-wheel off-road vehicle with low-pressure tires, a seat designed to be
straddled by the operator, and handlebars for steering. A vehicle with bench or bucket seats, seat
belts, or a steering wheel is not an ATV. Was the vehicle involved in the accident an ATV?
[REQUIRE ANSWER]
(220)
1
2
3
4
Yes
No
Don't know
Refused
[S - IF THE ANSWER IS 2-4, THEN SKIP TO QUESTION 20]
Q.11 How many wheels does the ATV have?
[REQUIRE ANSWER]
(221)
1
2
3
4
5
6
Three
Four
Six
Other
Don't know
Refused
[S - IF THE ANSWER IS 1-3 OR 5-6, THEN SKIP TO QUESTION 13]
Q.12 Specify how many wheels.
Enter DK for don't know.
[REQUIRE ANSWER]
____
(222-223)
-5-
Q.13 What company manufactured the ATV?
Do not read list unless requested.
Do not read the "Don't know" or "Refused" choices.
[REQUIRE ANSWER]
(224-225)
01
02
03
04
05
06
07
08
09
10
Arctic Cat
Bombardier
Honda
Kawasaki
Polaris
Suzuki
Yamaha
Other
Don't know
Refused
[S - IF THE ANSWER IS 1-7 OR 9-10, THEN SKIP TO QUESTION 15]
Q.14 Specify the "other" manufacturer.
Enter DK for don't know.
[REQUIRE ANSWER]
_________________________________________________________________________________
(226-325)
Q.15 What is the model name and/or number of the ATV?
Enter DK for don't know.
[REQUIRE ANSWER]
_________________________________________________________________________________
-6-
(326-425)
Q.16 Does the ATV have automatic or manual transmission?
Manual Transmission: Operator has to change the gears on the ATV.
Automatic Transmission: Operator does not have to physically change the gears.
[REQUIRE ANSWER]
(426)
1
2
3
4
Automatic
Manual
Don't know
Refused
[D - IF THE ANSWER TO QUESTION 11 IS 1 OR 3-6, THEN SKIP TO QUESTION 18]
Q.17 Is the ATV equipped with four-wheel drive?
[REQUIRE ANSWER]
(427)
1
2
3
4
Yes
No
Don't know
Refused
Q.18 Is the ATV equipped with the following lights?
Check all that apply.
Don't read the "Don't know" or "Refused" choices.
[REQUIRE ANSWER]
(428-431)
1
2
3
4
5
6
7
Headlights
Taillights
Brake lights
Other
ATV is not equipped with lights
Don't know
Refused
[S - IF THE ANSWER IS 1-3 OR 5-7, AND...]
[S - IF THE ANSWER IS 4, THEN SKIP TO QUESTION 19]
[S - IF THE ANSWER IS 1-3 OR 5-7, THEN SKIP TO QUESTION 29]
-7-
Q.19 Specify the "other" type of lights of the ATV.
Enter DK for don't know.
[REQUIRE ANSWER]
_________________________________________________________________________________
(432-531)
[D - IF THE ANSWER TO QUESTION 10 IS 1, THEN SKIP TO QUESTION 29]
Q.20 A UTV or ROV is a four- or more wheeled vehicle with bench or bucket seats equipped with seat
belts, a steering wheel, and foot pedals. A dune buggy, sand rail, and go cart are not considered a
UTV or a ROV. Was the vehicle involved in the accident a UTV or a ROV?
A UTV or ROV is sometimes called a side-by-side. If the respondent mentions that the vehicle
was a side-by-side, mark "Yes".
[REQUIRE ANSWER]
(532)
1
2
3
4
Yes
No
Don't know
Refused
[S - IF THE ANSWER IS 1 OR 3 OR 4, THEN SKIP TO QUESTION 23]
-8-
Q.21 What type of vehicle was involved in the accident?
Read the choices.
Do not read the "Don't know" or "Refused" choices.
[REQUIRE ANSWER]
(533)
1
2
3
4
5
6
7
Dirt bike
Dune buggy
Go cart
ATV
Other
Don't know
Refused
[S - IF THE ANSWER IS 4, THEN SKIP TO QUESTION 11]
[S - IF THE ANSWER IS 1 OR 2 OR 3 OR 6 OR 7, THEN SKIP TO QUESTION 126]
Q.22 Specify what type of vehicle was involved.
Enter DK for don't know.
[REQUIRE ANSWER]
_________________________________________________________________________________
(534-633)
[D - IF THE ANSWER TO QUESTION 21 IS 5, THEN SKIP TO QUESTION 126]
Q.23 Was the vehicle equipped with a rollover protective structure, like a roll bar or roll cage?
[REQUIRE ANSWER]
(634)
1
2
3
4
Yes
No
Don't know
Refused
-9-
Q.24 What company manufactured the vehicle?
Do not read the list unless requested; don't read the "don't know" or "refused" options.
[REQUIRE ANSWER]
(635-636)
01
02
03
04
05
06
07
08
09
10
11
Arctic Cat
Bad Boy Buggies
Honda
John Deere
Kawasaki
Polaris
Yamaha
Dyamo
Other
Don't know
Refused
[S - IF THE ANSWER IS 1-8 OR 10-11, THEN SKIP TO QUESTION 26]
Q.25 Specify the "other" manufacturer.
Enter DK for don't know.
[REQUIRE ANSWER]
_________________________________________________________________________________
-10-
(637-736)
Q.26 What is the model of the vehicle?
Do not read the list unless requested; don't read the "don't know" or "refused" options.
[REQUIRE ANSWER]
(737-738)
01
02
03
04
05
06
07
08
09
10
11
Big Red
Gator
Mule
Prowler
Ranger
Razor/RZR
Rhino
Teryx
Other
Don't know
Refused
[S - IF THE ANSWER IS 1-8 OR 10-11, THEN SKIP TO QUESTION 28]
[D - IF THE ANSWER TO QUESTION 10 IS 2-4, AND...]
[D - IF THE ANSWER TO QUESTION 20 IS 2-4, AND...]
[D - IF THE ANSWER TO QUESTION 23 IS 3-4, AND...]
[D - IF THE ANSWER TO QUESTION 24 IS 10-11, AND...]
[S - IF THE ANSWER IS 10 OR 11, AND...]
[D - IF THE ANSWER TO QUESTION 21 IS 6-7, THEN SKIP TO QUESTION 126]
Q.27 Specify the "other" model.
Enter DK for don't know.
[REQUIRE ANSWER]
_________________________________________________________________________________
-11-
(739-838)
Q.28 Can the vehicle obtain speeds greater then 30 miles per hour?
[REQUIRE ANSWER]
(839)
1
2
3
4
Yes
No
Don't know
Refused
[D - IF THE ANSWER TO QUESTION 20 IS 3-4, AND...]
[D - IF THE ANSWER TO QUESTION 23 IS 3-4, AND...]
[D - IF THE ANSWER TO QUESTION 24 IS 10-11, AND...]
[D - IF THE ANSWER TO QUESTION 26 IS 10-11, AND...]
[S - IF THE ANSWER IS 3-4, THEN SKIP TO QUESTION 126]
Q.29 What is the vehicle's engine size in cubic centimeters or cc's?
Note: The engine size might be part of the model name/number.
Enter DK for don't know.
[REQUIRE ANSWER]
_________________________________________________________________________________
Q.30 What is the model year of the vehicle?
(format: XXXX; enter DK for don't know)
[REQUIRE ANSWER]
________
(940-943)
-12-
(840-939)
Q.31 Were there any aftermarket modifications to the vehicle?
For example: tire upgrades, doors in UTVs/ROVs, special exhaust system, etc.
[REQUIRE ANSWER]
(944)
1
2
3
4
Yes
No
Don't know
Refused
[S - IF THE ANSWER IS 2-4, THEN SKIP TO QUESTION 33]
Q.32 Specify the aftermarket modifications.
Enter DK for don't know.
[REQUIRE ANSWER]
________________________________________________________________________________
(945-1044)
Q.33 Which of the following choices best describes how the vehicle was being used at the time of the
accident?
Read choices.
Do not read the "Don't know" or "Refused" choices.
[REQUIRE ANSWER]
(1045)
1
2
3
4
5
6
7
8
Recreational purposes
Farming or ranching
Other business or occupational tasks
Household chores
Yard or Garden work
Other
Don't know
Refused
[S - IF THE ANSWER IS 1-5 OR 7-8, THEN SKIP TO QUESTION 35]
-13-
Q.34 Please specify the "other" type of activity.
Enter DK for don't know.
[REQUIRE ANSWER]
_______________________________________________________________________________
(1046-1145)
Q.35 Was the vehicle in operation when the accident occured?
[REQUIRE ANSWER]
(1146)
1
2
3
4
Yes (The vehicle was being operated at the time of the accident.)
No (The vehicle was in transport, being repaired, or otherwise not being operated at the time of the accident.)
Don't know
Refused
Q.36 Please describe the sequence of events of the accident.
Probe for details. Find out the series of events in the accident and factors that may have
contributed to the accident. Review the main points of the summary to the respondent. Ask if
you missed any important details. In retelling the response, make sure that it makes sense.
Ask the respondent to expand on parts that are unclear.
Enter DK for don't know.
[REQUIRE ANSWER]
_______________________________________________________________________________
[D - IF THE ANSWER TO QUESTION 35 IS 2, THEN SKIP TO QUESTION 126]
-14-
(1147-1646)
Q.37 The following questions help gather specific details about the accident. Some might seem repetitive;
however, this allows for the most accurate collection of information.
Which of the following would you consider the first thing that occurred in the accident?
Read all choices, except "Don't know" and "Refused", before receiving an answer to ensure
the most accurate choice.
[REQUIRE ANSWER]
(1647)
1
2
3
4
5
6
7
Collision (vehicle, tree, rock, or some other object)
Making a turn
Failed to make a turn OR missed a turn in the trail, road, or path
Overturning of the vehicle
Other
Don't know
Refused
[S - IF THE ANSWER IS 1, THEN SKIP TO QUESTION 41]
[S - IF THE ANSWER IS 2, THEN SKIP TO QUESTION 39]
[S - IF THE ANSWER IS 3 OR 6 OR 7, THEN SKIP TO QUESTION 43]
[S - IF THE ANSWER IS 4, THEN SKIP TO QUESTION 44]
Q.38 Specify the "other" event.
Enter DK for don't know.
[REQUIRE ANSWER]
_______________________________________________________________________________
[D - IF THE ANSWER TO QUESTION 37 IS 5, THEN SKIP TO QUESTION 43]
-15-
(1648-1747)
Q.39 What was the direction of the turn?
[REQUIRE ANSWER]
(1748)
1
2
3
4
Left
Right
Don't know
Refused
Q.40 What was the sharpness or degree of the turn?
[REQUIRE ANSWER]
(1749)
1
2
3
4
Not a sharp turn (More than 90 degrees)
Sharp turn (90 degrees or less)
Don't know
Refused
[S - IF THE ANSWER IS 1-4, THEN SKIP TO QUESTION 43]
Q.41 What was hit or what hit the vehicle?
Read choices.
Do not read the "Don't know" or "Refused" choices.
[REQUIRE ANSWER]
(1750)
1
2
3
4
5
6
7
8
9
Car
Truck or SUV
Van
UTV or ROV
ATV
Stationary object; for example, a tree, rock, building, etc
Other
Don't know
Refused
[S - IF THE ANSWER IS 1-5 OR 8-9, THEN SKIP TO QUESTION 43]
-16-
Q.42 Specify the object that the vehicle hit.
Enter DK for don't know.
[REQUIRE ANSWER]
_______________________________________________________________________________
Q.43 Did the vehicle overturn, even if only to one side?
[REQUIRE ANSWER]
(1851)
1
2
3
4
Yes
No
Don't know
Refused
Q.44 Were you/Was your child (fill in the appropriate terminology) the...
Read choices.
[REQUIRE ANSWER]
(1852)
1
2
3
4
5
6
Driver
Passenger
Bystander
Other
Don't know
Refused
[D - IF THE ANSWER TO QUESTION 10 IS 1, AND...]
[S - IF THE ANSWER IS 1-3 OR 5-6, THEN SKIP TO QUESTION 46]
[D - IF THE ANSWER TO QUESTION 21 IS 4, AND...]
[S - IF THE ANSWER IS 1-3 OR 5-6, THEN SKIP TO QUESTION 46]
[D - IF THE ANSWER TO QUESTION 20 IS 1, AND...]
[S - IF THE ANSWER IS 1 OR 3 OR 5-6, THEN SKIP TO QUESTION 46]
-17-
(1751-1850)
Q.45 Specify the location of you/your child in the vehicle.
For example: right front passenger, middle rear passenger, in cargo area, etc.
Enter DK for don't know.
[REQUIRE ANSWER]
_______________________________________________________________________________
(1853-1952)
[D - IF THE ANSWER TO QUESTION 44 IS 2 OR 4, THEN SKIP TO QUESTION 46]
Q.46 How many passengers, not including the driver, occupied the vehicle at the time of the accident?
[REQUIRE ANSWER]
(1953)
1
2
3
4
5
6
7
8
9
0
1
2
3
4
5
6
0 (No passengers)
More than 6
Don't know
Refused
[D - IF THE ANSWER TO QUESTION 44 IS 3-6, THEN SKIP TO QUESTION 126]
[D - IF THE ANSWER TO QUESTION 44 IS 1, THEN SKIP TO QUESTION 51]
[D - IF THE ANSWER TO QUESTION 44 IS 2, THEN SKIP TO QUESTION 82]
Q.47 The following questions are about the driver of the vehicle at the time of accident.
-18-
Q.48 How old was the driver at the time of the accident?
Enter DK for don't know.
[REQUIRE ANSWER]
______
(1954-1956)
Q.49 Is the driver male or female?
[REQUIRE ANSWER]
(1957)
1
2
3
4
Male
Female
Don't know
Refused
Q.50 Was the driver injured?
Do not read the choices.
[REQUIRE ANSWER]
(1958)
1
2
3
4
5
Yes
Yes, fatality
No
Don't know
Refused
[S - IF THE ANSWER IS 2-5, AND...]
[D - IF THE ANSWER TO QUESTION 10 IS 1, THEN SKIP TO QUESTION 64]
[S - IF THE ANSWER IS 2-5, AND...]
[D - IF THE ANSWER TO QUESTION 21 IS 4, THEN SKIP TO QUESTION 64]
[S - IF THE ANSWER IS 2-5, THEN SKIP TO QUESTION 52]
-19-
Q.51 Can you describe the driver's injuries?
Include body part(s) and diagnosis. For example: "fracture of the lower left arm",
"contusions/bruises on right foot", "lacerations/cuts to the face", etc.
Enter DK for don't know.
[REQUIRE ANSWER]
_______________________________________________________________________________
(1959-2208)
[D - IF THE ANSWER TO QUESTION 10 IS 1, THEN SKIP TO QUESTION 64]
[D - IF THE ANSWER TO QUESTION 21 IS 4, THEN SKIP TO QUESTION 64]
Q.52 Did the driver or any part of the driver's body leave the interior portion of the vehicle during the
accident?
In other words, was the driver ejected, either partially or fully? Partially or fully are answered
as "yes".
[REQUIRE ANSWER]
(2209)
1
2
3
4
Yes
No
Don't know
Refused
[S - IF THE ANSWER IS 2-4, THEN SKIP TO QUESTION 55]
-20-
Q.53 Which part of the driver's body?
Read choices.
[REQUIRE ANSWER]
(2210)
1
2
3
4
All of the driver's body exited the vehicle
Part of the driver's body (for example: leg, hand, foot, etc.)
Don't know
Refused
[S - IF THE ANSWER IS 3-4, THEN SKIP TO QUESTION 55]
Q.54 Did the driver voluntarily put part of his/her body outside of the vehicle, for example, sticking out an
arm or leg to break a fall?
[REQUIRE ANSWER]
(2211)
1
2
3
4
Yes
No
Don't know
Refused
Q.55 Did part of the vehicle hit or land on the driver?
[REQUIRE ANSWER]
(2212)
1
2
3
4
Yes
No
Don't know
Refused
[S - IF THE ANSWER IS 2-4, THEN SKIP TO QUESTION 69]
-21-
Q.56 Which one of the following sections of the vehicle hit or landed on the driver? The part of the
vehicle...
Read choices.
Do not read the "Don't know" or "Refused" choices.
[REQUIRE ANSWER]
(2213)
1
2
3
4
Above the level of the steering wheel; for example, the roll cage
Below the level of the steering wheel; for example, the bumper or doorway
Don't know
Refused
[S - IF THE ANSWER IS 3-4, THEN SKIP TO QUESTION 63]
[S - IF THE ANSWER IS 2, THEN SKIP TO QUESTION 61]
Q.57 Which one of the following best describes the area above the steering wheel that hit the driver?
Read choices.
Do not read the "Don't know" or "Refused" choices.
[REQUIRE ANSWER]
(2214)
1
2
3
4
5
6
Roof
Front pillar (column/support)
Rear pillar (column/support)
Other
Don't know
Refused
[S - IF THE ANSWER IS 5-6, THEN SKIP TO QUESTION 63]
[S - IF THE ANSWER IS 1, THEN SKIP TO QUESTION 59]
[S - IF THE ANSWER IS 2-3, THEN SKIP TO QUESTION 63]
-22-
Q.58 Specify the "other" section above the level of the steering wheel that hit/landed on the driver.
Enter DK for don't know.
[REQUIRE ANSWER]
_______________________________________________________________________________
(2215-2314)
[D - IF THE ANSWER TO QUESTION 57 IS 4, THEN SKIP TO QUESTION 63]
Q.59 Which of the following sections of the roof best describes the part that hit or landed on the driver?
[REQUIRE ANSWER]
(2315)
1
2
3
4
5
6
Section nearest the front of the vehicle (cross member)
Section nearest the rear of the vehicle (cross member)
Driver or passenger side of the vehicle
Other
Don't know
Refused
[S - IF THE ANSWER IS 1-3 OR 5-6, THEN SKIP TO QUESTION 63]
Q.60 Specify the "other" part of the roof that hit or landed on the driver.
Enter DK for don't know.
[REQUIRE ANSWER]
_______________________________________________________________________________
[D - IF THE ANSWER TO QUESTION 59 IS 4, THEN SKIP TO QUESTION 63]
-23-
(2316-2415)
Q.61 Thinking about the vehicle, the part that best describes what hit or landed on the driver is...
Read choices.
Do not read the "Don't know" or "Refused" choices.
Front: hood, front bumper, front fender, front wheels, etc.
Doorway: Section near the driver's/passenger's legs
Rear: rear bumper, rear fender, rear wheels, etc.
[REQUIRE ANSWER]
(2416)
1
2
3
4
5
6
7
8
Front
Doorway
Below the feet/Bottom of the vehicle
Rear
Cargo bed area
Other
Don't know
Refused
[S - IF THE ANSWER IS 1-5 OR 7-8, THEN SKIP TO QUESTION 63]
Q.62 Specify what "other" part of the vehicle hit the driver.
Enter DK for don't know.
[REQUIRE ANSWER]
_______________________________________________________________________________
-24-
(2417-2516)
Q.63 Did the vehicle come to rest on the driver?
[REQUIRE ANSWER]
(2517)
1
2
3
4
Yes
No
Don't know
Refused
[S - IF THE ANSWER IS 1, THEN SKIP TO QUESTION 68]
[S - IF THE ANSWER IS 2-4, THEN SKIP TO QUESTION 69]
Q.64 Did part of the ATV hit or land on the driver?
[REQUIRE ANSWER]
(2518)
1
2
3
4
Yes
No
Don't know
Refused
[S - IF THE ANSWER IS 2-4, THEN SKIP TO QUESTION 70]
Q.65 Which part of the ATV hit or landed on the driver?
[REQUIRE ANSWER]
(2519)
1
2
3
4
5
6
7
8
9
Handlebars
Cargo rack
Left side
Right side
Front
Back
Other
Don't know
Refused
[S - IF THE ANSWER IS 1-6 OR 8-9, THEN SKIP TO QUESTION 67]
-25-
Q.66 Specify the "other" part of the ATV that hit the driver.
Enter DK for don't know.
[REQUIRE ANSWER]
_______________________________________________________________________________
(2520-2619)
Q.67 Did the ATV come to rest on the driver?
[REQUIRE ANSWER]
(2620)
1
2
3
4
Yes
No
Don't know
Refused
[S - IF THE ANSWER IS 2-4, THEN SKIP TO QUESTION 70]
Q.68 What part of the driver's body was pinned by the vehicle?
Enter DK for don't know.
[REQUIRE ANSWER]
_______________________________________________________________________________
[D - IF THE ANSWER TO QUESTION 67 IS 1, THEN SKIP TO QUESTION 70]
Q.69 Was the driver wearing a seat belt at the time of the accident?
[REQUIRE ANSWER]
(2721)
1
2
3
4
Yes
No
Don't know
Refused
-26-
(2621-2720)
Q.70 Was the driver wearing a helmet at the time of the accident?
[REQUIRE ANSWER]
(2722)
1
2
3
4
Yes
No
Don't know
Refused
Q.71 Which of the following best describes how the driver learned to operate the vehicle?
Read the choices.
Do not read the "Don't know" or "Refused" choices.
[REQUIRE ANSWER]
(2723)
1
2
3
4
5
6
7
8
Training course
Friend or Relative
Dealer
Self-taught
Driver's Education
Other
Don't know
Refused
[S - IF THE ANSWER IS 1-5 OR 7-8, THEN SKIP TO QUESTION 73]
Q.72 Please specify how the driver learned to operate the vehicle.
Enter DK for don't know.
[REQUIRE ANSWER]
_______________________________________________________________________________
-27-
(2724-2973)
Q.73 Did the driver own the vehicle at the time of the accident?
Do not read the choices.
[REQUIRE ANSWER]
(2974)
1
2
3
4
5
6
7
Yes
No, the vehicle was rented.
No, the vehicle was borrowed.
No, driver's/passenger's parent(s) own the vehicle
No
Don't know
Refused
Q.74 At the time of the accident, what was the driver's weight?
(in pounds)
Enter DK for don't know.
[REQUIRE ANSWER]
______
(2975-2977)
Q.75 At the time of the accident, what was the driver's height?
Format: (x ft x in, or xx in)
Enter DK for don't know.
[REQUIRE ANSWER]
____________________
(2978-2987)
-28-
Q.76 In thinking about the driver's experience with all off-road vehicles and also this vehicle...
1 = Less than 1 year
2 = Between 1 year and 5 years
3 = More than 5 years
4 = Don't know
5 = Refused
[REQUIRE ANSWER]
Answer Choices
How many years of
experience does
the driver have
with ANY types
off-road vehicles,
including ATVs
and other types of
off road vehicles?
How many years of
experience does
the driver have
with this specific
type of vehicle?
Less than 1 year,
between 1 and 5
years, or more
than 5 years
Less than 1
Between
1 and 5
More than 5
Don't know
1
2
3
4
5
(2988)
1
2
3
4
5
(2989)
Refused
[D - IF THE ANSWER TO QUESTION 44 IS 1, AND...]
[D - IF THE ANSWER TO QUESTION 46 IS 2-6 OR 8, THEN SKIP TO QUESTION 78]
[D - IF THE ANSWER TO QUESTION 44 IS 2, THEN SKIP TO QUESTION 104]
[D - IF THE ANSWER TO QUESTION 44 IS 1, AND...]
[D - IF THE ANSWER TO QUESTION 46 IS 1, THEN SKIP TO QUESTION 77]
[D - IF THE ANSWER TO QUESTION 46 IS 7 OR 9 OR 10, AND...]
[D - IF THE ANSWER TO QUESTION 44 IS 1, THEN SKIP TO QUESTION 104]
Q.77 Earlier you indicated that there was a passenger in or on the vehicle. The following questions will
help gather information about the passenger.
[D - IF THE ANSWER TO QUESTION 46 IS 1, THEN SKIP TO QUESTION 79]
-29-
Q.78 Earlier you indicated there were passengers in or on the vehicle at the time of the accident. For the
following set of questions, think about the most severely injured passenger. If no passengers were
injured, think about the youngest passenger.
If the respondent does not know about the passengers' injuries or information about their
ages, then ask the respondent to consider just one passenger.
Q.79 How old was the passenger at the time of the accident?
Enter DK for don't know.
[REQUIRE ANSWER]
______
(2990-2992)
Q.80 Is the passenger male or female?
[REQUIRE ANSWER]
(2993)
1
2
3
4
Male
Female
Don't know
Refused
-30-
Q.81 Was the passenger injured?
Do not read the choices.
[REQUIRE ANSWER]
(2994)
1
2
3
4
5
Yes
Yes, fatality
No
Don't know
Refused
[S - IF THE ANSWER IS 2-5, AND...]
[D - IF THE ANSWER TO QUESTION 10 IS 1, THEN SKIP TO QUESTION 95]
[S - IF THE ANSWER IS 2-5, AND...]
[D - IF THE ANSWER TO QUESTION 21 IS 4, THEN SKIP TO QUESTION 95]
[S - IF THE ANSWER IS 2-5, THEN SKIP TO QUESTION 83]
Q.82 Can you describe the passenger's injuries?
Include body part(s) and diagnosis. For example: "fracture of the lower left arm",
"contusions/bruises on right foot", "lacerations/cuts to the face", etc.
Enter DK for don't know.
[REQUIRE ANSWER]
_______________________________________________________________________________
[D - IF THE ANSWER TO QUESTION 10 IS 1, THEN SKIP TO QUESTION 95]
[D - IF THE ANSWER TO QUESTION 21 IS 4, THEN SKIP TO QUESTION 95]
-31-
(2995-3244)
Q.83 Did the passenger or any part of the passenger's body leave the interior portion of the vehicle during
the accident?
In other words, was the passenger ejected, either partially or fully?
[REQUIRE ANSWER]
(3245)
1
2
3
4
Yes
No
Don't know
Refused
[S - IF THE ANSWER IS 2-4, THEN SKIP TO QUESTION 86]
Q.84 Which part of the passenger's body?
Read choices.
Do not read the "Don't know" or "Refused" choices.
[REQUIRE ANSWER]
(3246)
1
2
3
4
All of the passenger's body exited the vehicle
Part of the passenger's body (for example: leg, hand, foot, etc.)
Don't know
Refused
[S - IF THE ANSWER IS 3-4, THEN SKIP TO QUESTION 86]
Q.85 Did the passenger voluntarily put part of his/her body outside of the vehicle, for example, sticking
out an arm or leg to break a fall?
[REQUIRE ANSWER]
(3247)
1 Yes
-32-
2 No
3 Don't know
4 Refused
Q.86 Did part of the vehicle hit or land on the passenger?
[REQUIRE ANSWER]
(3248)
1
2
3
4
Yes
No
Don't know
Refused
[S - IF THE ANSWER IS 2-4, THEN SKIP TO QUESTION 100]
Q.87 Which one of the following sections of the vehicle hit or landed on the passenger? The part of the
vehicle...
Read choices.
Do not read the "Don't know" or "Refused" choices.
[REQUIRE ANSWER]
(3249)
1
2
3
4
Above the level of the steering wheel, for example, the roll cage
Below the level of the steering wheel, for example, the bumper or doorway
Don't know
Refused
[S - IF THE ANSWER IS 3-4, THEN SKIP TO QUESTION 94]
[S - IF THE ANSWER IS 2, THEN SKIP TO QUESTION 92]
-33-
Q.88 Which one of the following best describes the area above the steering wheel that hit the passenger?
Read choices.
Do not read the "Don't know" or "Refused" choices.
[REQUIRE ANSWER]
(3250)
1
2
3
4
5
6
Roof
Front pillar (column/support)
Rear pillar (column/support)
Other
Don't know
Refused
[S - IF THE ANSWER IS 1, THEN SKIP TO QUESTION 90]
[S - IF THE ANSWER IS 2-3 OR 5 OR 6, THEN SKIP TO QUESTION 94]
Q.89 Specify the "other" section above the level of the steering wheel that hit/landed on the passenger.
Enter DK for don't know.
[REQUIRE ANSWER]
_______________________________________________________________________________
[D - IF THE ANSWER TO QUESTION 88 IS 4, THEN SKIP TO QUESTION 94]
-34-
(3251-3350)
Q.90 Which section of the roof best describes the part that hit or landed on the passenger?
Read choices.
Do not read the "Don't know" or "Refused" choices.
[REQUIRE ANSWER]
(3351)
1
2
3
4
5
6
Section nearest the front of the vehicle (cross member)
Section nearest the rear of the vehicle (cross member)
Driver or passenger side of the vehicle
Other
Don't know
Refused
[S - IF THE ANSWER IS 1-3 OR 5-6, THEN SKIP TO QUESTION 94]
Q.91 Specify the "other" part of the roof that hit or landed on the passenger.
Enter DK for don't know.
[REQUIRE ANSWER]
_______________________________________________________________________________
[D - IF THE ANSWER TO QUESTION 90 IS 4, THEN SKIP TO QUESTION 94]
-35-
(3352-3451)
Q.92 Thinking about the vehicle, the part that best describes what hit or landed on the passenger is...
Read choices.
Do not read the "Don't know" or "Refused" choices.
Front: hood, front bumper, front fender, front wheels, etc.
Doorway: Section near the driver's/passenger's legs
Rear: rear bumper, rear fender, rear wheels, etc.
[REQUIRE ANSWER]
(3452)
1
2
3
4
5
6
7
8
Front
Doorway
Below the feet/Bottom of the vehicle
Rear
Cargo bed area
Other
Don't know
Refused
[S - IF THE ANSWER IS 1-5 OR 7-8, THEN SKIP TO QUESTION 94]
Q.93 Specify what "other" part of the vehicle hit the passenger.
Enter DK for don't know.
[REQUIRE ANSWER]
_______________________________________________________________________________
-36-
(3453-3552)
Q.94 Did the vehicle come to rest on the passenger?
[REQUIRE ANSWER]
(3553)
1
2
3
4
Yes
No
Don't know
Refused
[S - IF THE ANSWER IS 1, THEN SKIP TO QUESTION 99]
[S - IF THE ANSWER IS 2-4, THEN SKIP TO QUESTION 100]
Q.95 Did part of the ATV hit or land on the passenger?
[REQUIRE ANSWER]
(3554)
1
2
3
4
Yes
No
Don't know
Refused
[S - IF THE ANSWER IS 2-4, THEN SKIP TO QUESTION 101]
Q.96 Which one of the following parts of the ATV hit or landed on the passenger?
Read choices.
Do not read the "Don't know" or "Refused" choices.
[REQUIRE ANSWER]
(3555)
1 Handlebars
-37-
2
3
4
5
6
7
8
9
Cargo rack
Left side
Right side
Front
Back
Other
Don't know
Refused
[S - IF THE ANSWER IS 1-6 OR 8-9, THEN SKIP TO QUESTION 98]
Q.97 Specify the "other" part of the ATV that hit the passenger.
Enter DK for don't know.
[REQUIRE ANSWER]
_______________________________________________________________________________
(3556-3655)
Q.98 Did the ATV come to rest on the passenger?
[REQUIRE ANSWER]
(3656)
1
2
3
4
Yes
No
Don't know
Refused
[S - IF THE ANSWER IS 2-4, THEN SKIP TO QUESTION 101]
Q.99 What part of the passenger's body was pinned by the vehicle?
Enter DK for don't know.
[REQUIRE ANSWER]
_______________________________________________________________________________
[D - IF THE ANSWER TO QUESTION 98 IS 1, THEN SKIP TO QUESTION 101]
-38-
(3657-3906)
Q.100 Was the passenger wearing a seat belt at the time of the accident?
[REQUIRE ANSWER]
(3907)
1
2
3
4
Yes
No
Don't know
Refused
Q.101 Was the passenger wearing a helmet at the time of the accident?
[REQUIRE ANSWER]
(3908)
1
2
3
4
Yes
No
Don't know
Refused
Q.102 At the time of the accident, what was the passenger's height?
Format: (x ft x in, or xx in)
Enter DK for don't know.
[REQUIRE ANSWER]
____________________
(3909-3918)
Q.103 At the time of the accident, what was the passenger's weight?
(in pounds)
Enter DK for don't know.
[REQUIRE ANSWER]
______
(3919-3921)
[D - IF THE ANSWER TO QUESTION 44 IS 2, THEN SKIP TO QUESTION 47]
-39-
Q.104 Which of the following choices best describes the location of the accident?
Read the choices.
Do not read the "Don't know" or "Refused" choices.
[REQUIRE ANSWER]
(3922)
1
2
3
4
5
6
7
8
9
0
Paved road
Non-paved road
Paved surface that is not a road, like a driveway or a parking lot
Field
Yard
Woods
Off-highway vehicle park
Other
Don't know
Refused
[S - IF THE ANSWER IS 1-7 OR 9-10, THEN SKIP TO QUESTION 106]
Q.105 Specify the "other" location.
Enter DK for don't know.
[REQUIRE ANSWER]
_______________________________________________________________________________
-40-
(3923-4022)
Q.106 Which of the following best describes the slope of the terrain being traveled?
Read the choices.
Do not read the "Don't know" or "Refused" choices.
[REQUIRE ANSWER]
(4023)
1
2
3
4
5
Flat
Gentle slope
Steep
Don't know
Refused
[D - IF THE ANSWER TO QUESTION 104 IS 1 OR 3 OR 9-10, AND...]
[S - IF THE ANSWER IS 1 OR 4-5, THEN SKIP TO QUESTION 111]
[S - IF THE ANSWER IS 1 OR 4-5, THEN SKIP TO QUESTION 109]
Q.107 Which of the following best describes the direction of travel on the sloped terrain?
Read the choices.
Do not read the "Don't know" or "Refused" choices.
Cresting example: Riding over the top of the hill
[REQUIRE ANSWER]
(4024)
1 Up
-41-
2
3
4
5
6
7
Down
Across
Crest
Other
Don't know
Refused
[D - IF THE ANSWER TO QUESTION 104 IS 1 OR 3 OR 9-10, AND...]
[S - IF THE ANSWER IS 1-4 OR 6 OR 7, THEN SKIP TO QUESTION 111]
[S - IF THE ANSWER IS 1-4 OR 6-7, THEN SKIP TO QUESTION 109]
Q.108 Specify the "other" direction of travel on the slope.
Enter DK for don't know.
[REQUIRE ANSWER]
_______________________________________________________________________________
(4025-4124)
[D - IF THE ANSWER TO QUESTION 107 IS 5, AND...]
[D - IF THE ANSWER TO QUESTION 104 IS 1 OR 3 OR 9-10, THEN SKIP TO QUESTION 111]
Q.109 Which of the following choices best describes the surface of the terrain?
Read choices.
Do not read the "Don't know" or "Refused" choices.
[REQUIRE ANSWER]
(4125)
1 Pavement
-42-
2
3
4
5
6
7
8
9
Gravel
Dirt
Sand
Mud
Grass
Other
Don't know
Refused
[S - IF THE ANSWER IS 1-6 OR 8-9, THEN SKIP TO QUESTION 111]
Q.110 Specify the "other" type of surface.
Enter DK for don't know.
[REQUIRE ANSWER]
_______________________________________________________________________________
-43-
(4126-4225)
Q.111 Which of the following best describes the condition of the terrain?
Read the choices.
Do not read the "Don't know" or "Refused" choices.
[REQUIRE ANSWER]
(4226)
1
2
3
4
5
6
7
Dry
Wet
Icy
Snowy
Other
Don't know
Refused
[S - IF THE ANSWER IS 1-4 OR 6 OR 7, AND...]
[D - IF THE ANSWER TO QUESTION 10 IS 1, AND...]
[D - IF THE ANSWER TO QUESTION 37 IS 4, THEN SKIP TO QUESTION 115]
[S - IF THE ANSWER IS 1-4 OR 6 OR 7, AND...]
[D - IF THE ANSWER TO QUESTION 10 IS 1, AND...]
[D - IF THE ANSWER TO QUESTION 43 IS 1, THEN SKIP TO QUESTION 115]
[S - IF THE ANSWER IS 1-4 OR 6 OR 7, AND...]
[D - IF THE ANSWER TO QUESTION 21 IS 4, AND...]
[D - IF THE ANSWER TO QUESTION 37 IS 4, THEN SKIP TO QUESTION 115]
[S - IF THE ANSWER IS 1-4 OR 6-7, AND...]
[D - IF THE ANSWER TO QUESTION 21 IS 4, AND...]
[D - IF THE ANSWER TO QUESTION 43 IS 1, THEN SKIP TO QUESTION 115]
[S - IF THE ANSWER IS 1-4 OR 6-7, AND...]
[D - IF THE ANSWER TO QUESTION 43 IS 2-4, THEN SKIP TO QUESTION 116]
[S - IF THE ANSWER IS 1-4 OR 6-7, AND...]
[D - IF THE ANSWER TO QUESTION 20 IS 1, AND...]
[D - IF THE ANSWER TO QUESTION 37 IS 4, THEN SKIP TO QUESTION 113]
[S - IF THE ANSWER IS 1-4 OR 6 OR 7, AND...]
[D - IF THE ANSWER TO QUESTION 20 IS 1, AND...]
[D - IF THE ANSWER TO QUESTION 43 IS 1, THEN SKIP TO QUESTION 113]
-44-
Q.112 Specify the "other" condition of the terrain.
Enter DK for don't know.
[REQUIRE ANSWER]
_______________________________________________________________________________
(4227-4326)
[D - IF THE ANSWER TO QUESTION 111 IS 5, AND...]
[D - IF THE ANSWER TO QUESTION 10 IS 1, AND...]
[D - IF THE ANSWER TO QUESTION 37 IS 4, THEN SKIP TO QUESTION 115]
[D - IF THE ANSWER TO QUESTION 111 IS 5, AND...]
[D - IF THE ANSWER TO QUESTION 10 IS 1, AND...]
[D - IF THE ANSWER TO QUESTION 43 IS 1, THEN SKIP TO QUESTION 115]
[D - IF THE ANSWER TO QUESTION 111 IS 5, AND...]
[D - IF THE ANSWER TO QUESTION 21 IS 4, AND...]
[D - IF THE ANSWER TO QUESTION 37 IS 4, THEN SKIP TO QUESTION 115]
[D - IF THE ANSWER TO QUESTION 111 IS 5, AND...]
[D - IF THE ANSWER TO QUESTION 21 IS 4, AND...]
[D - IF THE ANSWER TO QUESTION 43 IS 1, THEN SKIP TO QUESTION 115]
[D - IF THE ANSWER TO QUESTION 111 IS 5, AND...]
[D - IF THE ANSWER TO QUESTION 43 IS 2-4, THEN SKIP TO QUESTION 116]
[D - IF THE ANSWER TO QUESTION 111 IS 5, AND...]
[D - IF THE ANSWER TO QUESTION 20 IS 1, AND...]
[D - IF THE ANSWER TO QUESTION 37 IS 4, THEN SKIP TO QUESTION 113]
[D - IF THE ANSWER TO QUESTION 111 IS 5, AND...]
[D - IF THE ANSWER TO QUESTION 20 IS 1, AND...]
[D - IF THE ANSWER TO QUESTION 43 IS 1, THEN SKIP TO QUESTION 113]
Q.113 Earlier you indicated the vehicle overturned during the accident. In which direction did the vehicle
overturn?
Read choices.
[REQUIRE ANSWER]
(4327)
1 Driver's side
-45-
2
3
4
5
6
Passenger's side
Front
Back
Don't know
Refused
[S - IF THE ANSWER IS 3-6, THEN SKIP TO QUESTION 116]
Q.114 Did the vehicle roll over...
[REQUIRE ANSWER]
(4328)
1
2
3
4
5
6
7
On the side then stop (90 degrees).
Onto the top then stop (180 degrees).
Onto the top, to the side then stop (270 degrees)
A full rotation then stop (360 degrees)
More than one full rotation
Don't know
Refused
[S - IF THE ANSWER IS 1-7, THEN SKIP TO QUESTION 116]
Q.115 Earlier you indicated that the ATV overturned during the accident. In which direction did the ATV
overturn?
Read the choices.
[REQUIRE ANSWER]
(4329)
1 Left
2 Right
-46-
3
4
5
6
Front
Back
Don't know
Refused
Q.116 What would you estimate the speed of the vehicle at the time of the accident?
[REQUIRE ANSWER]
(4330)
1
2
3
4
5
6
7
8
Less than 5 miles per hour (mph)
5 to 9 mph
10 to 14 mph
15 to 19 mph
20 to 24 mph
25 or more mph
Don't know
Refused
[D - IF THE ANSWER TO QUESTION 18 IS 5, THEN SKIP TO QUESTION 119]
Q.117 The following questions gather more information about the vehicle and the accident
scenario.
Were any lights in use at the time of the accident?
Read the choices.
Do not read the "Don't know" or "Refused" choices.
[REQUIRE ANSWER]
(4331)
1 Yes
-47-
2
3
4
5
No
Vehicle not equipped with lights
Don't know
Refused
[S - IF THE ANSWER IS 2-5, THEN SKIP TO QUESTION 119]
Q.118 Specify the types of vehicle lights in use, for example, taillights or headlights.
Enter DK for don't know.
[REQUIRE ANSWER]
_______________________________________________________________________________
Q.119 Was the vehicle carrying cargo at the time of the accident?
[REQUIRE ANSWER]
(4432)
1
2
3
4
Yes
No
Don't know
Refused
[S - IF THE ANSWER IS 2-4, THEN SKIP TO QUESTION 125]
[S - IF THE ANSWER IS 1, AND...]
[D - IF THE ANSWER TO QUESTION 10 IS 1, THEN SKIP TO QUESTION 122]
[S - IF THE ANSWER IS 1, AND...]
[D - IF THE ANSWER TO QUESTION 21 IS 4, THEN SKIP TO QUESTION 122]
-48-
(4332-4431)
Q.120 Where was the cargo located?
Read choices.
[REQUIRE ANSWER]
(4433)
1
2
3
4
5
6
7
Front
Back
Top
Cargo bed
Other
Don't know
Refused
[S - IF THE ANSWER IS 1-4 OR 6-7, THEN SKIP TO QUESTION 124]
Q.121 Specify the "other" location of the cargo.
Enter DK for don't know.
[REQUIRE ANSWER]
_______________________________________________________________________________
[D - IF THE ANSWER TO QUESTION 120 IS 5, THEN SKIP TO QUESTION 124]
Q.122 Where was the cargo located?
Read the choices.
Do not read the "Don't know" or "Refused" choices.
[REQUIRE ANSWER]
(4534)
1 Font
-49-
(4434-4533)
2
3
4
5
6
7
Back
Top
Cargo rack
Other
Don't know
Refused
[S - IF THE ANSWER IS 1-4 OR 6-7, THEN SKIP TO QUESTION 124]
Q.123 Specify the "other" location of the cargo.
Enter DK for don't know.
[REQUIRE ANSWER]
_______________________________________________________________________________
Q.124 What was the estimated weight of the cargo?
Read the choices.
Do not read the "Don't know" or "Refused" choices.
[REQUIRE ANSWER]
(4635)
1
2
3
4
5
Less than 10 pounds
10 to 50 pounds
51 to 100 pounds
100 to 150 pounds
more than 150 pounds
-50-
(4535-4634)
6 Don't know
7 Refused
Q.125 For the following question, I would like to assure of the confidentiality of the information provided.
Did the driver have any alcoholic beverages prior to the accident?
[REQUIRE ANSWER]
(4636)
1
2
3
4
Yes
No
Don't know
Refused
Q.126 Thank you for your time. The information provided through this survey will be used to help prevent
similar injuries.
Q.127 Date completed. Format: MMDDYY
[REQUIRE ANSWER]
MMDDYY ..........
-51-
____________ (4637-4642)
| File Type | application/pdf |
| Author | Mah, Jean |
| File Modified | 2016-09-27 |
| File Created | 2016-05-09 |