Simulator Sickness Attachment N - Simulator Sickness Questionnaire

Human Factors Considerations in Commercial Motor Vehicle Automated Driving Systems and Advanced Driver Assistance Systems

Attachment N - Simulator sickness questionnaires

OMB: 2126-0080

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Virginia Tech Transportation Institute 

Human Factors in CMV ADS 

Simulator Sickness Questionnaire- Administered after initial 5-minute test drive.   

 

Date: __________ Driver ID #______________ 

Please answer each of the statements in the table using the scale below. Circle whole numbers only. 

 

SYMPTOM 

RATING 

General Discomfort                                                             

 

Fatigue 

 

Headache   

 

Eye Strain                                                                     

 

Difficulty Focusing                                                            

 

Increased Salivation                                                           

 

Dry Mouth                                                                      

 

Sweating     

 

Nausea     

 

Difficulty Concentrating               

 

Fullness of Head                                                               

 

Blurred Vision                                                                 

 

Dizzy (eyes open)                                                              

 

Dizzy (eyes closed)                                                            

 

Vertigo   

 

Stomach Awareness                                                             

 

Burping 

 

Simulator Sickness Score: ______________ 



Periodic Simulator Health Checks

These questions will be asked between periodically throughout the study while participants take short breaks. These help identify if the participant does not feel the negative effects of simulator sickness.

Verbally ask the participant:

Are you feeling any of the following symptoms?

Nausea

General Discomfort

Stomach Awareness

Increased Salivation

Sweating

Difficulty Concentrating

Dizziness

Eyestrain

If yes to one or more: Ask the participant if they would like to take a short break (10-15 minutes), or if they need to leave. If possible, have the participant look at something far in the distance, at least 20 feet away.

If not: Ask them if they are ready to continue



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File Created2023-10-02

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