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FRIAR Draft Form
OMB Control No. 2127-XXXX
Expiration Date X/XX/XXX2
NHTSA is collecting information from the first responder community about potential
safety-related defects in motor vehicles or items of motor vehicle equipment. The
purpose of this collection is to provide first responders a direct and expeditious avenue
to report deaths, injuries, crashes, or other incidents that they believe may have
resulted from safety-related defects to NHTSA’s Office of Defects Investigation (ODI).
This collection of information is voluntary and will be used for formative purposes only
so that we may develop communications programs designed to 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 2127XXXXXX. Public reporting for this collection of information is estimated to be
approximately ten 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
NHTSA Form 1741
First Responder Incident Advanced Reporting (FRIAR) Notification Form
,-
Branching options
.
Main 1
1. First responder type*
0
Law enforcement
0
Firefighter
0
Paramedic
0
EMT
0
Dispatcher
0
Crash Investigator
0
Fire Investigator
2. What is the name of your agency?
NHTSA Form 1741
First Responder Incident Advanced Reporting (FRIAR) Notification Form
3. Would you prefer us to contact you or your agency?
Q
Contact me
Go to 2. Contact me
0
Contact my agency
Go to 3. Contact my agency
Go to
4. Main 2
V
Contact me
4. Name
5. Phone number
6. Email
Go to
4. Main 2
V
Contact my agency
NHTSA Form 1741
First Responder Incident Advanced Reporting (FRIAR) Notification Form
7. Agency Contact's Name
8. Agency Phone Number
9. Agency Email
Go to
4. Main 2
V
Main 2
10. Are you reporting a concern with a vehicle, child seat, or tires?
0
Vehicle
Go to 5. Vehicle Concern
0
Child Seat
Go to 6. Child Seat Concern
0
Tires
Go to 7. Tire Concern
0
Other Vehicle Equipment
Go to 8. O ther Vehicle Equipment C...
Go to
9. Main 3
Vehicle Concern
NHTSA Form 1741
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First Responder Incident Advanced Reporting (FRIAR) Notification Form
1 1. VIN
12. License Plate
13. Make & Model OR Fleet Operator
Go to
9. Main 3
V
Child Seat Concern
14. Child Seat Model Name
15. Child Seat Serial Number
Go to
9. Main 3
V
Tire Concern
NHTSA Form 1741
First Responder Incident Advanced Reporting (FRIAR) Notification Form
16. Tire DOT #
17. Tire Brand / Line
18. Tire Size
Go to
9. Main 3
V
Other Vehicle Equipment Concern
19. Type of Equipment
20. Brand & Product Identifier, if available
Go to
9. Main 3
V
Main 3
NHTSA Form 1741
First Responder Incident Advanced Reporting (FRIAR) Notification Form
2 1. Incident Date
22. Incident Time
23. Incident Location
24. Have you seen this concern before?
Q
Yes
Q
No
25. What happened?
*
If the vehicle or equipment involved had any additional identifying marks state them here.
When describing what happened, try to answer these questions as specifically as possible:
What component or system failed or malfunctioned, and is it available for inspection upon
request?
How was your safety or the safety of others put at risk?
Have you observed this issue more than once?
Is there a news story or video link you can provide?
NHTSA Form 1741
First Responder Incident Advanced Reporting (FRIAR) Notification Form
26. Upload Files (Optional)
Upload photos of the incident or other documentation like a police report, correspondence
with the manufacturer or insurer, etc. If you don't already have an electronic version of the
documentation, please scan and upload.
t Upload file
27. Are you reporting a concern with a driving assistance or driving automation
system?
Driver assistance system (lane and speed maintenance, automatic emergency braking, etc.)
or
Automated driving system ("driverless" vehicle)
0
Yes, driving assistance system
0
Yes, automated driving system
0
No
Go to
11. Main 4
Go to 10. Driving Automation Cone ...
V
Driving Automation Concern
NHTSA Form 1741
First Responder Incident Advanced Reporting (FRIAR) Notification Form
28. Fleet Operator
29. Issue Category
Q
Unsafe driving behavior (e.g., crash, near miss)
0
Disobeyed traffic rule
Q
Unable to obey hand signals or other direction
Q
Blocking traffic/vehicle stuck
Q
Parking/Pull over location
Q
Other
11. Main 4
Go to
V
Main 4
30. Was there a crash?
Go to
Q
Yes
Go to 12. Crash with
Q
No
Go to 17. Main 5
17. Main 5
NHTSA Form 1741
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First Responder Incident Advanced Reporting (FRIAR) Notification Form
Crash with
31. Crash with
Q
Vehicle
Go to 13. Vehicle
Q
Non-motorist
Go to 14. Non-motorist
Q
Other
Go to 15. Other
16. Crash cont.
Go to
V
Vehicle
32. What vehicle did it crash with?
Go to
Q
Passenger car
Q
SUV /Van
Q
Pickup Truck
Q
Motorcycle
Q
Bus
Q
Heavy Truck
Q
F rst Responde r Vehicle
Q
Other
i
16. Crash cont.
NHTSA Form 1741
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First Responder Incident Advanced Reporting (FRIAR) Notification Form
Non-motorist
33. What kind of non-motorist was struck?
Q
Pedestrian
Q
Cyclist
Q
e-Scooter
Q
Other non-motorist
Go to
16. Crash cont.
V
Other
34. What was struck / what happened?
Q
Pole /Tree
Q
Other Fixed Object
Q
Animal
Q
Roadway Departure
Q
Rollover
Q
Other
Go to
16. Crash cont.
NHTSA Form 1741
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First Responder Incident Advanced Reporting (FRIAR) Notification Form
Crash cont.
35. Were airbags deployed in any vehicle?
Q
Yes
0
No
Q
Unknown
36. Were any vehicles towed?
Q
Yes
Q
No
Q
Unknown
Go to
17. Main 5
V
Main 5
37. Was there a fire?
Q
Yes
Go to 18. Fire
Q
No
Go to 19. Main 6
Go to
19. Main 6
NHTSA Form 1741
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First Responder Incident Advanced Reporting (FRIAR) Notification Form
Fire
38. How was it extinguished?
0
Fire department
Q
Fire burnt out on its own
Q
Unknown
Q
Other
39. How much of the vehicle was consumed?
0
Minor Damage
0
Moderate Damage
0
Total Loss
0
Unknown
Go to
19. Main 6
V
Main 6
40. Was there an injury or fatality?
Q
Yes
Go to 20. Injury or Fatality
Q
No
Go to End of the form
NHTSA Form 1741
First Responder Incident Advanced Reporting (FRIAR) Notification Form
Go to
End of the form
V
Injury or Fatality
4 1. Number of fatalities, if any
The value must be a number
42. Number of people injured, if any
The value must be a number
43. Was medical attention required?
Q
Yes
0
No
Q
Unknown
Go to
End of the form
NHTSA Form 1741
V
First Responder Incident Advanced Reporting (FRIAR) Notification Form
| File Type | application/pdf |
| File Title | FRIAR Draft Form |
| Author | Vasquez, Genesis (NHTSA) |
| File Modified | 2024-04-16 |
| File Created | 2024-03-01 |