NHTSA 1273 ATT C1 - Vehicle Inspection Form

ATTACHMENT C1

VEHICLE INSPECTION FORM

United States Department of Transportation National Highway Traffic Safety Administration

VEHICLE INSPECTION (CAPI)

Form Approved O.M.B. No. 2127-0626 Expiration Date: XXXX Tire Pressure Monitoring System – Outage Rates and Repair Costs

Paperwork Reduction Act Burden Statement

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 2127-0626 (Expiration date: XX/XX/XXXX). Public reporting for this collection of information is estimated to be approximately 10 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 1273.

Formatting conventions:

Questionnaire item

///PROGRAMMING LOGIC///

Explanatory notes

Programmer Notes:

• All variables are assumed to be numeric

• For SELECT ALL THAT APPLY items, create a series of variables with _1, _2, etc. appended to original variable name to indicate selection status of each response option

• For OTHER: SPECIFY items, create a new variable (length $ 256) with _OTHER appended to original variable name to hold open-end text

Disposition Definitions:

• 61 = Completed inspection

MODULE INSPECTION: IF DRIVER IS PARTICIPATING AND MODELYEAR≥2004

///Generate MASTERID and communicate to driver interviewer for syncing///

TPMSTAPE Has an attempt been made to cover up any indicator lights on the dash (e.g., with tape)?

1. YES

2. NO

///TURN IGNITION FROM LOCK (0) TO ON (II) POSITION AND PAUSE 5 SECONDS///

TPMSON Select all TPMS-related indicator lights or readouts visibly illuminated on the dash (allowing for minor stylistic variations or differences in wording):

[SELECT ALL THAT APPLY FROM GRAPHICAL GRID]

///VALIDATE: SELECTION OF “NONE VISIBLE” MEANS NO OTHER OPTIONS ARE SELECTED///

WORDS ON DIGITAL READOUT: “CHECK {LEFT FRONT} TIRE PRESSURE”	WORDS ON DIGITAL READOUT: “TIRE PRESSURE TOO LOW”
WORDS ON DIGITAL READOUT: “TPMS SYSTEM MALFUNCTION”
OTHER: SPECIFY	NONE VISIBLE

WARN1 Are ANY indicator lights (other than TPMS indicators) illuminated in ON (II) position?

1. YES

2. NO

98. DON’T KNOW

///TURN IGNITION FROM ON (II) TO START (III) POSITION AND PAUSE 5 SECONDS///

TPMSSTART Select all TPMS-related indicator lights or readouts visibly illuminated on the dash (allowing for minor stylistic variations or differences in wording):

[SELECT ALL THAT APPLY FROM GRAPHICAL GRID]

///VALIDATE: SELECTION OF “NONE VISIBLE” MEANS NO OTHER OPTIONS ARE SELECTED///

SOLID	FLASHING
SOLID	FLASHING
WORDS ON DIGITAL READOUT: “CHECK {LEFT FRONT} TIRE PRESSURE”	WORDS ON DIGITAL READOUT: “TIRE PRESSURE TOO LOW”
WORDS ON DIGITAL READOUT: “TPMS SYSTEM MALFUNCTION”
OTHER: SPECIFY	NONE VISIBLE

WARN2 Are any other indicator lights (other than TPMS indicators) illuminated in START (III) position?

1. YES

2. NO

98. DON’T KNOW

• IF TPMSON NE 9 AND TPMSSTART IN 2,4,9 THEN TPMSMALF=1; indicator(s) working @ ON, system malfunction @ START

• ELSE IF TPMSON NE 9 AND TPMSSTART IN 1,3,5,6,7,8 THEN TPMSMALF=2; indicator(s) working @ ON, low pressure only @ START

• ELSE IF TPMSON=9 AND TPMSSTART=11 THEN TPMSMALF=3; no TPMS indicator(s) @ ON, no TPMS indicator(s) @ START

• ELSE IF TPMSON NE 9 AND TPMSSTART=11 THEN TPMSMALF=4; indicator(s) @ ON, no indicator(s) @ START

• ELSE TPMSMALF=5; status unclear, screen out

OBSERVER: Before proceeding with observation, communicate TPMS indicator status (TPMSMALF=1,2,3,4,5) to interviewer verbally or using pre-determined hand signal, and await interviewer code match confirmation.

ODOMETER Odometer reading

/RANGE 1-1,000,000/

EMAG Does the vehicle contain visible equipment that could cause electromagnetic interference (e.g., radar detector)?

1. YES

2. NO

///LOOP: X = {LF, LR, RR, RF}///

STEMCON_X What is the condition of the valve stem on the X tire?

1. GOOD

2. POOR (E.G., CRACKED OR CORRODED)

3. NO VALVE STEM VISIBLE

///ASK IF STEMCON_X = 1,2, Not missing valve stem on X tire///

STEMMAT_X Of what material is the valve stem on the X tire made?

1. RUBBER OR PLASTIC

2. METAL

3. OTHER MATERIAL

CAPCON_X What is the condition of the valve cap on the X tire?

1. GOOD

2. POOR (E.G., CRACKED OR CORRODED)

3. NO VALVE CAP VISIBLE

///ASK IF CAPCON_X = 1,2, Not missing valve cap on X tire///

CAPMAT_X Of what material is the valve cap on the X tire made?

1. RUBBER OR PLASTIC

2. METAL

3. OTHER MATERIAL

///END LOOP///

SPARE Does the vehicle appear to have one or more spare tires (mini- or full-size) or non-matching wheels installed?

1. YES

2. NO

///SET DISPO = 61, Completed inspection///

END MODULE INSPECTION

MODULE NON-RESPONSE: ALL VEHICLES APPROACHED

///Set MASTERID to contain site ID and timestamp to enable linking with Driver Interview///

DATE [INTERNAL]

TIME [INTERNAL]

SITENUM [INTERNAL]

BODY_OBS Body type of vehicle

1. SUV

2. AUTO (INCLUDES SEDAN/WAGON/HATCHBACK)

3. VAN (INCLUDES TRADITIONAL AND MINIVANS)

4. LIGHT TRUCK

MAKE_OBS Make of vehicle

1. BMW

2. BUICK

3. CADILLAC

4. CHEVROLET

5. CHRYSLER

6. DODGE

7. FORD

8. GMC

9. HONDA

10. HYUNDAI

11. JEEP

12. KIA

13. LEXUS

14. MAZDA

15. MERCEDES

16. NISSAN

17. RAM

18. SUBARU

19. TOYOTA

20. VOLKSWAGEN

21. OTHER: SPECIFY

98. DON’T KNOW

LANG_OBS Language spoken

1. ENGLISH

2. SPANISH

3. OTHER

98. DON’T KNOW

AGE_OBS Age of driver

1. YOUNG ADULT (Up to 25)

2. ADULT (25-69)

3. SENIOR (70 and over)

98. DON’T KNOW

SEX_OBS Sex of driver

1. MALE

2. FEMALE

98. DON’T KNOW

OCCUPAD Number of ADULT occupants (if ages are unclear, count all as adult)

/RANGE 1-10/

98. DON’T KNOW

OCCUPCH Number of CHILD occupants (if ages are unclear, count all as adult)

/RANGE 1-10/

98. DON’T KNOW

DAMG_OBS Is there damage to the vehicle?

1. NONE VISIBLE (ALLOWING FOR PAINT SCRAPES, WINDOW ISSUES, WIPER ISSUES)

2. MINOR (E.G., DENTED FENDERS/BODY PANELS)

3. MAJOR (E.G., MAJOR DAMAGE TO HOOD, FRONT END, REAR END, DOORS THAT WOULD MAKE PARTS OF VEHICLE UNUSABLE)

98. DON’T KNOW

HITCH Is the vehicle equipped with a rear hitch?

1. YES

2. NO

98. DON’T KNOW

ELEC_OBS Is the car a hybrid or electric?

1. YES

2. NO

98. DON’T KNOW

FUEL_OBS Fuel type purchased

1. DIESEL

2. REGULAR (GENERALLY 87 OCTANE)

3. MID-GRADE (GENERALLY 89 OCTANE)

4. PREMIUM (GENERALLY 91 OCTANE)

5. OTHER

98. DON’T KNOW

PAY Where was payment for fuel made?

1. AT PUMP

2. IN STORE

98. DON’T KNOW

END MODULE NON-RESPONSE

NHTSA Form 1273 8/19/15