Form NHTSA Form 1418 NHTSA Form 1418 DADSS Recruitment

OMB Control Number: 2127-XXXX

Expiration Date: XX/XX/XXXX

Driver Alcohol Detection System for Safety – Field Operational Test

Script for Eligibility & Collection of Demographic Data

This collection of information is voluntary and will be used to recruit individuals to participate in this study.  Public reporting burden for this survey is estimated to average 4 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. We will not collect any personal information that would allow anyone to identify you.  Please note that 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 currently valid OMB control number. The OMB control number for this collection is number 2127-XXX.

Good (morning/afternoon/evening). Thank you for your interest in voluntarily participating in a driving research study that requires you to drive four hours a day, five days a week for three consecutive weeks. In addition to the driving task, I will need to ask you some basic questions about yourself such as gender, height, weight and your driving history. The compensation for this study, if you qualify, is $19.50 per hour. Would you like to see if you are eligible for the study?

[If at any time the individual does not meet a specific criterion, indicate to them that they are ineligible to participate. Thank them for their time and conclude the phone interview.]

Eligibility Questions

1. Are you at least 21 years of age?

2. Do you hold a valid U.S. or Canadian driver’s license?

3. Do you have any driving infractions and/or convictions on your driving record for the previous three years and are you willing to submit to a driving records check for this study?

4. Do you have any criminal convictions in your past including criminal driving offenses and are you willing to submit to a background check for this study?

5. Are you willing to work at least willing to work at least five (5) days per week for 12 consecutive weeks during a three-month data collection cycle?

6. Health Questions:

   1. Do you have a substance abuse condition? (including alcoholism)

   2. Do you have a history of neck or back conditions which limit your ability to drive?

   3. Do you have a history of brain damage from stroke, tumor, head injury, recent concussion, or disease or infection of the brain?

   4. Do you have a current heart condition?

   5. Do you have current uncontrolled respiratory disorders or disorders requiring oxygen?

   6. Have you had epileptic seizures or lapses of consciousness within the last 12 months?

   7. Do you have chronic migraines or tension headaches (no more than one per month during the past 12 months)?

   8. Do you have current problems with motion sickness, inner ear problems, dizziness, vertigo, or balance problems?

   9. Do you have uncontrolled diabetes? (have they been recently diagnosed, or have they been hospitalized for this condition, or any changes in their insulin prescription during the past 3 months)

   10. Have you had any major surgery within the past 6 months? (including eye procedures).

   11. Do you currently take any medications or supplements? (Probe for substances that may cause drowsiness or impair motor abilities)

   12. Are you pregnant or planning to become pregnant? (Only ask female recruits)

7. Do you have normal (or corrected-to-normal) hearing and vision?

8. Are you able to read, write, speak and understand English well?

9. Do you or anyone in your household work in or are retired from any of the following businesses, occupations, or industries:

   1. The police force or another law enforcement agency, working as a police officer, corrections officer, or probation officer

   2. A newspaper, magazine, radio or television station, or related website or online news site

   3. An advertising, marketing, or public relations agency

   4. A market or public opinion research company

   5. The automobile or automotive industry

   6. Liquor sales or hospitality, such as bartending

   7. Law, such as a lawyer or attorney, or working at a law firm, or in the legal profession

   8. The federal, state, or county Departments of Transportation

10. Have you or anyone in your immediate family been a victim of drunk driving, or personally know someone that has been a victim?

Demographic Data [Collect only if they are eligible and willing to participate]

1. Indicate if they are male or female.

2. How tall are you?

3. How much do you weigh?

4. What is your occupation?

[If they are willing to participate, indicate that while driving they must not consume alcohol at all. If they drive and are found to have alcohol in their BrAC readings prior to commencing a shift or while driving, they will be removed from the study. If they are willing to participate, schedule him/her for an orientation session. Collect their physical and email addresses for the purpose of submitting payment to them and to send them directions to the orientation and test sites.]

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