APPENDIX B—INFORMED CONSENT FORM

[Contractor Facility]
Informed Consent for Participants of Investigative Projects

Title of Project: Evaluation of the Degree of Enhanced Visibility of Pedestrians and Traffic Control Devices under Various Vision Enhancement Systems

Investigators: [List Name of Investigators Here]

THE PURPOSE OF THE PROJECT IS TO DETERMINE THE DEGREE OF ENHANCED VISIBILITY OF THE ROADWAY ENVIRONMENT WITH VARIOUS TYPES OF VISION ENHANCEMENT SYSTEMS WHILE DRIVING AT NIGHT.

1. PROCEDURES
   
   Show a current valid driver's license.
   Read and sign this Informed Consent Form (if you agree to participate).
   Participate in three vision tests.
   Perform one or more of the following portions of the study (you will be performing the studies that are marked with a check mark):
   
   
   • Study 1: Drive a vehicle on the Smart Road at no more than 25-miles per hour and report when you see the first and the last pavement markings on a given portion of the road.
     
     
   • Study 2: Drive a vehicle on the Smart Road at no more than 25-miles per hour and evaluate the level of discomfort caused by glare from headlamps of vehicles coming in the opposite direction.
     
     
   • Study 3: Drive a vehicle along the Smart Road at no more than 25 miles per hour and respond when you see objects in and along the roadway.
     
     
2. RISKS
   

   The primary risks that you may come into contact with are the obstacles on the road for Study 3. It is for this reason that you are to maintain a speed of not more than 25 miles per hour (this will be maintained for all three studies) and to maintain a 200-foot area between the vehicle and the obstacles (only applies to Study 3). For your safety, the following precautions are taken:

   • The Smart Road is equipped with guardrails. Therefore, if you do lose control of the vehicle, the guardrails will prevent you from sliding off the road.
     
     
   • You are required to wear a seat belt at all times in the vehicle, and the vehicle is equipped with anti-lock brakes.
     
     
   • You do not have any medical condition that would put you at a greater risk, including but not restricted to heart conditions, head injuries, epilepsy, and balance disorders.
     
     
   • In addition, you have not had radial keratotomy, [laser] eye surgery, or any other ophthalmic surgeries.
     
     
   • The only other risk that you may be exposed to is fatigue after sitting in the driver's seat for a prolonged period of time. However, if you would like to take a break at any time, please inform the experimenter.
     
     
3. BENEFITS OF THIS PROJECT
   

   While there are no direct benefits to you from this research (other than payment), you may find the experiment interesting. No promise or guarantee of benefits is made to encourage you to participate. Your participation will help to improve the body of knowledge regarding various vision enhancement systems.

4. EXTENT OF ANONYMITY AND CONFIDENTIALITY
   

   The data gathered in this experiment will be treated with confidentiality. Shortly after you have participated, your name will be separated from your data. A coding scheme will be employed to identify the data by participant number only (e.g., Participant No. 3). After the experiment, the data will be kept in a locked safe.

5. COMPENSATION
   

   You will be paid 20 dollars per hour for participating in this study. You will be paid in cash at the end of your voluntary participation in this study.

6. FREEDOM TO WITHDRAW
   

   As a participant in this research, you are free to withdraw at any time without penalty. If you choose to withdraw, you will be compensated for the portion of time of the study for which you participated. Furthermore, you are free not to answer any question or respond to experimental situations without penalty.

7. APPROVAL OF RESEARCH
   

   Before data can be collected, the research must be approved, as required, by the Institutional Review Board for Research Involving Human Subjects at [name of contractor review board]. You should know that this approval has been obtained.

8. SUBJECT'S RESPONSIBILITIES

   If you voluntarily agree to participate in this study, you will have the following responsibilities:

   1. To follow the experimental procedures as well as you can, and
      
      
   2. To inform the experimenter if you incur difficulties of any type.
      
      
   3. Wear your seat belt.
      
      
   4. Abide by the 25 mile-per-hour speed limit.
   
   
9. SUBJECT'S PERMISSION

   I have read and understand the Informed Consent and conditions of this project. I have had all my questions answered. I hereby acknowledge the above and give my voluntary consent for participation in this project.

   If I participate, I may withdraw at any time without penalty. I agree to abide by the rules of this project.

   ________________________________________________________________________________________
   Signature                                                                                                     Date

   Should I have any questions about this research or its conduct, I may contact: (List names and contact information for review board and investigators here).

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