APPENDIX B—INFORMED CONSENT FORM

[Contractor’s university] Informed Consent for Participants of Investigative Projects

TITLE OF THE PROJECT: EVALUATION OF IN-VEHICLE NEW TECHNOLOGIES

INVESTIGATORS: [names of investigators]

1. THE PURPOSE OF THE RESEARCH

   The purpose of this research is to gather information pertaining to different Night Vision Systems to be used to improve night driving conditions

2. PROCEDURES

   During the course of this experiment you will be asked to perform the following tasks:

   1. Read and sign an Informed Consent Form.
   2. Show a current driver’s license.
   3. Complete three vision tests.
   4. Drive a vehicle on the Smart Road at 25 miles per hour, and notify the experimenter when you can detect and identify different objects along the roadway.
   5. Complete questionnaires
   6. Listen to the instructions regarding any tasks you may perform.

      It is important for you to understand that we are evaluating the technology and displays, not you. Any tasks you perform, mistakes you make, or opinions you have will only help us do a better job of designing these systems. Therefore, we ask that you perform to the best of your abilities. The information and feedback that you provide is very important to this project.

3. RISKS

   There are risks or discomforts to which you are exposed in volunteering for this research. They include the following:

   1. The risk of an accident normally associated with driving an unfamiliar automobile at 25 miles per hour or less, on straight and slightly curved roadways.
   2. Possible fatigue due to the length of the experiment. However, you will be given the option to take breaks when you choose.
   3. Discomfort caused by the glare of a vehicle parked in the oncoming lane.

      The following precautions will be taken to ensure minimal risk to you.

   1. The in-vehicle experimenter will monitor participants driving and will ask you to stop if he/she feel the risks are too great to continue. However, as long as you are driving the research vehicle, it remains your responsibility to drive in a safe, legal manner.
   2. You will be required to wear the lap and shoulder belt restraint system while in the car. The vehicle is also equipped with a driver’s side and passenger’s side airbag supplemental restraint system.
   3. The Smart Road test track is equipped with guardrails to prevent vehicles from slipping off the road.
   4. The vehicle is equipped with a fire extinguisher and first-aid kit, which may be used in an emergency.
   5. The headlights of oncoming vehicles are production headlights and meet all the legal requirements for passenger vehicles in the state of Virginia.
   6. If an accident does occur, the experimenters will arrange medical transportation to a nearby hospital emergency room. Participants will be required to undergo examination by medical personnel in the emergency room.
   7. All data collection equipment is mounted such that, to the greatest extent possible, it does not pose a hazard to the driver in any foreseeable situation.
   8. None of the data collection equipment or the display technology interferes with any part of the driver’s normal field of view present in the automobile.
   9. The in-vehicle experimenters are aware of the location of other test vehicles on the road, and maintain radio contact with each other.
   10. If you are pregnant, you have reviewed this consent form with your obstetrician and discussed the risks of participating in this study with him/her. You are willing to accept all possible risks of participation.
   11. You do not have any medical condition that would put you at a greater risk, including but not restricted to epilepsy, balance disorders, and lingering effects of head injuries or stroke
   12. When oncoming traffic is presented, participants will be driving at 25 mi/h or less on the Smart Road, which was designed to Department of Transportation specifications for two-lane divided highways with a 65 mi/h speed limit.

       In the event of an accident or injury in an automobile, the automobile liability coverage for property damage and personal injury is provided. The total policy amount per occurrence is 1 million dollars. This coverage (unless the other party was at fault, which would mean all expense would go to the insurer of the other party’s vehicle) would apply in case of an accident for all volunteers and would cover medical expenses up to the policy limit.

       Participants in a study are considered volunteers, regardless of whether they receive payment for their participation; under Commonwealth of Virginia law, workers compensation does not apply to volunteers; therefore, if not in an automobile, the participants are responsible for their own medical insurance for bodily injury. Appropriate health insurance is strongly recommended to cover these types of expenses.

4. BENEFITS OF THIS PROJECT

   There are no direct benefits to you from this research other than payment for participation. No promise or guarantee of benefits will be made to encourage you to participate. Subject participation may have a significant impact on future night vision systems.

5. EXTENT OF ANONYMITY AND CONFIDENTIALITY

   The data gathered in this experiment will be treated with confidentiality. Shortly after participation, 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. 1). You will be allowed to see your data and withdraw the data from the study if you so desire, but you must inform the experimenters immediately of this decision so that the data may be promptly removed. At no time will the researchers release the results of this study to anyone other than the client and individuals working on the project without your written consent. The client has requested that the videotape including your eye movement data and image, be given to them when the study is completed. They would only use the videotape for research purposes. [The contractor] will not turn over the videotape of your image to the client without your permission.

6. COMPENSATION

   You will receive 20 dollars per hour for your participation in this study. This payment will be made to you at the end of your voluntary participation in this study. If you choose to withdraw before completing all scheduled experimental conditions, you will be compensated for the portion of time of the study for which you participated.

7. FREEDOM TO WITHDRAW

   As a participant in this research, you are free to withdraw at any time for any reason. 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 questions or respond to any research situations without penalty.

8. APPROVAL OF RESEARCH

   This research has been approved, as required, by the Institutional Review Board for Research Involving Human Subjects at [university and university transportation research center].

9. PARTICIPANT’S RESPONSIBILITIES

   If you voluntarily agree to participate in the study, you will have the following responsibilities: To be physically free from any illegal substances (alcohol, drugs, etc.) for 24 hours prior to the experiment, and to conform to the laws and regulations of driving.

10. PARTICIPANT’S PERMISSION

    Check one of the following:

    • [The contractor] has my permission to give the videotape including my image to the client who has sponsored this research. I understand that the client will only use the videotape for research purposes.
    • [The contractor] does not have my permission to give the videotape including my image to the client who has sponsored this research. I understand that [the contractor] will maintain possession of the videotape, and that it will only be used for research purposes.

    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 understand that I may withdraw at any time without penalty. I agree to abide by the rules of this project.

    __________________________       _________________________
    Participant’s Signature                          Date

    Should I have any questions about this research or its conduct, I may contact:

    [Name]                                                  [Phone]
    [Name]                                                  [Phone]
    [Name]                                                  [Phone]

    __________________________       _________________________
    Experimenter’s Signature                      Date

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