APPENDIX D—PREDRIVE QUESTIONNAIRE

1. Please indicate approximately how often you drive at night (Please check only one)
   
   
   • Every night
   • Three times per week
   • Once per week
   • Less often than one time per week
     
     
2. When driving at night, do you mostly wear... (Please check only one)
   
   
   • Single vision eyeglasses
   • Bifocal eyeglasses
   • Trifocal eyeglasses
   • Contact lenses
   • Do not wear corrective lenses when driving
     
     
3. Would you say you drive at night with: (Please circle only one)
   
   
   
   
4. While driving at night, oncoming headlights and streetlights cause you... (Please circle only one)
   
   
   
   
5. In general, how do you feel about driving at night in good weather? (Please circle only one)
   
   
   
   
6. In general, how do you feel about driving at night in typical bad weather conditions (light rain, snow, fog)? (Please circle only one)
   
   
   
   
7. What vehicle do you most often drive at night?
   
   

              Make_____________
   
              Model______________
   
              Year________________

8. What are you most concerned about when driving at night?

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