APPENDIX H—PREDRIVE QUESTIONNAIRE

ENV-Disability Glare 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 that 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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