Form NHTSA 1763 NHTSA 1763 Respondent Questions - Drivers and Motorcyclists

National Roadside Survey of Alcohol and Drug Prevalence of Road Users: 2025

NHTSA Form No. 1763

Respondent Questions – Drivers and Motorcyclists

Paperwork Reduction Act Statement

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 current valid OMB Control Number. The OMB Control Number for this information collection is 2127-XXXX. The information collected is necessary to help NHTSA to learn more about alcohol and drug-involved driving. We estimate that it will take approximately 10 minutes to complete. The information collected is voluntary. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to: Information Collection Clearance Officer, National Highway Traffic Safety Administration, 1200 New Jersey Ave SE, Room W45-205, Washington, DC, 20590.

Table of Contents

Data Collector Observation (Recorded before initial interaction) 2

Driver (including Motorcyclist) Survey 2

Data Collector Observations of Drivers/Motorcyclists (Recorded after interaction is complete) 10

Data Collector Observation (Recorded before initial interaction)

1. Mode of transportation

• Car (branch to driver survey)

• SUV/ Crossover (branch to driver survey)

• Minivan (branch to driver survey)

• Van (branch to driver survey)

• Pickup truck (branch to driver survey)

• Motorcycle (branch to motorcycle items of driver survey)

• Other Motor Vehicle: _______________ (branch to driver survey)

• Walking (branch to ORU survey)

• Bicycle (branch to ORU survey)

• E-Bicycle (branch to ORU survey)

• Scooter (branch to ORU survey)

• E-Scooter (branch to ORU survey)

• Wheelchair or other assistive aid (branch to ORU survey)

• Other ORU mode: _______________ (branch to ORU survey)

Branch to Driver/Motorcyclist survey as appropriate.

Driver (including Motorcyclist) Survey

Note: This survey involves branching and skip logic. Numbered items with an “M” indicate questions that will be asked for motorcyclists in place of the standard question listed above the entry for drivers.

1. What is your age? ________ years

2. Where are you coming from?

• Own home

• Someone else’s home

• Work

• Restaurant/eating place

• Bar, tavern, club

• School/church

• Sport or recreation facility/park

• Store or gas station

• Hotel/motel

• Other: ___________

3. Where are you going to?

• Own home

• Someone else’s home

• Work

• Restaurant/eating place

• Bar, tavern, club

• School/church

• Sport or rec facility/park

• Store or gas station

• Hotel/motel

• Other: _____________

4. Are you employed as a rideshare driver (e.g., Uber, Lyft)?

• Yes, currently driving to/from a job

• Yes, not currently driving to/from a job

• No

5. How often do you wear your seat belt when driving?

• All of the time

• Most of the time

• Some of the time

• Rarely

• Never

If “Motorcycle” selected for observation of vehicle type:

5M. How often do you wear your helmet when operating a motorcycle?

• All of the time

• Most of the time

• Some of the time

• Rarely

• Never

6. In the past 30 days, where you have seen or heard a message about traffic safety (e.g., sharing the road with walkers and cyclists, seatbelt use, speeding, distracted or impaired driving)? Check all that apply.

• Social media/Internet

• Radio

• TV

• Newspaper

• Road sign

• Brochure

• Police

• Billboard

• Poster

• Other: ____________________________________

• Have not seen/heard any messages in the past 30 days

7. In the past 30 days, have you seen or heard any of the following traffic safety slogans? Check all that apply.

• Drive Sober or Get Pulled Over

• Buzzed Driving is Drunk Driving

• You Booze, You Lose

• Buckle Up

• Drive Hammered. Get Nailed.

• Ride Sober or Get Pulled Over

• Look Twice, Save a Life

• Share the Road

• Drive High Get a DUI

• Click It or Ticket

• 5 to Drive

• Put the Phone Away or Pay

• Other: _______________________________________

• Have not seen/heard any slogans in the past 30 days

8. How important is it for your State to enforce drinking and driving laws?

• Very important

• Fairly important

• Somewhat important

• Not that important

9. In the past 30 days, have you ridden in a car driven by someone (including yourself) who was “high” or using alcohol or drugs?

• Yes, rode with someone else

• Yes, drove myself

• No

If “Motorcycle” selected for observation of vehicle type:

9M. In the past 30 days, have you ridden on a motorcycle operated by someone (including yourself) who was “high” or using alcohol or drugs?

• Yes

• No

10. Do you think lowering the BAC illegal limit from .08 to .05 would improve driving safety?

[If site is in Utah] “Do you think lowering the BAC illegal limit from .08 to .05 improved driving safety?”

• Yes, would improve driving safety

• No, would have no impact on driving safety

• No, would worsen driving safety

• Not sure

The following questions ask about your use of alcohol. This is for research purposes only. All of your responses are completely anonymous.

11. How often do you have a drink containing alcohol?

• Never

• Monthly or less

• 2-4 times/month

• 2-3 times/week

• 4 or more times/week

12. How many standard drinks containing alcohol do you have on a typical day?

• 1 or 2

• 3 or 4

• 5 or 6

• 7 to 9

• 10 or more

13. How often do you have six or more drinks on one occasion?

• Never

• Less than monthly

• Monthly

• Weekly

• Daily or almost daily

14. In the past 30 days, did you drive a motor vehicle when you thought you had too much alcohol to drink?

• Yes

• No

If “Motorcycle” selected for observation of vehicle type:

14M. In the past 30 days, did you operate a motorcycle when you thought you had too much alcohol to drink?

• Yes

• No

15. How many alcoholic drinks could you have within two hours before you would consider yourself unsafe to drive? __________ drinks

If “Motorcycle” selected for observation of vehicle type:

15M. How many alcoholic drinks could you have within two hours before you would consider yourself unsafe to operate a motorcycle? ___________drinks

Please indicate the last time you used one of the following drugs.

	Never used	Used in the last 4 hours	Used in the last 24 hours	Used in the last 30 days
Cannabis/marijuana (pot, weed)				
Sativex or Marinol (dronabinol)				
Cocaine				
Heroin				
LSD (acid)				
Ecstasy (“E”, MDMA, “X”)				
Methamphetamine (speed, crank, crystal meth)				
Ketamine (Special K)				
Morphine or codeine (e.g., Tylenol with codeine)				
Other prescription pain medications (Oxycontin/ oxycodone, Percocet, Opana/Oxymorphone, Vicodin/hydrocodone)				
ADHD medications or other amphetamines (Ritalin, Adderall, Concerta, Benzedrine, Dexedrine)				
Muscle relaxants (Soma, Flexeril)				
Benzodiazepines (Xanax/alprazolam, Valium/diazepam, Ativan/lorazepam)				
More than one drug simultaneously				

If not “Never used” selected for Question 16:

30. How do you typically use cannabis/marijuana? Check all that apply.

• Smoke

• Vape

• Edible

• Dab

• Tincture

• Topical cream

• Drink

• Other

If not “Never used” selected for Question 16:

31. Do you have a prescription for cannabis/marijuana?

• Yes

• No

32. In the past 30 days, have you driven when feeling buzzed/different/high from a drug other than alcohol?

• Yes

• No

If “Motorcycle” selected for observation of vehicle type:

32M. In the past 30 days, have you operated a motorcycle when feeling buzzed/different/high from a drug other than alcohol?

• Yes

• No

33. In the past 30 days, have you driven after using alcohol in combination with another drug?

• Yes

• No

If “Motorcycle” selected for observation of vehicle type:

33M. In the past 30 days, have you operated a motorcycle after using alcohol in combination with another drug?

• Yes

• No

34. What is your sex?

• Female

• Male

35. What is your race and/or ethnicity? (Select all that apply and enter additional details in the spaces below)

• American Indian or Alaska Native

(If selected) Provide details below:

Enter, for example, Navajo Nation, Blackfeet Tribe of the Blackfeet Indian Reservation of Montana, Native Village of Inupiat Traditional Government, Nome Eskimo Community, Aztec, Maya, etc.:

_____________________________________________________________________

• Asian

(If selected) Provide details below:

• Chinese

• Asian Indian

• Filipino

• Vietnamese

• Korean

• Japanese

• Another group (For example, Pakistani, Hmong, Afghan, etc.): __________________________________________________________________

• Black or African American

(If selected) Provide details below:

• African American

• Jamaican

• Haitian

• Nigerian

• Ethiopian

• Somali

• Another group (For example, Trinidadian and Tobagonian, Ghanian, Congolese, etc.): ________________________________________________________________

• Hispanic or Latino

(If selected) Provide details below:

• Mexican

• Puerto Rican

• Salvadoran

• Cuban

• Dominican

• Guatemalan

• Another group (For example, Colombian, Honduran, Spaniard, etc.): ___________________________________________________________________

• Middle Eastern or North African

(If selected) Provide details below:

• Lebanese

• Iranian

• Egyptian

• Syrian

• Iraqi

• Israeli

• Another group (For example, Moroccan, Yemeni, Kurdish, etc.): ________________________________________________________________

• Native Hawaiian or Pacific Islander

(If selected) Provide details below:

• Native Hawaiian

• Samoan

• Chamorro

• Tongan

• Fijian

• Marshallese

• Another group (For example, Chuukese, Palauan, Tahitian, etc.): ________________________________________________________________

• White

(If selected) Provide details below:

• English

• German

• Irish

• Italian

• Polish

• Scottish

• Another group (For example, French, Swedish, Norwegian, etc.): ________________________________________________________________

Data Collector Observations of Drivers/Motorcyclists (Recorded after interaction is complete)

2. Age

• 16-20

• 21-34

• 35-65

• 65+

• Could not determine

3. Race and/or ethnicity (Select all that apply)

• American Indian or Alaska Native

• Asian

• Black or African American

• Hispanic or Latino

• Middle Eastern or North African

• Native Hawaiian or Pacific Islander

• White

4. Sex

• Male

• Female

• Could not determine

5. Driver Seat Belt Use

• Lap and shoulder belts

• Shoulder belt only

• Lap belt only

• No belt use

• Could not determine

• Not applicable

6. Front-seat Passenger Seat Belt Use

• Lap and shoulder belts

• Shoulder belt only

• Lap belt only

• No belt / helmet use

• Could not determine

• Not applicable (no passengers)

7. Motorcycle Type

• Cruiser

• Touring

• Supersport

• Sport

• Dual purpose

• Scooter

• Standard

• Moped

• Other: ______

• Could not determine

8. Operator Helmet Use

• Yes - DOT-Compliant

• Face shield

• HIVIZ (reflective, bright colors)

• Yes - Not DOT-Compliant

• Face shield

• HIVIZ (reflective, bright colors)

• No helmet

• Could not determine

9. Motorcycle Operator Additional Gear (check all that apply)

• Eye protection

• Top apparel

  • HIVIZ (reflective, bright colors)

• Riding jacket (armored, leather)

• Denim Jacket

• No Jacket

• Riding Vest

• Long sleeve shirt

• Short sleeve shirt

• Bottom apparel

• HIVIZ (reflective, bright colors)

• Riding Pants (armored, leather)

• Chaps

• Jeans

• Shorts

• Shoes

• Riding Boots (over-ankle, close-toed)

• Sneakers

• Sandals (open toe)

• Full finger leather gloves

• Other: ______________

10. Motorcycle Passenger Helmet Use (if applicable)

• Yes, DOT-Compliant

• Face shield

• HIVIZ (reflective, bright colors)

• Yes, non-DOT-Compliant

• Face shield

• HIVIZ (reflective, bright colors)

• No

• Could not determine

• No passenger

11. Motorcycle Passenger Additional Gear (check all that apply)

• Face shield and/or eye protection

• Top protective apparel (sturdy, long sleeve jacket)

• Reflective gear or apparel

• High Visibility gear or apparel (retroreflective, white, bright colors)

• Bottom protective apparel (Long, heavy pants)

• Over-ankle close-toed boots

• Full finger leather gloves

• Other: ______________

12. Number of Passengers (excluding driver)

• 0 (Skip to question S)

• 1

• 2

• 3

• 4

• 5

• 6+

13. Passengers (presumed) age 15 and under

• Yes

• No (Skip to question S)

14. Child Safety Seat/Booster Seat used (child 1)

• Yes

• No

15. Child Safety Seat/Booster Seat used (child 2)

• Yes

• No

16. Child Safety Seat/Booster Seat used (child 3)

• Yes

• No

17. Child Safety Seat/Booster Seat used (child 4)

• Yes

• No

18. Child Safety Seat/Booster Seat used (child 5)

• Yes

• No

19. Conversion protocol implemented

• No (Skip to question T)

• Yes

If yes, how much paid?

• $20

• $40

• $60

• $80

• $100

20. IDP implemented

• No (Skip to end of observations)

• Yes

If yes, initial BrAC: _______________

If the driver appears younger than 25:

What is your age? ______years

If yes, what action was taken?

• Switched driver

• Friend/family

• Waited/BrAC was below limit for age group, final BrAC: ______________

• Taxi/tow truck, cost of taxi/tow truck: _____________

• Walked, distance: _______________ Walked with: _______________

• Other (specify):__________________

• No action taken

If Switched Driver or Friend/Family is selected, read consent:

“Before you drive away from the study site, we would like to confirm you have a valid driver’s license and get a sample of your breath to make sure you are not too impaired by alcohol to drive safely. The results will be provided to you. If your BrAC is positive, we will go over alternatives to get you to your next destination safely as appropriate. If you have any food, gum, or tobacco in your mouth, or have recently used mouthwash, cough medicine, or smoked a cigarette or a vape in the last couple minutes, please take a drink of water to clear your mouth. If you agree to the breath test, please say “yes” and I will document your agreement on my tablet.

1. New driver is at least 18 years old and has a valid unrestricted driver’s license (not provisional) and consented: □ Yes □ No

If yes: Take a deep breath and blow until I say “Stop.”

2. New driver BrAC: ______________

If yes, was the survey completed?

• Yes

• No

If yes, describe the situation, including problems or unusual circumstances (please indicate if driver was under 21 years old): _____________________________

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