TEEN DRIVER SEAT BELT OBSERVATION FORM
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1 TEEN DRIVER SEAT BELT OBSERVATION FORM High Schools will count only teen drivers and passengers. If the vehicle is being driven by an adult, only count teen passengers. DO NOT notify students that counts are being done. DO NOT reward students for correct behavior. You are to only observe and take counts. Choose a day to conduct your pre-observations. Schedule about minutes to get all your field observations done in one day and at one time. You ll need to observe and count at least 100 cars, or if you re a smaller school, about 90% of your driving student population. If your school has multiple entrances/exits, recruit some additional team members or students who can make observations at those locations during the same time frame, but make sure you are not counting the same cars! If using multiple teams, give each team their own complete set of Observation Forms. If using paper, mail, , or fax them to TDS: Teens in the Driver Seat c/o TTI 1100 NW Loop 410, Suite 605 San Antonio, TX FAX: (please # pages) s-tisdale@tti.tamu.edu Immediately after your three weeks of activities and messaging, conduct your post-observations in the same manner as pre-observations. How to get an accurate count: o Don t guess. If you can t see well enough change your location, get vehicles to slow down or get an additional person to help. o Observations are generally more accurate when made on stopped vehicles. The opportunity for a good view of each passenger is better at Stop Signs or intersections with a traffic signal. Take a careful look inside the car. o If you miss counting a car, it s okay. It s better to be accurate than count more cars. o Use the same location and conduct the pre- and post-count at the same time of day. Use the same team, if possible, for consistency. o Organize your observation team and coordinate where everyone will be standing, how many cars you will be observing and the time frame the counts will be taken. o Make sure everyone understands what to do and what to observe. It may be helpful to observe a few cars together, to make sure everyone has a clear understanding of what they are looking for and what information and codes will be recorded below. Page 1
2 Observers Scribe School, City TEEN DRIVER SEAT BELT OBSERVATION FORM Date Pre- or Post-Observation? Location: Start Time am-pm End Time am-pm Record: SEAT BELT USE. Circle Y (wearing seat belt) or N (not wearing seat belt) for teen driver and teen passengers. SAMPLE Y N Y N Y N Y N Y N SAMPLE Y N Y N Y N Y N Y N 1 Y N Y N Y N Y N Y N 26 Y N Y N Y N Y N Y N 2 Y N Y N Y N Y N Y N 27 Y N Y N Y N Y N Y N 3 Y N Y N Y N Y N Y N 28 Y N Y N Y N Y N Y N 4 Y N Y N Y N Y N Y N 29 Y N Y N Y N Y N Y N 5 Y N Y N Y N Y N Y N 30 Y N Y N Y N Y N Y N 6 Y N Y N Y N Y N Y N 31 Y N Y N Y N Y N Y N 7 Y N Y N Y N Y N Y N 32 Y N Y N Y N Y N Y N 8 Y N Y N Y N Y N Y N 33 Y N Y N Y N Y N Y N 9 Y N Y N Y N Y N Y N 34 Y N Y N Y N Y N Y N 10 Y N Y N Y N Y N Y N 35 Y N Y N Y N Y N Y N 11 Y N Y N Y N Y N Y N 36 Y N Y N Y N Y N Y N 12 Y N Y N Y N Y N Y N 37 Y N Y N Y N Y N Y N 13 Y N Y N Y N Y N Y N 38 Y N Y N Y N Y N Y N 14 Y N Y N Y N Y N Y N 39 Y N Y N Y N Y N Y N 15 Y N Y N Y N Y N Y N 40 Y N Y N Y N Y N Y N 16 Y N Y N Y N Y N Y N 41 Y N Y N Y N Y N Y N 17 Y N Y N Y N Y N Y N 42 Y N Y N Y N Y N Y N 18 Y N Y N Y N Y N Y N 43 Y N Y N Y N Y N Y N 19 Y N Y N Y N Y N Y N 44 Y N Y N Y N Y N Y N 20 Y N Y N Y N Y N Y N 45 Y N Y N Y N Y N Y N 21 Y N Y N Y N Y N Y N 46 Y N Y N Y N Y N Y N 22 Y N Y N Y N Y N Y N 47 Y N Y N Y N Y N Y N 23 Y N Y N Y N Y N Y N 48 Y N Y N Y N Y N Y N 24 Y N Y N Y N Y N Y N 49 Y N Y N Y N Y N Y N 25 Y N Y N Y N Y N Y N 50 Y N Y N Y N Y N Y N Page 2
3 51 Y N Y N Y N Y N Y N 76 Y N Y N Y N Y N Y N 52 Y N Y N Y N Y N Y N 77 Y N Y N Y N Y N Y N 53 Y N Y N Y N Y N Y N 78 Y N Y N Y N Y N Y N 54 Y N Y N Y N Y N Y N 79 Y N Y N Y N Y N Y N 55 Y N Y N Y N Y N Y N 80 Y N Y N Y N Y N Y N 56 Y N Y N Y N Y N Y N 81 Y N Y N Y N Y N Y N 57 Y N Y N Y N Y N Y N 82 Y N Y N Y N Y N Y N 58 Y N Y N Y N Y N Y N 83 Y N Y N Y N Y N Y N 59 Y N Y N Y N Y N Y N 84 Y N Y N Y N Y N Y N 60 Y N Y N Y N Y N Y N 85 Y N Y N Y N Y N Y N 61 Y N Y N Y N Y N Y N 86 Y N Y N Y N Y N Y N 62 Y N Y N Y N Y N Y N 87 Y N Y N Y N Y N Y N 63 Y N Y N Y N Y N Y N 88 Y N Y N Y N Y N Y N 64 Y N Y N Y N Y N Y N 89 Y N Y N Y N Y N Y N 65 Y N Y N Y N Y N Y N 90 Y N Y N Y N Y N Y N 66 Y N Y N Y N Y N Y N 91 Y N Y N Y N Y N Y N 67 Y N Y N Y N Y N Y N 92 Y N Y N Y N Y N Y N 68 Y N Y N Y N Y N Y N 93 Y N Y N Y N Y N Y N 69 Y N Y N Y N Y N Y N 94 Y N Y N Y N Y N Y N 70 Y N Y N Y N Y N Y N 95 Y N Y N Y N Y N Y N 71 Y N Y N Y N Y N Y N 96 Y N Y N Y N Y N Y N 72 Y N Y N Y N Y N Y N 97 Y N Y N Y N Y N Y N 73 Y N Y N Y N Y N Y N 98 Y N Y N Y N Y N Y N 74 Y N Y N Y N Y N Y N 99 Y N Y N Y N Y N Y N 75 Y N Y N Y N Y N Y N 100 Y N Y N Y N Y N Y N Page 3
4 101 Y N Y N Y N Y N Y N 126 Y N Y N Y N Y N Y N 102 Y N Y N Y N Y N Y N 127 Y N Y N Y N Y N Y N 103 Y N Y N Y N Y N Y N 128 Y N Y N Y N Y N Y N 104 Y N Y N Y N Y N Y N 129 Y N Y N Y N Y N Y N 105 Y N Y N Y N Y N Y N 130 Y N Y N Y N Y N Y N 106 Y N Y N Y N Y N Y N 131 Y N Y N Y N Y N Y N 107 Y N Y N Y N Y N Y N 132 Y N Y N Y N Y N Y N 108 Y N Y N Y N Y N Y N 133 Y N Y N Y N Y N Y N 109 Y N Y N Y N Y N Y N 134 Y N Y N Y N Y N Y N 110 Y N Y N Y N Y N Y N 135 Y N Y N Y N Y N Y N 111 Y N Y N Y N Y N Y N 136 Y N Y N Y N Y N Y N 112 Y N Y N Y N Y N Y N 137 Y N Y N Y N Y N Y N 113 Y N Y N Y N Y N Y N 138 Y N Y N Y N Y N Y N 114 Y N Y N Y N Y N Y N 139 Y N Y N Y N Y N Y N 115 Y N Y N Y N Y N Y N 140 Y N Y N Y N Y N Y N 116 Y N Y N Y N Y N Y N 141 Y N Y N Y N Y N Y N 117 Y N Y N Y N Y N Y N 142 Y N Y N Y N Y N Y N 118 Y N Y N Y N Y N Y N 143 Y N Y N Y N Y N Y N 119 Y N Y N Y N Y N Y N 144 Y N Y N Y N Y N Y N 120 Y N Y N Y N Y N Y N 145 Y N Y N Y N Y N Y N 121 Y N Y N Y N Y N Y N 146 Y N Y N Y N Y N Y N 122 Y N Y N Y N Y N Y N 147 Y N Y N Y N Y N Y N 123 Y N Y N Y N Y N Y N 148 Y N Y N Y N Y N Y N 124 Y N Y N Y N Y N Y N 149 Y N Y N Y N Y N Y N 125 Y N Y N Y N Y N Y N 150 Y N Y N Y N Y N Y N Page 4
5 151 Y N Y N Y N Y N Y N 176 Y N Y N Y N Y N Y N 152 Y N Y N Y N Y N Y N 177 Y N Y N Y N Y N Y N 153 Y N Y N Y N Y N Y N 178 Y N Y N Y N Y N Y N 154 Y N Y N Y N Y N Y N 179 Y N Y N Y N Y N Y N 155 Y N Y N Y N Y N Y N 180 Y N Y N Y N Y N Y N 156 Y N Y N Y N Y N Y N 181 Y N Y N Y N Y N Y N 157 Y N Y N Y N Y N Y N 182 Y N Y N Y N Y N Y N 158 Y N Y N Y N Y N Y N 183 Y N Y N Y N Y N Y N 159 Y N Y N Y N Y N Y N 184 Y N Y N Y N Y N Y N 160 Y N Y N Y N Y N Y N 185 Y N Y N Y N Y N Y N 161 Y N Y N Y N Y N Y N 186 Y N Y N Y N Y N Y N 162 Y N Y N Y N Y N Y N 187 Y N Y N Y N Y N Y N 163 Y N Y N Y N Y N Y N 188 Y N Y N Y N Y N Y N 164 Y N Y N Y N Y N Y N 189 Y N Y N Y N Y N Y N 165 Y N Y N Y N Y N Y N 190 Y N Y N Y N Y N Y N 166 Y N Y N Y N Y N Y N 191 Y N Y N Y N Y N Y N 167 Y N Y N Y N Y N Y N 192 Y N Y N Y N Y N Y N 168 Y N Y N Y N Y N Y N 193 Y N Y N Y N Y N Y N 169 Y N Y N Y N Y N Y N 194 Y N Y N Y N Y N Y N 170 Y N Y N Y N Y N Y N 195 Y N Y N Y N Y N Y N 171 Y N Y N Y N Y N Y N 196 Y N Y N Y N Y N Y N 172 Y N Y N Y N Y N Y N 197 Y N Y N Y N Y N Y N 173 Y N Y N Y N Y N Y N 198 Y N Y N Y N Y N Y N 174 Y N Y N Y N Y N Y N 199 Y N Y N Y N Y N Y N 175 Y N Y N Y N Y N Y N 200 Y N Y N Y N Y N Y N Page 5
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TEEN OBSERVATION FORM High Schools will count only teen drivers. If your school does not have many teen drivers, please use the Junior High form to count adult drivers. Choose a day to conduct your pre-observations.
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