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                                        Seat Belt Observation Form
                                                  (front seat only)
Date                                                            Day of Week
Observer                                                        Badge No.
City/County                                                     Location
Time Started                                                    Time Ended

 Vehicle          Driver   Passenger    Vehicle       Driver      Passenger   Vehicle   Driver   Passenger
    1                                     34                                    67
    2                                     35                                    68
    3                                     36                                    69
    4                                     37                                    70
    5                                     38                                    71
    6                                     38                                    72
    7                                     40                                    73
    8                                     41                                    74
    9                                     42                                    75
   10                                     43                                    76
   11                                     44                                    77
   12                                     45                                    78
   13                                     46                                    79
   14                                     47                                    80
   15                                     48                                    81
   16                                     49                                    82
   17                                     50                                    83
   18                                     51                                    84
   19                                     52                                    85
   20                                     53                                    86
   21                                     54                                    87
   22                                     55                                    88
   23                                     56                                    89
   24                                     57                                    90
   25                                     58                                    91
   26                                     59                                    92
   27                                     60                                    93
   28                                     61                                    94
   29                                     62                                    95
   30                                     63                                    96
   31                                     64                                    97
   32                                     65                                    98
   33                                     66                                    99
                                                                               100
Coding: 0 = No Shoulder Belt           1 = Shoulder Belt
1. Total Number of Drivers and Passengers Observed                            _____________________________
2. Total Number of Drivers & Passengers w/ Shoulder Belts                     _____________________________
3. Total Belted (# 2) Divided by Total Observed (# 1) = Total Belt Use Rate   _____________________________
Don't send this-enter results of 1-3 on Enforcement Activity Report & submit after post-wave survey.


g:excel\san\svyfrm.xls
                  SEAT BELT OBSERVATION SURVEYS


WHY CONDUCT A SURVEY?
Results will show progress of enforcement and education in changing behaviors.

HOW TO CONDUCT THE SURVEY

There is no single way to conduct a survey. At a minimum, observations should be
conducted at several different locations and during different time periods. Survey
sites should reflect different types of motor vehicle travel such as residential, major
intersections, mall entrances, or highways and freeways in the community. Conduct
subsequent surveys in the same manner. Try to use the same locations, directions
of travel, day of week and times of day.

     1) Choose "key" sites in the community. Smaller populated areas should
        choose at least two sites and metropolitan areas choose at least five sites.


     2) Conduct observations until one hundred vehicles are observed at each site
        or for one hour at each site.

     3) Observe drivers and front seat occupants.

     4) Choose a location where you can see inside the cars such as at a stop sign
        or at a traffic light.

     5) Do Not count the cars when you cannot confirm if belts are used.

     6) Use the video "How to Conduct Informal Safety Belt Surveys" to educate
        observers; available through the Governor's Traffic Safety Bureau (GTSB).


     7) Use the back side of this form for counting vehicles. Copy as needed.

     8) Child restraint surveys need special instructions. Contact the GTSB.

Changes in the results of the surveys should be incorporated into local public
information and media materials.
Remember, the objective is to show that progress is being made toward increasing
safety belt usage.