FVMSS Impact Testing Checklist

TP208-13 67
DATA SHEET 1
COTR Vehicle Work Order
Vehicle model year, make, and model ____________________________________________
NHTSA no.____________________ Date______________
COTR signature___________________________________
Tests to be performed for this vehicle are checked below.
__1. Rear outboard seating position seat belts (S4.1.4.2(b) & (S4.2.4)
__2. Air bag labels (S4.5.1)
__3. Readiness indicator (S4.5.2)
__4. Passenger Air Bag Manual Cut-Off Device (S4.5.4)
__5. Lap belt lockability (S7.1.1.5)
__6. Seat belt warning system (S7.3)
__7. Seat belt contact force (S7.4.3)
__8. Seat belt latch plate access (S7.4.4)
__9. Seat belt retraction (S7.4.5)
__10. Seat belt guides and hardware (S7.4.6)
__11. Air bag suppression telltale (S19.2.2)
__12. Suppression tests with 12-month-old CRABI dummy (Part 572, Subpart R) using the following
indicated child restraints (mid-height seat position):
Section B – Rear Facing (unbelted and belted rear facing, unbelted forward facing)
__Britax Handle with Care 191 __ Full rearward __ Mid position __ Full forward
__Century Assura 4553 __ Full rearward __ Mid position __ Full forward
__Century Smart Fit 4543 __ Full rearward __ Mid position __ Full forward
__Cosco Arriva 02727 __ Full rearward __ Mid position __ Full forward
__Evenflo Discovery Adjust
Right 212 __ Full rearward __ Mid position __ Full forward
__Evenflo First Choice 204 __ Full rearward __ Mid position __ Full forward
__Graco Infant 8457 __ Full rearward __ Mid position __ Full forward
Section C – Convertible (unbelted and belted rear facing, unbelted and belted forward facing)
__Britax Roundabout 161 __ Full rearward __ Mid position __ Full forward
__Century Encore 4612 __ Full rearward __ Mid position __ Full forward
__Century STE 1000 4416 __ Full rearward __ Mid position __ Full forward
__Cosco Olympian 02803 __ Full rearward __ Mid position __ Full forward
__Cosco Touriva 02519 __ Full rearward __ Mid position __ Full forward
__Evenflo Horizon V 425 __ Full rearward __ Mid position __ Full forward
__Evenflo Medallion 254 __ Full rearward __ Mid position __ Full forward
__13. Suppression tests with Newborn infant (Part 572, Subpart K) using the following indicated child
restraints. (mid-height seat position)
Section A – Car Bed (Belted)
__Cosco Dream Ride 02-719 __ Full rearward __ Mid position __ Full forward
__14. Suppression tests with 3-year-old dummy (Part 572, Subpart P) using the following indicated child
restraints where a child restraint is required (mid-height seat position):
Section C – Convertible (Belted forward-facing)
TP208-13 68
Section D – Toddler/Belt Positioning Booster (Belted)

__Britax Roadster 9004 __ Full rearward __ Mid position __ Full forward
__Century Next Step 4920 __ Full rearward __ Mid position __ Full forward
__Cosco High Back
Booster 02-442 __ Full rearward __ Mid position __ Full forward
__Evenflo Right Fit 245 __ Full rearward __ Mid position __ Full forward
__15. Suppression tests with Representative 3-year-old child using the following indicated child restraints
where a child restraint is required (mid-height seat position) (Appendix H, Data Sheet 19H and
20H):
Section C - Convertible(Belted forward-facing)
Section D – Toddler/Belt Positioning Booster (Belted)
__Cosco High Back
__16. Suppression tests with 3-year-old dummy (Part 572, Subpart P) in the following positions
(mid-height seat position):
__Sitting on seat with back against seat back (S22.2.2.1)
__ Full rearward __ Mid position __ Full forward
__Sitting on seat with back against reclined seat back (S22.2.2.2)
__Sitting on seat with back not against seat back (S22.2.2.3)
__Sitting on seat edge, spine vertical, hands by the child’s side (S22.2.2.4)
__Standing on seat, facing forward (S22.2.2.5)
__Kneeling on seat facing forward (S22.2.2.6)
__Kneeling on seat facing rearward (S22.2.2.7)
__Lying on seat (S22.2.2.8)
__17. Suppression tests with representative 3-year-old child in the following positions
__Sitting on seat with back not against seat back (S22.2.2.3)
__Sitting on seat edge, spine vertical, hands by the child’s side (S22.2.2.4)
__Standing on seat, facing forward (S22.2.2.5)
__Kneeling on seat facing forward (S22.2.2.6)
__Kneeling on seat facing rearward (S22.2.2.7)
__Lying on seat (S22.2.2.8)
TP208-13 69
__18. Suppression tests with 6-year-old dummy (Part 572, Subpart N) using the following indicated
child restraints where a child restraint is required (mid-height seat position):
Section D
__Cosco High Back
__19. Suppression tests with representative 6-year-old child using the following indicated child
restraints where a child restraint is required (mid-height seat position):
Section D
__Cosco High Back
__20. Suppression tests with 6-year-old dummy (Part 572, Subpart N) in the following positions
__Sitting on seat edge, spine vertical, hands by the dummy’s side (S22.2.2.4)
__Sitting back in the seat and leaning on the right front passenger door (S24.2.3)
__21. Suppression tests with representative 6-year-old child in the following positions
__Sitting on seat edge, spine vertical, hands by the dummy’s side (S22.2.2.4)
__Sitting back in the seat and leaning on the right front passenger door (S24.2.3)
__22. Test of Reactivation of the Passenger Air Bag System with an Unbelted 5th Percentile Female
Dummy (S20.3, 22.3, S24.3) (mid-height seat position) Perform this test after the following
suppression test(s):__________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
__23. Test of Reactivation of the Passenger Air Bag System with a representative 5th Percentile Female
(S20.3, 22.3, S24.3) (mid-height seat position) Perform this test after the following suppression
test(s):__________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
__24. Low risk deployment test with 12-month-old dummy (Part 572, Subpart R) using the following
indicated child restraints (full forward, mid-height seat position)(S20.4):
Section B
__Britax Handle with Care 191
__Century Assura 4553
__Century Smart Fit 4543
__Cosco Arriva 02727
__Evenflo Discovery Adjust
Right 212
__Evenflo First Choice 204
__Graco Infant 8457
TP208-13 70
Section C
__Britax Roundabout 161
__Century Encore 4612
__Century STE 1000 4416
__Cosco Olympian 02803
__Cosco Touriva 02519
__Evenflo Horizon V 425
__Evenflo Medallion 254
__25. Low risk deployment test with 3-year-old dummy (Part 572, Subpart P) in the following positions:
__Position 1(rearmost, lowest seat position)
__Position 2 (mid-height seat position)
__26. Low risk deployment test with 6-year-old dummy (Part 572, Subpart N) in the following positions:
__Position 1(rearmost, lowest seat position)
__Position 2 (mid-height seat position)
__27. Low risk deployment test with 5th female dummy (Part 572, Subpart O) in the following positions
__Position 1(mid-height seat position)
__Position 2(mid-height seat position)
__28. Impact tests
__Frontal Oblique Test Speed__________
__Belted 50th male dummy driver and passenger ((0 to 48 kmph) (S5.1.1.(a))
__Unbelted 50th male dummy driver and passenger ((0 to 48 kmph) (S5.1.2(a)(1))
__Unbelted 50th male dummy driver and passenger ((32 to 40 kmph) (S5.1.2(a)(1) or S5.1.2(b))
__Frontal 0o Test Speed__________
__Belted 50th male dummy driver ((0 to 48 kmph) (S5.1.1(b)(1) or S5.1.1(a))
__Belted 50th male dummy passenger ((0 to 48 kmph) (S5.1.1(b)(1) or S5.1.1(a))
__Belted 5th female dummy driver ((0 to 48 kmph) (S16.1(a))
__Belted 5th female dummy passenger ((0 to 48 kmph) (S16.1(a))
__Belted 50th male dummy driver and passenger ((0 to 56 kmph) (S5.1.1(b)(2)(
__Unbelted 50th male dummy driver and passenger ((0 to 48 kmph) (S5.1.2(a)(1))
__Unbelted 50th male dummy driver ((32 to 40 kmph) (S5.1.2(a)(2) or S5.1.2(b))
__Unbelted 50th male dummy passenger (32 to 40 kmph) (S5.1.2(a)(2) or S5.1.2(b))
__Unbelted 5th female dummy driver (32 to 40 kmph) (S16.1(b))
__Unbelted 5th female dummy passenger (32 to 40 kmph) (S16.1(b))
__40% Offset 0o Belted 5th female dummy driver and passenger (0 to 40 kmph) (S18.1)
Test Speed__________
__29. Sled test: Unbelted 50th male dummy driver and passenger (S13)
__30. FMVSS 204 indicant test
__31. FMVSS 212 test
__32. FMVSS 219 indicant test
__33. FMVSS 301 frontal test

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TP208-13 67

Vehicle model year, make, and model ____________________________________________

NHTSA no.______ Date

Tests to be performed for this vehicle are checked below.

Section D – Toddler/Belt Positioning Booster (Belted)

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