| Vehicle No.: | 1 |
| Vehicle Make: | NHTSA |
| Vehicle Model: | DEFORMABLE IMPACTOR |
| Model Year: |   |
| Engine Type: | NOT APPLICABLE |
| Engine Displacement (liters): |   |
| Vehicle Test Weight (Kgrams): |   |
| Vehicle Length (mm): |   |
| Vehicle Width (mm): |   |
| NHTSA Number: |   |
| body Type: | NOT APPLICABLE |
| Vehicle Identification No.: |   |
| Transmission Type: | NOT APPLICABLE |
| Vehicle center of Gravity Distance Behind Front Axle (mm): |   |
| Steering Column Shear Capsule Separation: | NOT APPLICABLE |
| Steering Column Collapse Mechanism: | NOT APPLICABLE |
| Vehicle Modification Indicator: | RESEARCH VEHICLE |
| Description of Vehicle Modification: | NONE |
| Vehicle Speed (kph): |   |
| Crabbed Angle (degrees): |   |
| Principal Direction of Force (degrees): |   |
| Bumper Engagement: | NOT APPLICABLE |
| Sill Engagement: | NOT APPLICABLE |
| A-Pillar Engagement: | NOT APPLICABLE |
| Vehicle Damage Index (Collision Deformation Classification): |   |
| Angle of Moving Test Cart (degrees): |   |
| Vehicle Orientation of Moving Cart (degrees): | 0 |
| Total Length of Indentation: |   |
| Distance between center of Damaged area and C.G. Axis (mm): |   |
| Maximum Crush Distance: |   |
| Vehicle Commentary: | NHTSA REAR MDB |
| Damage Profile Distances One: |   |
| Damage Profile Distances Two: |   |
| Damage Profile Distances Three: |   |
| Damage Profile Distances Four: |   |
| Damage Profile Distances Five: |   |
| Damage Profile Distances Six: |   |
| Pre-test - Total Length of Vehicle at centerline: |   |
| Pre-test - Rear Surface of Vehicle to Front of Engine: |   |
| Pre-test - Rear Surface of Vehicle to Firewall: |   |
| Pre-test - Rear Surface of Vehicle to Upper Leading Edge of Right Door: |   |
| Pre-test - Rear Surface of Vehicle to Upper Leading Edge of Left Door: |   |
| Pre-test - Rear Surface of Vehicle to Lower Leading Edge of Right Door: |   |
| Pre-test - Rear Surface of Vehicle to Lower Leading Edge of Left Door: |   |
| Pre-test - Rear Surface of Vehicle to Upper Trailing Edge of Right Door: |   |
| Pre-test - Rear Surface of Vehicle to Upper Trailing Edge of Left Door: |   |
| Pre-test - Rear Surface of Vehicle to Lower Trailing Edge of Right Door: |   |
| Pre-test - Rear Surface of Vehicle to Lower Trailing Edge of Left Door: |   |
| Pre-test - Rear Surface of Vehicle to Bottom of A Post of Right Side: |   |
| Pre-test - Rear Surface of Vehicle to Bottom of A Post of Left Side: |   |
| Pre-test - Rear Surface of Vehicle to Firewall Right Side: |   |
| Pre-test - Rear Surface of Vehicle to Firewall Left Side: |   |
| Pre-test - Rear Surface of Vehicle to Steering Column: |   |
| Pre-test - center of Steering Column to A Post: |   |
| Pre-test - center of Steering Column to Headliner: |   |
| Pre-test - Rear Surface of Vehicle to Right Side of Front Bumper: |   |
| Pre-test - Rear Surface of Vehicle to Left Side of Front Bumper: |   |
| Pre-test - Length of Engine Block: |   |
| Post-test - Total Length of Vehicle at centerline: |   |
| Post-test - Rear Surface of Vehicle to Front of Engine: |   |
| Post-test - Rear Surface of Vehicle to Firewall: |   |
| Post-test - Rear Surface of Vehicle to Upper Leading Edge of Right Door: |   |
| Post-test - Rear Surface of Vehicle to Upper Leading Edge of Left Door: |   |
| Post-test - Rear Surface of Vehicle to Lower Leading Edge of Right Door: |   |
| Post-test - Rear Surface of Vehicle to Lower Leading Edge of Left Door: |   |
| Post-test - Rear Surface of Vehicle to Upper Trailing Edge of Right Door: |   |
| Post-test - Rear Surface of Vehicle to Upper Trailing Edge of Left Door: |   |
| Post-test - Rear Surface of Vehicle to Lower Trailing Edge of Right Door: |   |
| Post-test - Rear Surface of Vehicle to Lower Trailing Edge of Left Door: |   |
| Post-test - Rear Surface of Vehicle to Bottom of A Post of Right Side: |   |
| Post-test - Rear Surface of Vehicle to Bottom of A Post of Left Side: |   |
| Post-test - Rear Surface of Vehicle to Firewall Right Side: |   |
| Post-test - Rear Surface of Vehicle to Firewall Left Side: |   |
| Post-test - Rear Surface of Vehicle to Steering Column: |   |
| Post-test - center of Steering Column to A Post: |   |
| Post-test - center of Steering Column to Headliner: |   |
| Post-test - Rear Surface of Vehicle to Right Side of Front Bumper: |   |
| Post-test - Rear Surface of Vehicle to Left Side of Front Bumper: |   |
| Post-test - Length of Engine Block: |   |