HSIP Report Template

May 2017

1

[Q1] State

[Q2] Executive Summary 

Introduction

Standard text 

Program Structure

Program Administration

[Q3] Describe the general structure of the HSIP in the State. [large text question]

[Q4] Where is HSIP staff located within the State DOT? [Select one]

 Planning

 Operations

 Design

 Engineering

 Other

[Q5 (old Q3)] How are HSIP funds allocated in a State? [Select one]

 Central Office via Statewide Competitive Application Process

 SHSP Emphasis Area Data 

 Formula via Districts/Regions

 Formula via MPOs

 Other

[Q6 (old Q4)] Describe how local and tribal roads are addressed as part of HSIP. [large text question]

[Q7 (old Q5)] Identify which internal partners (e.g., State departments of transportation (DOTs) 

Bureaus, Divisions) are involved with HSIP planning. [Check all that apply]

 Traffic Engineering/Safety

 Design 

 Planning 

 Maintenance 

 Operations 

 Districts/Regions 

 Local Aid Programs Office/Division

 Governors Highway Safety Office 

 Other

[Q8 (old Q6)] Describe coordination with internal partners. [large text question]
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[Q9 (old Q7)] Identify which external partners are involved with HSIP planning. [Check all that apply]

 Regional Planning Organizations (e.g. MPOs, RPOs, COGs)

 Governors Highway Safety Office 

 Local Technical Assistance Program

 Local Government Agency

 Tribal Agency

 Law Enforcement Agency

 Academia/University

 FHWA

 Other

[Q10] Describe coordination with external partners. [large text question]

[Q11 (old Q8)] Have any program administration practices used to implement the HSIP changed since 

the last reporting period? [Yes/No dropdown]

[If yes] Describe HSIP program administration practices that have changed since the last reporting 

period. [large text question]

[Q12 (old Q9)] Are there any other any other aspects of HSIP Administration on which the State would 

like to elaborate? [Yes/No dropdown]

[If yes] Describe other aspects of HSIP Administration on which the State would like to elaborate.

[large text question]

Program Methodology

[Q13] Does the State have an HSIP manual or similar that clearly describes HSIP planning, 

implementation and evaluation processes? [Yes/no dropdown]

To upload a copy of your processes, click here [Link to file upload page for this section.]

[Q14 (old Q10)] Select the programs that are administered under the HSIP. [Check all that apply]

 HSIP (no 

subprograms)*

 HRRR*

 Wrong Way Driving*

 Median Barrier 

 Intersection 

 Safe Corridor 

 Horizontal Curve 

 Bicycle Safety 

 Rural State Highways 

 Skid Hazard 

 Red Light Running 

Prevention 

 Roadway Departure 

 Low-Cost Spot 

Improvements 

 Sign Replacement 

And Improvement 

 Local Safety 

 Pedestrian Safety

 Right Angle Crash 

 Left Turn Crash 

 Shoulder 

Improvement 

 Segments 

 Crash data
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*New response options

[Q15 (old Q11)] For each program selected above, provide additional information below. 

Program: [Prepopulates based on response to Q10]

Date that program methodology was last updated: [choose from calendar]

[New] What is the justification for this program? [select one]

 Addresses SHSP priority or emphasis area

 FHWA focused approach to safety

 Other

[New] What is the funding approach for this program? [select one]

 Competes will all projects

 Funding set-aside

 Other

What data types were used in the program methodology? [Check all that apply]

What project identification methodology was used for this program? [Check all that apply]

Are local roads (non-state owned and operated) included or addressed in this program?

Are local road projects identified using the same methodology as state roads?

How are projects under this program advanced for implementation?

Select the processes used to prioritize projects for implementation. For the methods selected, indicate 

the relative importance of each process in project prioritization. Enter either the weights or numerical 

rankings. If weights are entered, the sum must equal 100. If ranks are entered, indicate ties by giving 

both processes the same rank and skip the next highest rank (as an example: 1, 2, 2, 4).

[Q16 (old Q12)] What percentage of HSIP funds address systemic improvements? [Enter number]

HSIP funds are used to address which of the following systemic improvements? [Check all that apply]

 Cable Median 

Barriers 

 Rumble Strips 

 Traffic Control 

Device Rehabilitation 

 Pavement/Shoulder 

Widening 

 Install/Improve 

Signing 

 Install/Improve 

Pavement Marking 

and/or Delineation 

 Upgrade Guard Rails 

 Clear Zone 

Improvements 

 Safety Edge 

 Install/Improve 

Lighting 

 Add/Upgrade/Modif

y/Remove Traffic 

Signal 

 Horizontal curve 

signs*
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 High friction surface 

treatment*

 Wrong way driving 

treatments*

[Q17 (old Q13)] What process is used to identify potential countermeasures? [Check all that apply]

 Engineering Study 

 Road Safety Assessment 

 Crash data analysis

 SHSP/Local road safety plan

 Data-driven safety analysis tools (HSM, CMF Clearinghouse, SafetyAnalyst, usRAP)

 Stakeholder input

[Q18] Does the State HSIP consider connected vehicles and ITS technologies? [yes/no drop-down]

[If yes] Describe how the State HSIP considers connected vehicles and ITS technologies. [large text 

field]

[Q19] Does your State use the Highway Safety Manual to support HSIP efforts? [Yes/no dropdown]

[If yes] Please describe how your State uses the HSM to support HSIP efforts.

[Q20 (oldQ14)] Have any program methodology practices used to implement the HSIP changed since 

the last reporting period? [Yes/No dropdown]

[If yes] Describe program methodology practices that have changed since the last reporting period.

[large text question] 

[Q21 (old Q15)] Are there any other aspects of the HSIP methodology on which the State would like to 

elaborate? [Yes/No dropdown]

[If yes] Describe other aspects of the HSIP methodology on which the State would like to elaborate.

[large text question] 

Progress in Implementing Highway Safety Improvement Projects 

Funds Programmed

[Q22 (old Q16)] Reporting period for HSIP funding.

[Q23 (old Q17)] Enter the programmed and obligated funding for each applicable funding category.
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Funding Category Programmed Obligated % 

Obligated/Programmed 

[calculated by ORT]

HSIP (23 U.S.C. 148)

HRRR Special Rule (23 U.S.C. 

148(g)(1))

Penalty Funds (23 U.S.C. 154)

Penalty Funds (23 U.S.C. 164)

RHCP (for HSIP purposes) (23 

U.S.C. 130(e)(2))

Other Federal-aid Funds (i.e. 

STBG, NHPP)

State and Local Funds

Total

[Q24 (old Q18) ]How much funding is programmed to local (non-state owned and maintained) or 

tribal safety projects? [Enter number]

How much funding is obligated to local or tribal safety projects? [Enter number]

[Q25 (old Q19)] How much funding is programmed to non-infrastructure safety projects? [Enter 

number]

How much funding is obligated to non-infrastructure safety projects? [Enter number]

[Q26 (old Q20)] How much funding was transferred in to the HSIP from other core program areas 

during the reporting period under 23 U.S.C. 126? [Enter number]

How much funding was transferred out of the HSIP to other core program areas during the reporting 

period under 23 U.S.C. 126? [Enter number]
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[Q27 (old Q21)] Discuss impediments to obligating HSIP funds and plans to overcome this challenge in 

the future. [Large text field]

[Q28 (old Q22)] Do you want to elaborate on any other aspects of the State’s progress in 

implementing HSIP projects? [Yes/no dropdown]

[If yes] Describe any other aspects of the State’s progress in implementing HSIP projects on which the 

State would like to elaborate. [Large text field]

[Q29 (old Q23)] General Listing of Projects [modified template]

Progress in Achieving Safety Outcomes and Performance Targets

General Highway Safety Trends

[Q30 (old Q24)] Enter annual safety performance measure data. 

Performance Measure 2008 2009 2010 2011 2012^ 2013^ 2014^ 2015^ 2016^*

Fatalities

Serious Injuries#

Fatality Rate (per HMVMT)

Serious Injury Rate (per 

HMVMT)

Number non-motorized 

fatalities

Number of non-motorized 

serious injuries#

[Note: Beginning in 2017, users can only submit annual performance measure data for general highway 

safety trends. The HSIP ORT will continue to calculate the 5-yr rolling average and display both the 

annual and 5-yr average in the report output. HSIP ORT will combine non-motorized fatalities and 

serious injuries for report output. ]

# Data will be used for safety performance measure assessment

^Required fields

*If reporting year - 1 is not the most recent year, the State must:

Describe efforts to obtain most current calendar year’s crash data. [large text question]

[Q31] Describe fatality data source. [Select one]

 FARS

 State motor vehicle crash database

 Other
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[Q32 (old Q25)] To the maximum extent possible, present performance measure data by functional 

classification and ownership.

[Q33 (old Q26)] Are there any other aspects of the general highway safety trends on which the State 

would like to elaborate? [Yes/No dropdown]

[If yes] Provide additional discussion related to general highway safety trends. [large text question] 

Safety Performance Targets

[Q34] Calendar Year [Insert Year = Reporting Year +1] Targets*

Number of Fatalities Enter Numerical Value to the tenth decimal place

Describe the basis for established target, including how it supports SHSP goals. 

Number of Serious Injuries Enter Numerical Value to the tenth decimal place

Describe the basis for established target, including how it supports SHSP goals. 

Fatality Rate Enter Numerical Value to the thousandth decimal 

place

Describe the basis for established target, including how it supports SHSP goals. 

Serious Injury Rate Enter Numerical Value to the thousandth decimal 

place

Describe the basis for established target, including how it supports SHSP goals. 

Total Number of Non-Motorized Fatalities and 

Serious Injuries Enter Numerical Value to the tenth decimal place

Describe the basis for established target, including how it supports SHSP goals. 
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*Based on (Target Year – 4) to (Target Year) 5-year average

[For example, for the 2017 reporting period the target year is 2018 (to be displayed above table for this 

question). The footnote would read “Based on 2014 – 2018 5 year average”.]

[Q35] Describe efforts to coordinate with other stakeholders (e.g. MPOs, SHSO) to establish safety 

performance targets. [large text field] 

[Q36] Does the State want to report additional optional targets? [Yes/no drop-down]

If yes, click here [link to page to upload attachments for this section] to include optional targets and 

boundaries as a separate attachment. 

Applicability of Special Rules

[Q37] Does the HRRR special rule apply to the State for this reporting period? [Yes/no dropdown]

[Q 38 (old Q27)] Provide the number of older driver and pedestrian fatalities and serious injuries for 

the past seven years. 

Performance Measure 2009 2010 2011 2012 2013 2014 2015*

Number of Older Driver and Pedestrian 

Fatalities

Number of Older Driver and Pedestrian Serious 

Injuries

[*Reporting year -2; all fields required]

Effectiveness of Improvements 

Program Effectiveness

[Q39] How does the State measure effectiveness of the HSIP? [Check all that apply]

 Change in fatalities and serious injuries

 Benefit/Cost Ratio

 Economic Effectiveness (cost per crash reduced)

 Lives saved

 Other
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[Q40] Based on the measures of effectiveness selected above, describe the results of the State’s

program level evaluations. [large text question]

[Q41 (old Q29)] What other indicators of success does the State use to demonstrate effectiveness and 

success of the Highway Safety Improvement Program? [Check all that apply]

 # miles improved by HSIP

 More systemic programs

 # RSAs completed

 Policy change

 Organizational change

 Increased awareness of safety and data-driven process

 Increased focus on local road safety

 HSIP obligations

 Other

[Q42 (old Q30 and Q31)]. Are there any significant programmatic changes that have occurred since the 

last reporting period? [Yes/No dropdown]

[If yes]. Describe significant program changes that have occurred since the last reporting period. [large 

text question] 
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Effectiveness of Groupings or Similar Types of Improvements

SHSP Emphasis Areas

[Q43 (old Q32)] Present and describe trends in SHSP emphasis area performance measures.

Countermeasure Effectiveness

[Q44] Have you completed any countermeasure effectiveness evaluations during the reporting

period? [yes/no dropdown]

[If yes] Please provide the following summary information for each countermeasure effectiveness 

evaluation. 

Countermeasure name:

Description: 

Target Crash Type:

# installations:

[or] Miles treated:

# years before data:

# years after data: 

Methodology:

Results:

Click here [insert link to file upload for this section] to upload research report. 

[+Add another countermeasure. ]

Project Effectiveness

[Q45 (old Q36)] Provide the following information for previously implemented projects that the State 

evaluated this reporting period. 

[Q46 (old Q35) Are there any other aspects of the overall HSIP effectiveness on which you would like 

to elaborate? [Yes/No dropdown]

[If yes] Describe any other aspects of HSIP effectiveness on which you would like to elaborate. [large 

text question]
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Compliance Assessment 

[Q47] SHSP Update Cycle

What date was the State’s current SHSP approved by the Governor or designated State 

representative? [Choose from calendar]

What are the years being covered by the current SHSP? [insert year (4 characters)] to [Insert year 4 

characters)]

When do you anticipate completing the State’s next SHSP update? [Insert year (4 characters)]

MIRE Fundamental Data Elements

[Q48] Provide the current status (percent complete) of MIRE fundamental data elements collection 

efforts using the table below. [Separate MS Excel template also available]

MIRE 

FDE

Non Local Paved 

Roads - Segment

Non Local Paved 

Roads -

Intersection

Non Local Paved 

Roads - Ramps

Local Paved 

Roads Unpaved Roads

State- NonState State- NonState State- NonState State- NonState State- NonState

[Q49] Describe actions the State will take moving forward to meet the requirement to have complete 

access to the MIRE fundamental data elements on all public roads by September 30, 2026. [large text 

question]

[Q50] Serious Injury Definition

Provide the suspected serious injury identifier, definition and attributes used by the State for both the 

crash report form and the crash database using the table below. Please also indicate whether or not 

these elements are compliant with the MMUCC 4th edition criteria for data element P5. Injury Status, 

suspected serious injury. 

State Suspected 

Serious Injury 

Identifier 

(name)

MMUCC 4th

edition 

Compliant*

Suspected 

Serious Injury 

Definition

MMUCC 4th

edition 

Compliant*

Suspected 

Serious Injury 

Attributes

(descriptors)

MMUCC 4th

edition 

Compliant*

Crash Report 

Form

NA NA
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Crash Report 

Form 

Instruction 

Manual

Crash 

Database

NA NA

Crash 

Database Data 

Dictionary

[Note: *Yes/No dropdown]

[If no is selected for any of the elements above] Please describe the actions the State is taking to 

become compliant by April 15, 2019. [large text question]

[Q51] Program Assessment

Did the State conduct an HSIP program assessment during the reporting period? [yes/no dropdown]

[If yes] Describe the purpose and outcomes of the State’s HSIP program assessment. [large text field]

[If no] When does the State plan to complete its next HSIP program assessment? [insert year]