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Name
Contact phone number
Date of incident
Time of incident
AM
PM
Bus number
Direction/location of incident
Operator name
Fixed route issues
Passing by passenger(s)
Wheelchair securement devices
Wheelchair ramp malfunction
Discourteous operator
30-minutes delay-receiving alternative transportation
Operator failure to request alternative transportation
Operator failure to cycle lift
Operator failure to secure rider/wheelchair in the bus
Operator failure to appear Access telephone reservations Inadequate service
Running late/early
Operating off the route
Other (describe in statement)
Select all that apply.
Paratransit issues
Wheelchair lift
Wheelchair securement devices
Trip denials
Late pickups
Late drop-offs
Missed trips
Excessively long trips
Failure to provide origin-to-destination service
Access telephone reservations
Other (Describe in Statement)
Select all that apply.
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