OCTA ACCESS TRIP REPORT 

Thank you for taking the time to fill out this form.
Please be as accurate and complete as possible.

RESERVATION PROCESS 
 (COMPLETE FOR FIRST TRIP RESERVED IN CALL ONLY)

1. NAME:
2.  METRO WHEELS IDENTIFICATION NUMBER
   
3 through 14 Intentionally Left Blank
    
RIDE CHECK LINE (COMPLETE QUESTIONS 15 THROUGH 22 ONLY IF YOU SPOKE WITH ACCESS STAFF ABOUT A LATE ARRIVAL OR SCHEDULE CHANGE FOR THIS RIDE)
   

DID RIDE CHECK OPERATOR:
15.  IDENTIFY THE COMPANY & GIVE OWN NAME? 
 YES NO
16.  RIDE CHECK OPERATOR'S NAME:
17.  GIVE YOU AN ESTIMATED TIME OF ARRIVAL?
 YES NO
18.  GIVE ACCURATE INFORMATION?
 YES NO
19.  RESOLVE YOUR PROBLEM IN ONE CALL?
 YES NO
20.  HOW MANY MINUTES BEFORE PROBLEM WAS RESOLVED?
21.  WERE YOU NOTIFIED BY PHONE IF YOUR SCHEDULE WAS CHANGED OR IF YOUR RIDE WAS RUNNING LATE?
 YES NO NA
22.  WAS RIDE CHECK STAFF PROFESSIONAL & COURTEOUS?
 YES NO
   

TRIP AVAILABILITY & ON-TIME PERFORMANCE (COMPLETE FOR EVERY TRIP)
23a.  DATE OF TRIP:
  Year
23b. PICK-UP TIME WAS IN THE
AM PM
24a.  BUS NUMBER:
24b.  IF TRIP WAS SCHEDULED BASED ON PICK-UP TIME, WAS NEGOTIATED TIME WITHIN 60 MINUTES OF REQUESTED TIME?
 YES NO NA
25.  IF TRIP WAS SCHEDULED BASED ON ARRIVAL AT DESTINATION, WAS NEGOTIATED ARRIVAL TIME WITHIN 60 MINUTES OF REQUESTED ARRIVAL TIME?
 YES NO NA
26.  ACTUAL PICK-UP TIME (MINUTES EARLY OR LATE)
27.  IF SCHEDULED BASED ON ARRIVAL TIME, TRIP ARRIVED AT DESTINATION
28.  WAS TOTAL TIME ON VEHICLE 90 MINUTES OR LESS?
 YES NO

SERVICE QUALITY: (COMPLETE FOR EVERY TRIP)

  DID THE DRIVER:
29.  OFFER ASSISTANCE GETTING IN OR OUT OF THE BUS WITHOUT BEING ASKED?
 YES NO
30.  PROVIDE SATISFACTORY ASSISTANCE?
 YES NO NA
31.  ACT IN PROFESSIONAL & COURTEOUS MANNER?
 YES NO
32.  HAVE PROPER UNIFORM WITH NEAT APPEARANCE?
 YES NO
33.  SECURE MOBILITY DEVICE PROPERLY?
 YES NO NA
34a.  DRIVE SAFELY?
 YES NO
34b.  USE A CELL PHONE WHILE BUS WAS IN MOTION?
YES NO
34c.  READ MAP/OTHER MATERIAL WHILE BUS WAS IN MOTION?
YES NO
CONDITION OF VEHICLE 
(COMPLETE FOR EVERY TRIP)
35.  WAS THE INSIDE OF VEHICLE CLEAN?
 YES NO
36.  WAS THE OUTSIDE OF VEHICLE CLEAN?
 YES NO
37.  WERE WHEELCHAIR STRAPS STOWED OFF FLOOR?
 YES NO NA
38. WAS THE TWO-WAY RADIO TURNED ON?
YES NO NA - Unable to determine
39. 

GENERAL COMMENTS:

   
        


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