TRANSIT ACCESS - OCTA BUS WHEELCHAIR PASS-UP REPORT

1	NAME
2	METRO WHEELS IDENTIFICATION
3	DATE OF RIDE Year
4	RIDE ATTEMPT
5	ROUTE NUMBER
6	BUS #
7	TIME ARRIVING: HOUR: (PLEASE CONFIRM AM OR PM)
8	STREET BUS WAS TRAVELING ON BOARDING:
9	NEAREST CROSS STREET BOARDING:
10	WAS BOARDING STOP ACCESSIBLE? Yes No
11	DID THE OPERATOR:
	IF OTHER, PLEASE EXPLAIN:

12	DID OPERATOR ATTEMPT TO CALL IN ABOUT YOU IN YOUR PRESENCE BEFORE LEAVING? Yes No
13	DID THE NEXT BUS PICK YOU UP? Yes No
14	HOW & WHEN DID YOU LEAVE THE STOP?
	GENERAL COMMENTS