TRANSIT ACCESS - OCTA BUS WHEELCHAIR PICK-UP REPORT

OCTA BUS WHEELCHAIR PICK-UP REPORT

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

1	NAME
2	METRO WHEELS IDENTIFICATION
3	DATE OF RIDE Year
4	RIDE ATTEMPT
5	ROUTE NUMBER
6	BUS #
BOARDING THE 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
EXITING THE BUS
11	TIME EXITING: HOUR: (PLEASE CONFIRM AM OR PM)
12	STREET BUS WAS TRAVELING ON EXITING:
13	NEAREST CROSS STREET EXITING:
14	WAS EXITING STOP ACCESSIBLE? Yes No

DID THE OPERATOR:
15	STOP THE BUS WITH EASY ACCESS TO LIFT AREA? Yes No
16	ACT IN PROFESSIONAL AND COURTEOUS MANNER? Yes No
17	SECURE MOBILITY DEVICE PROPERLY? Yes No NA
17a	USE A CELL PHONE WHILE BUS WAS IN MOTION? Yes No N/A - Unable to determine
17b	HAVE PROPER UNIFORM WITH NEAT APPEARANCE? Yes No N/A - Unable to determine
LIFT OPERATING PROBLEMS
18	ANY LIFT OPERATING PROBLEMS? Yes No
19	IF #18 WAS YES, WERE YOU DELAYED?

DID THE OPERATOR ANNOUNCE:
20	ENOUGH STOPS THAT YOU FELT YOU KNEW WHERE YOU WERE? Yes No NA
21	MAJOR STOPS? Yes No NA
22	ROUTE TRANSFER POINTS & ROUTE NUMBER? Yes No NA
23	DESTINATION POINTS? Yes No NA
24	OTHER REQUESTED STOPS? Yes No NA
AUTOMATED VOICE ANNUNCIATOR &PUBLIC ADDRESS SYSTEMS:
25	WAS AUTOMATED ANNOUNCEMENT SYSTEM WORKING PROPERLY? Yes No NA - No Automated Announcement System
26	DID OP. USE THE PUBLIC ADDRESS SYSTEM? Yes No NA - Bus has Automated Announcement System
27	WAS P.A SYSTEM CLEAR & AUDIBLE? Yes No NA - Unable to determine
	GENERAL COMMENTS