San Joaquin Regional Transit District
Bus Accessible Service Report Card
Wheelchair Users Pickup Report

1.	Name
2.	Metro Wheels I.D. Number
3.	Date Of Ride Year
4.	Route Number.
5.	Bus Number.
6.	Attempted Boarding Today
	BOARDING THE BUS
6a..	Time Boarding
7.	Street Traveling On:
8.	Cross Street:
9.	Northbound Southbound Eastbound Westbound
10.	Was Stop Accessible? Yes No
11.	Was Path Of Travel To Stop Accessible? Yes No
	EXITING THE BUS
12.	Time Exiting
13.	Street Traveling On:
14.	Cross Street:
15.	Was Stop Accessible? Yes No
16.	Was Path Of Travel From Stop Accessible? Yes No
	Did The Operator:
17.	Stop The Bus With Easy Access To Lift? Yes No
18.	Act In Professional & Courteous Manner? Yes No
19.	Secure Mobility Device Properly? Yes No
	Did You Find Defects With These Accessibility Features?
20.	Securements Yes No
21.	Destination Sign Yes No
22.	Stop Request Bell Yes No
23.	Wheelchair Lift Yes No
	Did The Operator Announce:
24.	Route # And Destination When Door Opened? Yes No
25.	Stops at Major Intersections? Yes No N/A - We Did Not Cross Major Intersection
26.	Route Transfer Points? Yes No N/A - We Did Not Cross A Route Transfer Point
27.	Major Points Of Interest? Yes No N/A - We did not go to major activity cente
28.	Another Stop Which You Requested? Yes No N/A - I Did Not Request Another Stop
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