METROACCESS (WASHINGTON D.C)
TRIP 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 NUMBER:
  

3-13 INTENTIONALLY LEFT BLANK

DISPATCH (COMPLETE QUESTIONS 14 THROUGH 20 ONLY IF YOU SPOKE WITH METROACCESS DISPATCH STAFF ABOUT A LATE ARRIVAL OR SCHEDULE CHANGE FOR THIS RIDE)
14.  DATE OF CALL:
  Year
15.  TIME OF CALL
15a. REASON FOR CALL
16.  HOW MANY MINUTES BEFORE YOUR SERVICE PROBLEM WAS RESOLVED?

DID THE DISPATCH AGENT:

17.  IDENTIFY COMPANY & GIVE OWN NAME?
YES NO   
AGENT'S NAME:
17a. TRY TO RESOLVE PROBLEM:
(Example - Confirm Your Location, Ask For A Number Where You Can Be Reached, Call Driver/Service Provider)
YES NO  NOT APPLICABLE
18.  GIVE YOU AN ESTIMATED TIME OF ARRIVAL (ETA), IF REQUESTED?
YES NO 
19. GIVE INFORMATION WHICH TURNED OUT TO BE ACCURATE?
YES NO
20.  ACT IN PROFESSIONAL & COURTEOUS MANNER?
YES NO 

TRIP AVAILABILITY & ON-TIME PERFORMANCE (COMPLETE FOR EVERY TRIP)
21.  DATE OF TRIP:
  Year
22. VEHICLE NUMBER:
23. TYPE OF VEHICLE:
24. NAME OF OPERATING COMPANY
IF OTHER
25. SERVICE AREA:
(ORIGIN AND DESTINATION OF TRIP)
26. NEGOTIATED PICK-UP WITHIN 60 MINUTES OF REQUESTED TIME
YES NO 
27. THE VEHICLE ARRIVED AT PICK-UP
28. NOTIFIED IF SCHEDULE WAS CHANGED OR IF THE VEHICLE WAS RUNNING LATE
YES NO  NOT APPLICABLE
29. A LIFT EQUIPPED VEHICLE WAS SENT IF A LIFT WAS REQUIRED
YES NO  NOT APPLICABLE
30. HOW MANY MINUTES DID YOUR TRIP LAST WHILE ON THE VEHICLE?
31. YOU ARRIVED AT DESTINATION ON-TIME
YES NO 

DID THE DRIVER
(COMPLETE FOR EVERY TRIP)
32. INTRODUCE HIM / HERSELF?
YES NO 
33. HAVE A NEAT & PROFESSIONAL APPEARANCE?
YES NO  NOT APPLICABLE
34. ACT IN PROFESSIONAL & COURTEOUS MANNER?
YES NO 
35. OFFER HELP WITHOUT BEING ASKED?
YES NO 
36. GIVE ASSISTANCE WHCH WAS APPROPRIATE, IF ASKED?
YES NO  NOT APPLICABLE
37. DRIVE SAFELY?
YES NO 
38. SECURE MOBILITY DEVICE PROPERLY?
YES NO  NOT APPLICABLE
39. DROP YOU OFF OR PICK YOU UP AT THE CORRECT LOCATION OR ENTRANCE
YES NO 

CONDITION OF VEHICLE -
DID YOU OBSERVE DEFECTS WITH:
40. INTERIOR CLEANLINESS
YES NO  NOT APPLICABLE 
41. EXTERIOR CLEANLINESS
YES NO  NOT APPLICABLE
42. VEHICLE NUMBERS AND MARKINGS
YES NO  NOT APPLICABLE 
43. HEATING / AIR CONDITIONING
YES NO 
44. WHEELCHAIR LIFT
YES NO 
45. SECUREMENTS
YES NO 
46. OTHER (SPECIFY)
 

GENERAL COMMENTS:

 

 

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