Please complete and fax to Community Transit of Delaware
County, Inc.
at 610.490.3992
attn: Lisa S Soltner, Director
of Operations
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Passenger’s
Name:__________________________________
Passenger’s ID #:_____________
Incident Date:
____________ Pick Up Time: _________
Actual Pick Up Time: _________
Vehicle
Number: _________ Driver’s Name: _______________________________________
Agency:
______________________________________________________________________
Agency
Representative:
_______________________ Telephone
Number: ________________
Instructions:
Circle all items
that apply and explain. Use reverse side
if necessary.
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On-Time Performance: Pick-up was: More
than 20 minutes early More
than 35 minutes late More
than 60 minutes late Other:________________________ Passenger
rode on vehicle too long Vehicle
never showed Other:___________________ Passenger arrived at
destination: More
than 35 minutes late More
than 60 minutes late Did
not arrive at program at all Other:________________________ |
Lack of
Professionalism: Driver Vehicle
Escort/Aide Dispatcher Customer
Service Representative Driving: Too
fast/reckless Lack
of driver assistance Driver
smoking Passenger
not safely secured in vehicle Driver
not parking so that passenger may safely embark/disembark vehicle Dispatch/Customer
Service: Inaccurate
information given Inability
to contact driver via radio for ETA Phones: On
hold longer than 12 minutes Busy
signal No
answer |
Trip Scheduling: Not
in computer Wrong
date/time/destination Wrong
type of vehicle sent Standing
order unavailable Vehicle: Dirty Heating/Air
Conditioning Securement/Belts Other:________________________ Commendation: Driver Vehicle
Escort/Aide Dispatcher Customer
Service Representative Other:________________________ |
Additional
Comments:
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For Community Transit Use Only: Assigned
to: _________________________________
for investigation on ____/____/____ Response to: _________________________________
no later than ____/____/____ “Q” Incident
Number: ____________ What follow-up
is needed? Follow-up
completed by:
________________________________on ____/____/____ |