Complaint Form
Please indicate date complaint was made
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Month
-
Day
Year
Date
Person Calling In Complaint
First Name
Last Name
If Person is Calling on Behalf of Someone - Name of Person
First Name
Last Name
Phone number
-
Area Code
Phone Number
Email address
What type of Complaint?
Civil Rights (mistreated because of who they are)
Operational/Safety Issue
Nuisance Issue
Date of the Issue
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Month
-
Day
Year
Date
Time of the issue
1
2
3
4
5
6
7
8
9
10
11
12
:
Hour
00
10
20
30
40
50
Minutes
AM
PM
AM/PM Option
Bus Number (if bus involved - if unknown, put NK)
Staff Person Involved (if no, or unknown, put NK)
Detailed Description of the Issue (e.g. who, what, where when, how)
Any other critical information that will help us with the issue
Follow Up Response Requested (Please note that if the answer is yes, we will get back to them on the issue within 5-7 days)
Yes
No
Name of Person Taking Complaint
First Name
Last Name
Has an incident report been filed by the Driver
Yes
No
Don't know
Submit
Should be Empty: