Unplanned Service Interruption
Reporter (Dispatcher)
*
Please Select
Alex S
Andy G
Brandin B
Doug A
Doug M
Emily E
Esther A
Evan A
Greg G
Joe B
Kristen Z
Matt F
Mike D
Nikki B
Other
Other's Name (Reporter)
Incident Type
*
Driver Error
Informational
Driver Call-Off
Driver Question
Itinerary
Hotel Issue
New Booking
Scheduling Issue
Outside Service Request
Cancellation
Major Itinerary Change
Customer Issue
Hours of Service
Vehicle Question
Vehicle Cleanliness
Vehicle Readiness (Failed Pretrip)
Vehicle Issue
Breakdown (Vehicle Immobilized)
Accident
Injury
Spill
Positive Customer Experience
Other
Driver
Please Select
OTHER
None
Answering Service
Amon, Virgil [0136]
Anderson, Doug [0004]
Anderson, Evan [0712]
Baer, Nikki [0593]
Bankston, Scott [1258]
Bankston, Keri [1567]
Baughman, John [1733]
Berger, Joe [1498]
Bowser, Chrissy [0719]
Boyts, Scott [1760]
Brenizer, Owen [1685]
Brooks, Kenny [1622]
Burgess, Frank [1727]
Caiarelli, Steve [1376]
Castile, Melissa [1735]
Collier, Tiffany [1614]
Conn, Dan [1677]
Demars, Jason [1755]
Dessaw, Mike [1080]
Diedrich, Todd [1161]
Eaton, Don [1049]
Fisher, Lori [0150]
Fogarty, Jim [0829]
Fox, Rick [1516]
Frampton, Bill [1495]
Funk, Aaron [1658]
Glasser, Mary [1754]
Gray, Greg [1628]
Ho, Alex [1751]
Holmes, David [1083]
Hunter, Darryl [0517]
Kunkel, Tedd [1216]
Lawrence, Don [1446]
Leonard, Amanda [1293]
Lewis, Emily [1630]
Lininger, Walt [1562]
Long, Craig [1552]
Long, Jess [1345]
Luzier, Ray [1758]
Manners, Carrie [1625]
Marciniak, JoAnn [1633]
Martino, Angelo [1048]
Mason, Conor [1507]
Matos, Trina [1505]
McCandless, Bob [1521]
McCluskey, Terry [1508]
McHale, Chris [1681]
Moderelli, Guy [1052]
Morrison, Kirk [1660]
Murrin, Mike [0147]
Nagel, Edythe [1403]
Neubert, Ron [1632]
Obrien, Steve [1535]
Owen, Mark [1160]
Pawluk, Rose [1759]
Pearce, Dick [0269]
Porter, Barry [0387]
Ruth, Linda [1686]
Ruth, Randy [1597]
Schmidt, Kevin [1509]
Sinclair, John [0010]
Slusher, Nick [1294]
Stitt, Bill [0466]
Taylor, Robert [1519]
Valesko, Brandon [1729]
Watson, Brendan [1698]
Wilson, Bill [1680]
Walters, Glenn [0458]
Woods, Rodger [1706]
Wotherspoon, Steve [1337]
Yeckley, Chris [0867]
Young, Kirk [1050]
Yurkanin, Travis [1756]
OTHER
Other's Name (Driver)
Vehicle #
Charter #
Customer / Contact
What Happened?
*
Action Items / Game Plan
Support Required (select multiple if needed)
*
None Required
Dispatch
Mechanic on Call
Outside Service
Safety Department
Sales
Wash Bay
Executive Management (Doug & Evan)
Where did the event occur (use estimates if needed)
Street Address
Street Address Line 2
City
PA
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Passengers on board?
*
No
Yes
Customer Delayed?
*
No
Yes
Delay Duration:
*
Enter the number of hours, rounding to the nearest 15 minutes.
Driver's Question was:
Driver Should have known
Driver had a good question that he wouldn't have known without calling
Driver Training Issue
Vehicle Issue Component
AC / Heat
Air System
Audio / Video System
Battery
Body Component
Brakes
Body Damage
Communication / Driver Error
Electrical
Engine
Hoses / Clamps
Interior Cleanliness
Restroom
Radiator / Coolant
Tires
Transmission
WiFi
Other
Did the Incident Result in Damage to another person's Vehicle or Property.
No
Yes
Did Law Enforcement respond to the scene?
No
Yes
Were any vehicles towed away from the scene?
No
Yes
Did the Incident result in any injuries?
No
Yes
Were Injuries treated away from the scene?
No
Yes
Injured Persons Name, Contact info, Injury Description, and where they were taken:
Photo of damage to company vehicle:
2nd photo of damage to company vehicle
Photo of Accident scene:
Photo of damage o other vehicle or property
2nd photo of damage to other vehicle or property
Photo of other driver's license
Photo of other driver's insurance
Estimated Spill Amount
0 - 1 Gallon (Report)
1 - 5 Gallons (Contain & Report)
5 - 15 Gallons (Contain & Report)
15 - 42 Gallons (Emergency)
42+ Gallons (CRISIS)
Other
Would you like to add Photos?
N/A
Yes (Take a Picture)
Yes (Select a File)
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Distribution List
I declare under penalty of perjury that the foregoing is true and correct.
Signature
Was this an Anderson Tour?
No
Yes
Submit
Date & Time
*
/
Month
/
Day
Year
Date
Hour Minutes
Driver (old)
Should be Empty: