Transportation Satisfaction Survey

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1. Please provide the following information:

Please provide the following information:   Name of Person Completing Form:
Name of Person Receiving Services:
Phone Number:

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2. Are you satisfied with your service

Are you satisfied with your service   Yes No

3. Please rate your experience in the following areas:

	Always	Usually	Never	N/A
Are your pick-up and drop-off times consistent?	*Please rate your experience in the following areas: Are your pick-up and drop-off times consistent? Always	Are your pick-up and drop-off times consistent? Usually	Are your pick-up and drop-off times consistent? Never	Are your pick-up and drop-off times consistent? N/A
If a CHANGE IN ROUTING takes place are you notified beforehand?	If a CHANGE IN ROUTING takes place are you notified beforehand? Always	If a CHANGE IN ROUTING takes place are you notified beforehand? Usually	If a CHANGE IN ROUTING takes place are you notified beforehand? Never	If a CHANGE IN ROUTING takes place are you notified beforehand? N/A
In the event of inclement weather did you know where to look for cancellations i.e. radio stations?	In the event of inclement weather did you know where to look for cancellations i.e. radio stations? Always	In the event of inclement weather did you know where to look for cancellations i.e. radio stations? Usually	In the event of inclement weather did you know where to look for cancellations i.e. radio stations? Never	In the event of inclement weather did you know where to look for cancellations i.e. radio stations? N/A
In occurrences where the van was running late, OTHER THAN INCLEMENT WEATHER, were you notified?	In occurrences where the van was running late, OTHER THAN INCLEMENT WEATHER, were you notified? Always	In occurrences where the van was running late, OTHER THAN INCLEMENT WEATHER, were you notified? Usually	In occurrences where the van was running late, OTHER THAN INCLEMENT WEATHER, were you notified? Never	In occurrences where the van was running late, OTHER THAN INCLEMENT WEATHER, were you notified? N/A
The Drivers/Monitors interact appropriately and treat you with respect?	The Drivers/Monitors interact appropriately and treat you with respect? Always	The Drivers/Monitors interact appropriately and treat you with respect? Usually	The Drivers/Monitors interact appropriately and treat you with respect? Never	The Drivers/Monitors interact appropriately and treat you with respect? N/A
Is the appearance of the vehicles clean and damage free?	Is the appearance of the vehicles clean and damage free? Always	Is the appearance of the vehicles clean and damage free? Usually	Is the appearance of the vehicles clean and damage free? Never	Is the appearance of the vehicles clean and damage free? N/A
Are you able to reach the Transportation Director when necessary?	Are you able to reach the Transportation Director when necessary? Always	Are you able to reach the Transportation Director when necessary? Usually	Are you able to reach the Transportation Director when necessary? Never	Are you able to reach the Transportation Director when necessary? N/A
When you report a transportation issue is it resolved timely?	When you report a transportation issue is it resolved timely? Always	When you report a transportation issue is it resolved timely? Usually	When you report a transportation issue is it resolved timely? Never	When you report a transportation issue is it resolved timely? N/A

4. Do you wish to be contacted regarding transportation services you receive?

Do you wish to be contacted regarding transportation services you receive?   Yes No

5. In our efforts of being a "greener" agency please provide us with you email address for future correspondence.

In our efforts of being a "greener" agency please provide us with you email address for future correspondence.   Email Address: