Grafton-Coos Regional Coordination Survey

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The Grafton-Coos Regional Coordination Council on Community Transportation is conducting this survey to learn more about transportation providers in this region.The objective of this survey is to inform efforts to enhance coordination of services among the various agencies that are providing transportation by learning about common business and operational practices.

The survey contains 20 multiple choice questions and should take about 20 minutes to complete. Answers are required to all questions and space for comments or further explanation have been provided if you would like to offer additional information.

The survey will be open for response through July 15, 2010. When you have completed the survey you will be redirected to the Grafton-Coos Regional Coordination Council website at http://www.grafton-coosrcc.org

Thank you for participating in this survey.
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1. ORGANIZATION CONTACT INFORMATION: Please begin by entering information about your organization below:
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2. In which Grafton or Coos County cities and towns do you provide transportation?If you provide transports to residents throughout each of the counties, check just those boxes. If you provide service to a limited number of towns, please check all that apply
3. Please tell us about who your organization serves with transportation in the Grafton-Coos County Region. Please check all that apply.
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4. Does your organization transport passengers across state lines?
YesNo
We transport passengers across state lines, but only using non-CDL vehicles.
We transport passengers across state lines using volunteer-owned autos.
We transport passengers across state lines in our vehicles that comply with FMCSA/FTA regulations.
We DO NOT transport passengers across state lines.
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5. FLEET INFORMATION 1:Please tell us about the TYPES of vehicles in your fleet:
Check all that ApplyVehicles are Wheelchair Accessible
Sedans/Passenger Auto (up to 7 passengers)Non-CDL
Small Vans (8-15 passengers) Non-CDL
Large Vans (9-10 passengers) Non-CDL
Small Transit Bus (14-16 passengers)
Medium Transit Bus (18-20 passengers)
Large Transit Bus (20 + passengers)
Ambulance
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6. FLEET INFORMATION 2: Please indicate the NUMBER of each vehicle type that is used in your organization. Respond with a number, not text:
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7. FLEET INFORMATION 3: What is the SEATING CAPACITY of each type of vehicle in your fleet? Please respond with a whole number, not text:
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8. Please tell us if you have an Internet connection. If you do, please choose the type of connection from the list.
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9. MANAGEMENT INFORMATION SYSTEM: Most transportation providers record some information about clients in order to provide their services. First we would like to know a little bit about how your organization is managing data. We also want to learn about the staff that work on dispatching or scheduling trips. Please tell us whether:
YESNO
You collect trip information electronically
You collect trip information on paper only
You have personnel on staff that collect this data
You have volunteers on staff that collect this data
You provide training to staff on scheduling or dispatching
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10. DEMOGRAPHIC DATA: We would like to know more about the type of information that you collect and store in either paper files or electronic database about transports. Please indicate whether:
YESNO
You assign a unique customer identification number such as the last four digits of the social security number
You have a method for determining the unduplicated number of individuals served
You note special needs information such as mobility device or personal care attendant in your records
You Record Town of Residence
You Record the Zip Code
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11. TRIP PURPOSE INFORMATION:Do you collect information about the purpose of each trip? If so, do you capture general detail such as those options provided below:
YES, WE COLLECT THIS INFORMATIONNO, WE DO NOT COLLECT THIS INFORMATION
Acute Medical including Chemotherapy or Dialysis
General Medical
Human Services Appointments
Education/Training
Employment
Social Events
Shopping
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12. MODE OF TRANSPORT:Do you track the mode or method of each transport using descriptions such as those options listed below?
YESNO
Volunteer Driver
Taxi Company
Fixed Route
Demand Response (Dial-a-Ride)
Ambulance Van
Ambulance
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13. VEHICLE INFORMATION FOR BILLING:Does your agency track the type of vehicle in which individual clients are transported? Are the trip costs calculated (allocated) based on the type of vehicle used for the transport?
YESNO
We track the type of vehicle used:
We determine trip costs based on the type of vehicle used:
We have a trip cost allocation plan that is used to determine the costs/charges for each client:
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14. ORIGINATION/PICK-UP INFORMATION:Now we would like to learn more about the kind of information that is collected that might be used to determine actual travel patterns of clients and that might be used to improve coordination of trips. Do you collect the following information about the Origination/Pick-Up Location?
YES, WE COLLECT THIS INFORMATIONNO, WE DO NOT COLLECT THIS INFORMATION
Street Address
Town
State
Zip Code
Date
Time
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15. DESTINATION/DROP-OFF INFORMATION:Now we would like to learn the same thing about Drop-Off Information. Do you collect the following information about the Destination/Drop-Off Location?
YES, WE COLLECT THIS INFORMATIONNO, WE DO NOT COLLECT THIS INFORMATION
Street Address
Town
State
Zip code
Date
Time
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16. TRIP STATUS INFORMATION:The following information is often sought to determine whether trips have been completed as scheduled or whether there are instances of community need that cannot be met with existing resources. Do you record information about trips such as the items below?
YES, WE COLLECT THIS INFORMATIONNO, WE DO NOT COLLECT THIS INFORMATION
Trip completed as scheduled
Trip canceled
Trip Rescheduled
Reason for Cancellation(Weather, Eligibility Change)
Client canceled/Reason
Client No Show
Trip Request Denied/Reason
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17. FUNDING SOURCES: Many agencies have multiple funding sources for the provision of transportation services. Please select all the funding sources that your agency uses to provide transportation:
YESNO
FTA Rural Transportation 5311
FTA Elders & Persons 5310 (Funds Vehicles)
Title III B
Other FTA Program (For example:JARC or New Freedoms)
Medicaid
Other Department of Health & Human Services
Private Pay
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18. MATCH INFORMATION: Agencies match program funds in a variety of ways. Please tell us if your organization uses the following as sources of match funding? Check all that apply.
YESNO
Volunteer Hours
In-Kind Services
Local Tax Contribution
Donations
Fares (above program revenue amount)
State General Funds
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19. STAFF INFORMATION: Many transportation providers have employment and training standards for individuals who drive their clients. Please check the qualifications that apply to the type of driving staff you employ qualifications of staff and volunteers who drive for your agency:
Background CheckedDMV ChecksInsurance VerificationTested for Substance AbuseTrained to DriveTrained to Meet Special Needs
Volunteer Drivers
Bus/Van Drivers We Employ
Bus/Van Drivers Employed by Sub-contractors
20. Please tell us a little more about the type of training that you provide for staff and volunteers. Please check all that apply to each category of driver or that you do not provide the training.
Volunteer DriversPaid Staff Drivers
DO NOT PROVIDE TRAINING
Basic First Aid
Blood Borne Pathogen Protections
Body Mechanics and Ergonomics
Defensive Driving
Emergency Evacuation
Passenger Assistance
Incident/Accident Protocols
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