Passenger Complaint Form

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					                    Passenger Complaint Form
Name: ____________________________Phone: ______________
Date of Complaint: __________________ Time: ______________
Date of Incident: ___________________ Time: ______________
Route: _______________________ Vehicle Number:__________
   Fixed Route                   Paratransit

Complaint: ____________________________________________
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Investigated by: ________________________ Date: _________
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Director: ______________________________ Date: _________
             ADA Related                              NON-ADA Related

    Forward complaint to CATS ?                  Yes ______ No _______
                  ALTERNATE FORMAT AVAILABLE UPON REQUEST.

***If assistance in filling out a complaint form is required, please call the office
(219-391-8465) and our staff will assist you.***

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