Customer Feedback Form

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Time*

: Hours

Minutes

AM/PM
Name*
First Last
Please enter your name
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Do you wish to have a Follow Up?*
- Yes Phone Call
- Yes Email
- No
Do you wish to have a follow-up call or email? Please specify the best number or email to reach you.
Phone #
Email
Date of Occurrence*
MM slash DD slash YYYY

The date the incident happened.
Time of Occurrence*

: Hours

Minutes

AM/PM

Time the incident happened.
Service Mode*
- TARTA Fixed Route
- TARTA Flex
- TARPS
Which service did the incident take place on?
Bus Route*

If Fixed route, please enter the bus route or NA if not known or applicable. Ex. 15A
Bus number

Please enter the bus number if known. ex. 812
Location of Incident
The location the incident happened
Inbound or Outbound*
- Inbound
- Outbound
- N/A
Please choose if this was inbound our outbound. For Call-A-Ride or TARPS outbound would be TO your destination and inbound would be your return trip.
Operator/Driver Name

Operator/Driver (if known)
Operator/Driver - Description

Operator/Driver - Description if known
Operator/Driver - Badge Number

Operator/Driver - Badge Number (if known)
Incident description*
Please describe what happened. Include important details that will allow us to follow-up appropriately.
Upload Pictures
Drop files here or

Accepted file types: jpg, png, pdf, Max. file size: 512 MB, Max. files: 3.
Please upload any pictures you may have for this incident.
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Email
This field is for validation purposes and should be left unchanged.

Customer Feedback Form

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