Shelley Form
Transit Operator:
Date:
*
Previous Observation Date:
Date of Last Incident/Accident:
Vehicle #:
Route Number:
Boarding Location:
Brd Start Time:
SCORE: 3 - Exceeds Expectations, 2 - Meets Expectations, 1 - Needs Improvement, N/O - Not Observed
1. Smooth*
*
Please Select
3
2
1
N/O
Smooth
2. Turns*
*
Please Select
3
2
1
N/O
Turns
3. Railroad crossings*
*
Please Select
3
2
1
N/O
Railroad crossings
4. Speed control*
*
Please Select
3
2
1
N/O
Speed control
5. Stopping distance
*
Please Select
3
2
1
N/O
Stopping distance
6. Wears seatbelt
*
Please Select
Yes
No
Yes or No
Wears seatbelt
7. Door operation
*
Please Select
3
2
1
N/O
Door operation
8. Climate control
*
Please Select
3
2
1
N/O
Climate control
9. Proper uniform*
*
Please Select
3
2
1
N/O
Proper uniform
Passenger Relations
10. Passenger relations*
*
Please Select
3
2
1
N/O
Passenger relations
11. Proper greeting*
*
3
2
1
N/O
Proper greeting
12. Escorting door to door*
*
3
2
1
N/O
Escorting door to door
13. Offering assistance*
*
3
2
1
N/O
Offering assistance
14. Maintains safe positions*
*
3
2
1
N/O
Maintains safe positions
15. Offering assistance with seatbelt*
*
3
2
1
N/O
Offering assistance with seatbelt
16. Consistent comfort checks*
*
3
2
1
N/O
Consistent comfort checks
17. Bus interior*
*
Please Select
3
2
1
N/O
Bus interior
18. Distracted driving*
*
Please Select
3
2
1
N/O
Distracted driving
19. Miscellaneous Observations*
*
Please Select
3
2
1
N/O
Miscellaneous observations
Lift Procedures
20.Assisting ambulatory onto and off of lift
*
3
2
1
N/O
Assisting ambulatory onto and off of lift
21.Consistently asking passengers to hold onto handrail
*
3
2
1
N/O
Consistently asking passengers to hold onto handrail
22.Proper hand positioning
*
3
2
1
N/O
Proper hand positioning
23.Asking passengers to wait
*
3
2
1
N/O
Asking passengers to wait
24.Wheelchair management
*
3
2
1
N/O
Wheelchair management
25.Assisting passengers in wheelchairs onto and off of lift
*
3
2
1
N/O
Assisting passengers in wheelchairs onto and off of lift
Securement
26.Mobility Device Securement
*
3
2
1
N/O
Mobility Device Securement
27.Placing wheelchair correctly between tracks
*
3
2
1
N/O
Placing wheelchair correctly between tracks
28.Placing front securements to outside track
*
3
2
1
N/O
Placing front securements to outside track
29.Placing back securements to inside track
*
3
2
1
N/O
Placing back securements to inside track
30.Attaching all securements to permanent non removable frame
*
3
2
1
N/O
Attaching all securements to permanent non removable frame
31.Asking passengers to "rock and roll"
*
3
2
1
N/O
Asking passengers to "rock and roll"
32.Proper lap and shoulder belt placement
*
3
2
1
N/O
Proper lap and shoulder belt placement
33. On time/schedule
*
Please Select
3
2
1
N/O
(early or late)
On time/schedule
34. Operator Cellphone Use*
*
Yes
No
N/O
General Comments:
Full Name
*
First Name
Last Name
Email
example@example.com
Signature
Submit
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