Name *

Employer *

Supervisor *

Date Service Used *
Month January February March April May June July August September October November December Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 , Year 2009 2010 2011 2012

Time Service Used *
AM PM

PlanetTran Voucher Number *
(This is the number provided to PlanetTran when making your reservation. If you have lost the voucher number please contact the ABC TMA and we will provide it to you.)

Ride Origin *
Origin Work Home Transit Stop Other

If Other:

Ride Destination *
Destination Home Transit Stop Work Hospital School Other

If Other: *

Reason for Ride
Reason Personal Illness Unscheduled Overtime Family Illness Personal Crisis Other

Please Explain *

How long did you wait to be picked up?
Select One 0-15 minutes 15-30 minutes 30-45 minutes 45 + minutes

How important is this in your decision to rideshare or use transit to commute to work?
Select One Very Important Somewhat Important Not Important

Without the GRH program how often would you feel that you had to drive into work each month?
Select One Never 1-3 days 4-10 days Always

How would you rate the level of service?
Select One Excellent Above Average Average Poor

Please share your comments and suggestions on how to improve the program: