Bus Movement Standards Of Service & Inspection Checklist (DTMO Bus Form-01)

Use this form to report equipment inspection results and/or service feedback for a bus movement scheduled through a Transportation Officer. Submit a separate form for each move. Use the Comments fields to describe any issues, and attach photos of the VIN and of any damage or deficiencies where prompted.

SECTION I MOVEMENT INFORMATION

Date:

Format: mm/dd/yyyy

MRN Number: W_____

Enter the correct MRN for this move (found in the Final Move Package). Feedback cannot be associated with the move without the correct MRN.

Trip Type:

One-way
Round-Trip

SECTION II — CARRIER & VEHICLE INFORMATION
Note: Each DoD vehicle must be marked with the carrier's legal name, city/state, and DOT number (DBA 3.22). If markings are missing, note it in Comments.

Carrier (Company) Name:

Carrier DOT Number: (if known)

Bus/Vehicle Number: (If known)

Seating Capacity: (PAX)

SECTION III — UNIT / GROUP LEADER INFORMATION

Group Leader Name (Last, First, MI):	Group Leader Name (Last, First, MI):
Group Leader Rank/Grade:	Group Leader Rank/Grade:
Group Leader (Official Work) E-mail:	Group Leader (Official Work) E-mail:
Group Leader Phone:	Group Leader Phone:
Unit/Command Name	Unit/Command Name

Branch of Service:

SECTION IV — TRANSPORTATION OFFICER (TO) INFORMATION

A copy of this checklist can be sent to the TO if an e-mail is provided.

A copy of checklist will be sent to the TO if e-mail is provided.

TO Name:	TO Name:
TO E-mail (Work):	TO E-mail (Work):

SECTION V —SERVICE & COMFORT STANDARDS (Post-Move)

Rate each based on the DBA Standards of Service. Complete for Post-Move or Both.

Standard	Satisfactory	Deficient
Interior temperature / working A/C & heat	Interior temperature / working A/C & heat, Satisfactory	Interior temperature / working A/C & heat, Deficient
Cleanliness of interior & exterior	Cleanliness of interior & exterior, Satisfactory	Cleanliness of interior & exterior, Deficient
Restroom/lavatory clean, functional, supplied (tissue, soap/towelettes, water)	Restroom/lavatory clean, functional, supplied (tissue, soap/towelettes, water), Satisfactory	Restroom/lavatory clean, functional, supplied (tissue, soap/towelettes, water), Deficient
Adequate lighting	Adequate lighting, Satisfactory	Adequate lighting, Deficient
Non-smoking maintained	Non-smoking maintained, Satisfactory	Non-smoking maintained, Deficient
Rest/meal stops adequate and as scheduled	Rest/meal stops adequate and as scheduled, Satisfactory	Rest/meal stops adequate and as scheduled, Deficient

For any "Deficient" item above, describe in detail [text] below:

Interior temperature / working A/C & heat

Cleanliness of interior & exterior

Restroom/lavatory clean, functional, supplied (tissue, soap/towelettes, water)

Adequate lighting

Non-smoking maintained

Rest/meal stops adequate and as scheduled

Were there any safety concerns (lighting, fire extinguisher, etc.)?

Were there any interior/exterior concerns (lavatory, seats, tires, etc.)?

Were there any mechanical concerns (engine, A/C, heat, brakes, windshield wipers, etc.)?

SECTION VI —DRIVER PERFORMANCE

Inquiry	Yes	No
Driver appearance and demeanor professional?	Driver appearance and demeanor professional?, Yes	Driver appearance and demeanor professional?, No
Any abusive language, aggressive behavior, or solicitation by driver?	Any abusive language, aggressive behavior, or solicitation by driver?, Yes	Any abusive language, aggressive behavior, or solicitation by driver?, No
Driver demonstrated familiarity with route/itinerary?	Driver demonstrated familiarity with route/itinerary?, Yes	Driver demonstrated familiarity with route/itinerary?, No

SECTION VII —INCIDENTS

Inquiry	Yes	No
Did an accident/incident occur during the movement?	Did an accident/incident occur during the movement?, Yes	Did an accident/incident occur during the movement?, No
Was there a delay of one hour or more?	Was there a delay of one hour or more?, Yes	Was there a delay of one hour or more?, No
Was there damage to carrier equipment or passenger baggage/impedimenta?	Was there damage to carrier equipment or passenger baggage/impedimenta?, Yes	Was there damage to carrier equipment or passenger baggage/impedimenta?, No

If yes was selected for any of the above questions, please provide photos below.

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Image:

Tags: (Click on image or [Add Tag] here)

SECTION VIII —OVERALL FEEDBACK

Rate the overall service provided by this carrier:

Topics	Poor	Satisfactory	Good	Very Good	Excellent
Rating	Rating, Poor	Rating, Satisfactory	Rating, Good	Rating, Very Good	Rating, Excellent

Please provide any additional feedback on the overall service of the carrier.

Would you like to alert the DTMO Bus Team of issue concerning this move?

SECTION IX — ATTACHMENTS & SUBMISSION

If you have any additional photos of any deficiencies, damage, or issues noted above, you may upload additional images below.

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Image:

Tags: (Click on image or [Add Tag] here)

Please verify all e-mail addresses are correct. The Group Leader, TO, and DTMO will receive an e-mailed receipt of this form upon submission. You will be contacted if the MRN is incorrect.

CUI//PRVCY
PRIVACY ACT STATEMENT
AUTHORITY: 5 U.S.C. Section 552a
PURPOSE: Collecting feedback from passengers utilizing DoD Approved Bus Carrier's for GOPAX movements. Feedback will be utilized to improve carrier service by providing carriers an opportunity to respond to poor performance and address any concerns with a Corrective Action Plan.
ROUTINE USES: Department of Defense and External DoD Approved Bus Carrier's
DISCLOSURE: Providing this information is voluntary.

Visit the Defense Travel Management Office (DTMO) at travel.dod.mil
For DTS Support or Travel Assistance, go to travel.dod.mil/Support/