Paratransit Trip Denial Log

Required documentation of any denied ADA paratransit trip, including the specific denial reason and supporting details per 49 CFR 37.125.

Trip Request Details

• Date of Trip Request
  Date the paratransit trip was requested.
• Requested Pickup Date
  Date the rider requested pickup.
• Requested Pickup Time
  Requested pickup time, if applicable.
• Trip Type
  Select the trip type associated with the request.
• Service Area
  Optional service area or zone identifier.

Rider and Request Identification

• Rider ID or Client Number
  Use an internal rider identifier instead of full personal details whenever possible.
• Request Reference Number
  Reservation, dispatch, or call-center reference number.
• Staff Member Recording Denial
  Name or employee ID of the staff member documenting the denial.
• How Was the Request Received?
  Optional field for operational analysis.

Denial Reason and Operational Details

• Primary Reason for Denial
  Select the most specific reason that applies.
• Capacity Constraint Details
  Select all capacity-related factors that contributed to the denial.
• Detailed Explanation of Denial
  Provide a factual, specific explanation of why the trip was denied. Include operational facts, not opinions.
• Alternative Transportation or Trip Option Offered?
  Indicate whether an alternative was offered.
• Alternative Offered Details
  Describe any alternate pickup time, trip option, or referral provided.

Review, Follow-Up, and Compliance Notes

• Supervisor Notified?
  Indicate whether a supervisor was informed of the denial.
• Follow-Up Action Taken
  Select all actions taken after the denial.
• Compliance Notes
  Add any additional notes relevant to ADA compliance, audit trail, or investigation.
• Log Entry Date
  Date this denial log entry was created.

Certification

• Certification
• Submitted By
  Name or employee ID of the person submitting this log entry.
• Signature
  Signature confirming the accuracy of the record.