ICCC ICCC (Incident, Compliments, Complaints, Collisions) HiddenWho is this from? Transportation Demand Management Safety System HiddenRoot Cause Operations Shop Driver Sales Wash Crew 3 day callout Preventable Non-Preventable Accounting Coaching Completed Type of Action* Incident Compliment Complaint Collision Employee Injury Driver Violation Department* Operations Driver Shop Washcrew Office TrainingSafety/Compliance Base of Operation* Starline - Seattle A&A - Yakima A&A - Pasco Wheatland - Pullman Did this cause a service interruption?* Yes No Unknown at this time Time of Event* : Hours Minutes Date of Event* MM slash DD slash YYYY Person Submitting InformationName of person making notification* First Last This is the person who called in on the phone to make a complaint, is the employee reporting an issue or is the customer calling to provide positive feedback. PhoneCharter and Equipment InformationLocation of Event* Is vehicle number known?* Yes No Unknown at this time Equipment Number involved:* Is charter number known?* Yes No Unknown at this time Charter number:* Required for all Service InterruptionsWere PAX on-board the vehicle during the incident?* Yes No Unknown at this time Number of PAX on-board:*Passenger reaction(s):*Driver or Employee InformationWas the driver injured?* Yes No Is Employee name known?* Yes No Name of Employee* First Last Describe EventPlease describe Training or other type of event.*Complaint InformationDescription of Complaint:*What did the person making the call have to say? This is what they told you if you are the one making the entry, and you saw this happen, write down what happened here. Compliment InformationDescription of Compliment:*What did the person making the call have to say? This is what they told you if you are the one making the entry, and you saw this happen, write down what happened here. Incident InformationDescription of Incident:*Action Taken*Action Still Required and by Whom:*Collision InformationWere the Police or other authorities contacted?* Yes No Was the company driver cited?* Yes No Citation or case number* Please describe charge or details of situation listed on report such as Speeding, Failure to Yield, Following to Closely* How many vehicles were involved in this collision NOT INCLUDING company equipment* 0 1 2 3 Vehicle 1 License Plate* Vehicle 1 VIN (Vehicle Identification Number* Typically 17 digits in United StatesVehicle 1 Driver Name* First Last Vehicle 1 Driver Phone Number*Vehicle 1 Insurance Provider* Vehicle 1 Insurance Policy number* Vehicle 1 Insurance Company Phone*Vehicle 2 License Plate* Vehicle 2 VIN (Vehicle Identification Number* Typically 17 digits in United StatesVehicle 2 Driver Name* First Last Vehicle 2 Driver Phone Number*Vehicle 2 Insurance Provider* Vehicle 2 Insurance Policy number* Vehicle 2 Insurance Company Phone*Vehicle 3 License Plate* Vehicle 3 VIN (Vehicle Identification Number* Typically 17 digits in United StatesVehicle 3 Driver Name* First Last Vehicle 3 Driver Phone Number*Vehicle 3 Insurance Provider* Vehicle 3 Insurance Policy number* Vehicle 3 Insurance Company Phone*Collision DescriptionDescribe the collision in as much detail as possible.Witness InformationWas there a witness?* Yes No How Many witnesses?* 1 2 3 Witness Description of Incident*Name* First Last PhoneWitness Description of Incident*Name* First Last PhoneWitness Description of Incident*Name* First Last PhoneService InterruptionDepartment Responsible Driver Mechanics Wash Crew Dispatch Sales Safety/ Compliance Outside Influence If more than one department is responsible, complete multiple ICCCs. If the interruption was caused by circumstances outside our control, select "Outside Influence."Description of Service InterruptionPlease describe in detail the events that caused the service failure.Actions taken to resolve Service InterruptionIf not applicable enter: "n/a"Amount of RefundAdditional CostsTotalDescription of Associated Costs Describe any costs recorded in the "Additional Costs" Field. If not applicable enter: "n/a"Employee InjuryDescribe Injury*Upload support documents here: Drop files here or Select files Max. file size: 20 MB. Images, statements, documentsDriver ViolationDriver Email Violation Type* Speeding Harsh Event Following too closely Tampering with Device Hours of Service Percentage Over*Trip Miles*Manager or Recipient InformationManagement notified at the time: Yes No How were they notified:*Submitted by:* First Last Title* What position will need to address this issue?* Dispatch Training/Safety/Compliance HR Manager Operations Manager COO The system will send a message to the selected department AND the system administrator. Final ActionsInsurance Claim Number Leave blank if not applicable.Actions or Conclusions Remedial training needed Corrective action needed Manager Review PAN follow up Not at Fault TBD Kudos No further action required Upload any Document here Drop files here or Select files Max. file size: 20 MB. Describe action to be taken:HiddenHas this collision investigation process been completed? Yes No HiddenWas payment made and if so, how? Insurance In House No Payment Payment received from others HiddenWas this PANned? Yes No HiddenPlease provide finalization details
