ICCC

Who is this from?

Transportation Demand Management Safety System

Root Cause

Operations
Shop
Driver
Sales
Wash Crew
3 day callout
Preventable
Non-Preventable
Accounting
Coaching Completed

Type of Action*

Department*

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*

: HH

MM

Date of Event*

Person Submitting Information

Name 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.

Phone

Charter and Equipment Information

Location 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 Interruptions

Were 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 Information

Was the driver injured?*

Yes
No

Is Employee name known?*

Yes
No

Name of Employee*

First Last

Describe Event

Please describe Training or other type of event.*

Complaint Information

Description 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 Information

Description 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 Information

Description of Incident:*

Action Taken*

Action Still Required and by Whom:*

Collision Information

Were 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 States

Vehicle 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 States

Vehicle 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 States

Vehicle 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 Description

Describe the collision in as much detail as possible.

Witness Information

Was there a witness?*

Yes
No

How Many witnesses?*

1
2
3

Witness Description of Incident*

Name*

First Last

Phone

Witness Description of Incident*

Name*

First Last

Phone

Witness Description of Incident*

Name*

First Last

Phone

Service Interruption

Department Responsible

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 Interruption

Please describe in detail the events that caused the service failure.

Actions taken to resolve Service Interruption

If not applicable enter: "n/a"

Amount of Refund

Additional Costs

Total

Description of Associated Costs

Describe any costs recorded in the "Additional Costs" Field. If not applicable enter: "n/a"

Employee Injury

Describe Injury*

Upload support documents here:

Drop files here or

Images, statements, documents

Driver Violation

Driver Email

Violation Type*

Speeding
Harsh Event
Following too closely
Tampering with Device
Hours of Service

Percentage Over*

Trip Miles*

Manager or Recipient Information

Management notified at the time:

Yes
No

How were they notified:*

Submitted by:*

First Last

Title*

What position will need to address this issue?*

The system will send a message to the selected department AND the system administrator.

Final Actions

Insurance 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

Describe action to be taken:

Has this collision investigation process been completed?

Yes
No

Was payment made and if so, how?

Was this PANned?

Yes
No

Please provide finalization details

ICCC (Incident, Compliments, Complaints, Collisions)

Person Submitting Information

Charter and Equipment Information

Driver or Employee Information

Describe Event

Complaint Information

Compliment Information

Incident Information

Collision Information

Witness Information

Service Interruption

Employee Injury

Driver Violation

Manager or Recipient Information

Final Actions

Having Problems? Contact System Admin