ADA Complaint Form

Section 504

Americans with Disabilities Act and Section 504 of the Rehabilitation Act of 1973, as amended

ADA-Related Service Complaints

RTD welcomes comments, complements, and complaints from customers on their experiences using RTD services. Customer input helps us identify areas needing improvement, and commendations are always appreciated.

For information on filing a complaint, contact San Joaquin RTD’s Administrative Office. Complaints must be in writing and must be filed within 180 days following the date of the alleged discriminatory occurrence. A complaint may also be made on the ADA Complaint Form below. If the complainant is unable to write a complaint, RTD staff will provide assistance.

ADA Complaint Form Downloadable PDF

Section 1: BASIC INFORMATION OF COMPLAINANT

Person Submitting Complaint Information

Name

First

Last

Address

Address Line 1

Address Line 2

City

State

Zip Code

Phone

Complainant's Information

Name (only if different than person submitting the complaint)

First

Last

Address

Address Line 1

Address Line 2

City

State

Zip Code

Phone

SECTION 2: INCIDENT DETAILS

Accessibility Complaint

Date

Time

(if this does not apply to you, please skip and fill out the disability complaint portion)

Route Number

Operator Number

Operator Description

Discrimination Based on Disability Complaint

Date

Time

Have you filed this complaint with any federal, state, or local agency; or with any federal or state court?

If yes, please provide the contact information for the agency/court where the complaint was filed.

Address Line 1

Address Line 2

City

State

Zip Code

Phone

SECTION 3: INCIDENT EXPLANATION

ACCESSIBILITY ISSUE: If there is an accessibility issue, please explain how, when, where, and why you believe RTD is not accessible to persons with disabilities. You may attach additional pages if additional space is required. You may also attach any written materials or other information that you think is relevant to your complaint. DISCRIMINATION BASED ON DISABILITY: If there is alleged discrimination based on disability, please explain what happened and whom you believe was responsible. Provide all details, pertinent facts and circumstances surrounding the alleged discrimination that will help RTD investigate your complaint. Specific details include: dates, times, route numbers, bus numbers and locations. You may attach additional pages if additional space is required. You may also attach any written materials or other information that you think is relevant to your complaint.