SECTION 5310 QUARTERLY OPERATING REPORT MONTHS/YEAR: DATE PREPARED: ORGANIZATION NAME: VEHICLE MARKER PLATE #: ODOMETER READING: INSTRUCTIONS FOR ONE-WAY TRIPS PROVIDED TYPES OF PASSENGERS & TRIP PURPOSE: – In #4 & #5, record the number of one-way trips provided, NOT the number of individuals that are receiving service. A one-way trip should be recorded each time a passenger boards the vehicle. For example, a ROUND TRIP for a single individual will account for 2 ONE-WAY trips, because the passenger boarded the vehicle on 2 different occasions. TYPES OF PASSENGERS TRIP PURPOSE -60 w/ DISABILITY (WHEELCHAIR) MEDICAL -60 w/ DISABILITY EMPLOYMENT -60 OTHER NUTRITION 60+ SENIORS SOCIAL/REC EDUCATION 60+ w/ DISABILITY (WHEELCHAIR) SHOP/PERSONAL 60+ w/ DISABILITY OTHER TOTAL: TOTAL: ESTIMATE THE NUMBER OF INDIVIDUALS IN THE FOLLOWING GROUPS THAT RECEIVE SERVICE: BLACK HISPANIC WHITE ASIAN/PACIFIC ISLANDER AMERICAN INDIAN/ALASKAN NATIVE TOTAL MILES DRIVEN FOR THE QUARTER NUMBER OF DAYS OPERATED FOR THE QUARTER AVERAGE NUMBER OF HOURS IN SERVICE PER DAY AVERAGE NUMBER OF MILES DRIVEN PER DAY NUMBER OF GALLONS OF FUEL USED FOR THE QUARTER QUARTERLY OPERATING EXPENSES: PERSONNEL $ REPAIRS $ INSURANCE $ GASOLINE $ MAINTENANCE $ MISC $
SECTION 5310 QUARTERLY OPERATING REPORT MONTHS/YEAR: DATE PREPARED: ORGANIZATION NAME: VEHICLE MARKER PLATE #: ODOMETER READING: INSTRUCTIONS FOR ONE-WAY TRIPS PROVIDED – TYPES OF PASSENGERS & TRIP PURPOSE: In #4 & #5, record the number of one-way trips provided, NOT the number of individuals that are receiving service. A one-way trip should be recorded each time a passenger boards the vehicle. For example, a ROUND TRIP for a single individual will account for 2 ONE-WAY trips, because the passenger boarded the vehicle on 2 different occasions. TYPES OF PASSENGERS -60 w/ DISABILITY (WHEELCHAIR) -60 w/ DISABILITY -60 OTHER 60+ SENIORS 60+ w/ DISABILITY (WHEELCHAIR) 60+ w/ DISABILITY TOTAL: TRIP PURPOSE MEDICAL EMPLOYMENT NUTRITION SOCIAL/REC EDUCATION SHOP/PERSONAL OTHER TOTAL: ESTIMATE THE NUMBER OF INDIVIDUALS IN THE FOLLOWING GROUPS THAT RECEIVE SERVICE: BLACK HISPANIC WHITE ASIAN/PACIFIC ISLANDER AMERICAN INDIAN/ALASKAN NATIVE TOTAL MILES DRIVEN FOR THE QUARTER NUMBER OF DAYS OPERATED FOR THE QUARTER AVERAGE NUMBER OF HOURS IN SERVICE PER DAY AVERAGE NUMBER OF MILES DRIVEN PER DAY NUMBER OF GALLONS OF FUEL USED FOR THE QUARTER QUARTERLY OPERATING EXPENSES: PERSONNEL $ REPAIRS $ INSURANCE $ GASOLINE $ MAINTENANCE $ MISC $