Secure Transportation Complaint Form share Instagram link Twitter link Facebook link Edit Form Secure Transportation Complaint Form All complaints filed against a secure transportation service may be subject to the Colorado Open Records Act and subject to public disclosure. Your information: Name*? Mailing Address*? Phone Number* Email* What is your preferred method of contact?* Mail Phone Email Is the complaint on behalf of:* Yourself Someone else If the complaint is being filed for someone else, what is their name? What is their relationship to you? What is the basis of this complaint?* Client rights Response time Staff/personnel Unlicensed service/unpermitted vehicle(s) Other If other, please explain. Description of incident What is the name of the secure transportation service?* When did the event(s) of concern occur?*? Approximately what time did the event occur?*? Is the problem ongoing?* Yes No Is the individual still receiving care as a result of the incident(s)?* Yes No What is the individual's condition now?* Was anyone else involved in the incident? (i.e. other staff, family, friends, law enforcement, fire personnel, receiving facility staff, physicians, or bystanders)* Yes No Were there any witnesses to the incident(s)?* Yes No Please list anyone who was involved with or witnessed the incident(s). Do you have any evidence of the incident? (i.e. pictures, video or audio recordings)* Yes No If yes, are you willing to provide these as part of the investigation into the incident? Yes No You may upload evidence here.? Have you taken any additional actions?* Yes No If yes, what actions have you taken? Have you spoken with anyone from the secure transportation service?* Yes No If yes, who did you speak with? Has the secure transportation service tried to address the situation?* Yes No If yes, what has been done? What prompted this complaint? Please describe what happened and attach additional pages if necessary.* File upload for additional pages to describe complaint. Are any law enforcement agencies involved?* Yes No Please name the law enforcement agency or agencies involved.