Accessibility Advisory Committee
Thursday, November 14, 2019 6:30 PM Boardroom, Development and Engineering Services, 305 Barrie Street, Bradford
Agenda
A meeting of the Accessibility Advisory Committee of The Corporation of the Town of Bradford West Gwillimbury will be held Thursday, November 14, 2019 at 6:30 PM, in the Boardroom, Development and Engineering Services, 305 Barrie Street, Bradford, ON. Pages 1. Call to Order The Chair calls the meeting to order.
2. Adoption of Agenda Recommendation: That the Committee Agenda dated November 14, 2019 be adopted as printed.
3. Declarations of Pecuniary Interest and the General Nature
4. Presentations/Deputations There are no presentations.
5. Open Forum Members of the public who are in attendance are invited to address the Committee by signing the Open Forum Register.
6. Adoption of Minutes
6.1 Recommendation: That the minutes of the September 12, 2019 meeting be adopted as printed.
7. Unfinished Business
3 - 32 7.1 BWG Transit - Specialized Services
Page 1 of 32 Accessibility Advisory Committee - November 14, 2019 Agenda That Report COM 2019 36, entitled “BWG Transit – Specialized Services” be received for information.
7.2 Multiyear Plan Updates
7.3 Public Consultation/Survey Results
8. New Business
8.1 CIP Discussion with Michael Kemp, Office of Economic Development
9. Site Plan Reviews Staff have reviewed the number and dimensions of accessible parking spaces in Site Plan circulations.
10. Announcements
11. Next Meeting
11.1 Meeting Date - February 13, 2020
11.2 Agenda items - Employment Initiatives
12. Adjourn Recommendation: That the meeting is hereby adjourned at ______.
Page 2 of 32 Report of Community Services
REPORT #: COM 2019 36
DATE: 14 Nov 2019
TO: Members of the Committee
SUBJECT: BWG Transit - Specialized Services
PREPARED BY: Paul Dubniak, Transportation Technologist
1. RECOMMENDATIONS:
That Report COM 2019 36, entitled “BWG Transit – Specialized Services” be received for information.
2. PREAMBLE:
The purpose of this report is to provide the Committee with information and options for Specialized Transit service.
3. BASIC DATA PERTAINING TO THE MATTER:
Bradford currently operates a scheduled, fixed route ‘conventional’ bus service that meets the requirements of the AODA. The routes operate along a predetermined routing with bus stop infrastructure providing locations to board and alight the transit vehicle. Since BWG Transit service inception, Town staff have received requests for a ‘specialized’ or ‘paratransit’ service.
Specialized services are a pre-booked, shared ride, door to door service for unconditional (permanent) or temporary/conditional passengers that have physical, cognitive, visual or sensory disabilities. Examples of specialized services are:
York Region – Mobility Plus Simcoe County – Linx Plus+ Innisfil – Barrie-Innisfil Taxi Peel Region – Transhelp Toronto – Wheel Trans Orillia – O.W.L.S Barrie – ParaTransit Bracebridge – Bracebridge Mobility Midland/Penetanguishene – Community Reach
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The service is provided to residents who may have difficulty using the conventional service whom must apply and are assessed on a case-by-case basis. The traditional steps for specialized transit eligibility are as follows:
• Complete application form which includes rider information and section to be completed by certified health care professional (Attachment 1 – Example application form) • Often Mini-Mental State Examinations (MMSE) are completed by the transit agency once per month to better understand a potential rider’s needs (Support person for instance) • If registration is approved the passenger is given a card and registration number which is required when a trip is booked • Trip bookings can be received up to three days in advance and made on a ‘first come, first served’ basis. Return trip can be booked at the same time • Pickup/drop-offs can have up to a 45 minute window (in some cases chosen by passenger). Another example is a 30 minute pickup window where the bus can arrive 15 minutes before the scheduled time, or 15 minutes after. • Operators will not wait more than 5 minutes once at the predetermined pick-up location • Rides are shared with other passengers and vehicles DO NOT follow a specific route
In its operation specialized services are fluid in terms of operation and routing allowing for greater flexibility and the ability to make the most from the service. As a result allowances are required in terms of specific pick up and drop off times, as well as travel times that passengers will be on a vehicle for.
Should the Town start a specialized service, it should be noted that the Accessibility for Ontarians with Disabilities Act has several sections (63-74) relate to Specialized service operation, including:
• Eligibility and process requirements • Fare parity – states that the same fare structure and payment options are available on both services (TransitFare smartcard reader) • Hours of service – must operate the same hours and days of service as the conventional transportation services • Booking and Trip restrictions
The vehicles typically used by specialized stem from their primary use. They typically have seating options that are flexible to meet passenger needs. Vehicles are traditionally smaller than conventional fleet vehicles to allow for improved maneuverability as door-to-door services require. Attachment 2 provides examples of vehicles used for specialized services.
Historically conventional and specialized services have run as independent entities. Over the last decade this has changed as demands on transit have increased and agencies have sought methods of maximizing available budgets. For the following options, applicants would apply through the Town. Once approved the Town would maintain the list of riders that would be shared with the service provider. The service provider would then be responsible for day- to-day operation.
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Specialized services operate within the jurisdiction that provides the service, but can cross borders to facilitate transfers between providers. Visitors to the area are eligible to use the service even if they are not registered as long as they can provide confirmation that they are eligible for specialized transportation services in the jurisdiction in which they reside, or who meet the specialized transportation services eligibility requirements of the specialized transportation service provider.
Neighbouring Specialized Providers
Mobility PLUS – York Region Transit
YRT Mobility Plus was created in 2001 following the merger of the various transit agencies in York Region. The service as a whole is being incorporated with the ‘Family of Services’ model and being re-branded as ‘Move on Request’ in 2019.
Staff have spoken with Mobility Plus representatives in the past regarding potential pick up and drop off locations. It was hoped that the GO Station could be used at a future time, but as the location is locked for most of the day it did not meet the Mobility Plus criteria. The Wendy’s at 32 Bridge was initially discussed as a meeting point as the location is open during operational hours and could provide shelter during a transfer. Agreement with property owner/s would need to be insinuated for verification of option.
Barrie-Innisfil Taxi – Innisfil
Innisfil operates an accessible service through a taxi provider. Fares mirror the costs with the UBER program. As Innisfil operates a door-to-door on-demand service as their conventional service, direct parallels with the current Bradford offering is difficult to compare conventional or accessible services.
Linx Plus+ – Simcoe County
Linx+ began service on September 3, 2019 and operates along Route 1 (Penetanguishene to Barrie). Linx Plus+ service will commence along Routes 2 (Wasaga Beach to Barrie), 3 (Orillia to Barrie) and 4 (Wasaga Beach to Collingwood).
The service currently operates within 400 meters of Linx conventional fixed routes for those unable to travel to stop locations. The model operates off a 'family of services' where a person's trip may use a specialized vehicle, conventional vehicle and another specialized vehicle for door-to-door service. Staff at Linx/Linx+ were asked about potential growth in the future and at this time Linx has not received direction from the County council to expand Linx+ services outside of the 400 metre zone.
Specialized Transit service options
For the Town of Bradford, several options are provided below for operation of a Specialized Transit service.
Option 1: Continue transit services as is
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Option 2: Partner with service provider or non-profit community group with an accessible van
This option could mimic the Taxi-to-GO/Reagens program, but utilize an accessible cab vehicle (similar to the BB Taxi vehicle the Town of Bradford supported for conversion through the Accessibility Committee). For this option, the successful provider would be required to provide all the resources necessary to operate a specialized service. At least one spare vehicle maybe required in case of mechanical issues and dependent on program participation/demand, capacity could be met quickly.
Capital costs associated with this option are: Vehicle – $35,000 to $180,000 Technology – $4,000 to $10,000 (Smart Card reader)
Operational costs associated with this option are: Operation through Contractor/Non-Profit – $10,000 to $150,000+ annually Administration of program/ staff time start up – $40,000
Note: Due to the variables involved, costs for this option can have a wide range.
Option 3: Provide specialized as a parallel to conventional services
This option would see BWG Transit operate both a conventional and specialized service under the same umbrella. There would be no changes to the conventional service in operation. Policies and updates would be required for physical and digital notices.
Capital costs associated with this option are: Vehicle – $50,000 to $180,000 (A 2014 vehicle up for replacement could be retained for the short term) Technology – $15,000 (Free if 2014 vehicle up for replacement is retained as it is now installed) Based on tech for the transit vehicle and scheduling system
Operational costs associated with this option are: Operation through Contractor – $230,000 + internal staff to administer and review eligibility
Option 4: Modify part of or all current services to ‘On Demand’ with a specialized component.
As pressures mount for transit to service more groups or serve traditionally difficult areas (lower density, industrial, new developments, urban/rural peripheral areas, etc.) conventional transit agencies have begun to explore other forms of service delivery to areas where it was considered cost prohibitive or ‘too early’. On-Demand transit is a form of transport where vehicles alter their routes based on rider demand rather than using a fixed route or timetable. Vehicles typically pick-up and drop-off passengers in locations according to passenger’s needs. Transit agencies use their own fleet and operators to provide the service.
York Region had several areas with underperforming routes and converted many of these the services to On-Demand in many cases utilizing Mobility Plus capacity. This resulted in transit
Page 6 of 32 COM 2019 36 BWG Transit - Specialized Services Page 5 of 30 levels more appropriate to resident needs at a more effective cost. Riders can then use YRT’s family of services to complete their trip.
Belleville Transit and Sault Ste. Marie Transit now utilizes an On-Demand system for their evening services. Riders can utilize an app or call the agency customer service to book a trip. Information regarding the booking is immediately sent to the user as well as vehicle operator.
Stratford Transit is currently reviewing the use of On-Demand to control its Sunday service.
Town staff have fielded requests for transit service from a variety of locations within the urban boundary (Lormel, Bradford Capital, Westbrook, Great Gulf and Toronto/Church) as well as The Elden and Bond Head. Those making the requests have been all ages with varying levels of ability. With traditional service delivery methods many of these residents are years away from having service within a 400 metre walking distance. If this option were selected, it would have the potential to:
• Provide specialized service • Include the Taxi-to-GO/Reagens • Improve travel options • Improve efficiency • Quickly expand to new areas currently outside of the service area (400 metre walk to transit stop) • Utilize existing fleet • Decrease mileage and fuel costs
Public transit by its nature is public, but a person’s trip is very personal. On-Demand services change the traditional thought of transit passengers adapting to the service, to transit adapting to the passenger.
Capital costs associated with this option are:
Vehicle – $180,000* additional fleet dependent on demand Technology – $10,000 to $25,000 per vehicle (includes annual licensing fee) + $15,000 to $40,000 for implementation and deployment.
Operational costs associated with this option are: Operation through Contractor – $230,000** + internal staff to administer and review eligibility
*Utilizes existing fleet **Operational costs may be covered in the operation of Route 2
As part of this option, costs can vary depending on the scope of work and size of implementation. There are also potential cost savings in terms of fleet requirements, fuel and mileage. This option could be explored further and included for detail pricing as part of the upcoming renewal of contract.
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4. EFFECT ON TOWN FINANCES:
As the report is for information purposes, there are no associated costs. Costs are scaled estimates based on the options provided.
5. ATTACHMENTS:
Attachment 1 – Examples Application Form - Mobility Plus and Linx+ Attachment 2 – Examples of Specialized Transit Vehicles
6. APPROVALS:
Joe Coleman, Manager of Transportation Approved - 18 Oct 2019 Terry Foran, Director of Community Services Approved - 30 Oct 2019 Ian Goodfellow, Director of Finance/Treasurer Approved - 30 Oct 2019 Geoff McKnight, Chief Administrative Officer Approved - 30 Oct 2019
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York Region’s shared ride, door-to-door, accessible public transit service for people with disabilities
mobility plus application package
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Mobility Plus Application
INTRODUCTION Mobility Plus is York Region’s door-to-door shared Cognitive and Mental Health – Applicants ride accessible public transit service for people with cognitive and / or mental health disabilities with disabilities. An applicant may be eligible for who are unable to take conventional transit Mobility Plus services if he / she is a York Region may be eligible for trips to and from approved resident and has a disability that prevents them day programs and work placements. Written from using conventional transit for all or part of confirmation from the day program or placement the trip. This could be due to a visual, sensory, agency is required. cognitive / mental health or physical disability, and Physical – Applicants who have a physical could be either short-term or long-term. Disability disability that prevents them from: alone does not create eligibility; the decision is based on the applicant’s functional ability to use >> walking / rolling 175 metres, conventional transit and is not a medical decision, >> standing or waiting 15 minutes for a bus, or nor is it based on the applicant’s income or age. >> accessing a bus stop due to environmental In addition, unavailability of conventional transit barriers such as inclement weather, lack of curb service does not constitute eligibility. cuts, uneven / broken sidewalks, or steep terrain. Conventional public transit means accessible Eligibility for Mobility Plus is approved according fixed route public transit, i.e. Viva rapid transit, to levels of eligibility in three categories: YRT local routes, Community Bus and Dial-a-Ride. 1. Unconditional – A person with a disability TYPES OF DISABILITIES that prevents them from using conventional public transit. Visual – Applicants who are legally blind and have unsuccessfully travel-trained through an 2. Temporary – A person with a temporary approved agency such as the Canadian National disability that prevents them from using Institute for the Blind ( CNIB ) or who have been conventional public transit for all or part of deemed unsuitable for travel training. their trip. Sensory – Applicants experiencing sensory 3. Conditional eligibility – A person with a motor area conditions ( such as Parkinson’s disability for which environmental or physical disease ) that impact one’s physical ability to barriers limit their ability to consistently use use conventional public transit. conventional public transit.
rev. 04-19
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Mobility Plus Application
HOW TO APPLY SECTION E – consent for the Health Care This four-part application package must be fully Professional completed and signed by you and your health The Transit Ability Coordinator may also contact care professional. you to request that you attend an assessment if SECTION A must be completed by the applicant they are unable to make a decision on eligibility and contains questions about your everyday based on the information in your application. If you mobility and ability / inability to use conventional are not satisfied with the decision of the Transit public transit. Ability Coordinator, you may appeal the decision to the Mobility Plus Eligibility Appeal Panel by calling SECTION B must be completed by your registered 1-877-464-9675, press #1 for Community Support health care professional. Completed applications: Services including Financial Assistance, Children >> may be sent by mail to: Services and Housing, and choose Mobility Plus Eligibility Appeal Panel or send your Notice Mobility Plus Eligibility, York Region Transit of Appeal form to: Access York. 17250 Yonge St, nd 55 Orlando Avenue, 2 Floor Newmarket, ON, L3Y 6Z1 Richmond Hill, Ontario, L4B 0B4 Please photocopy the entire completed >> emailed to [email protected] application for your records in case the original >> or faxed to 905-762-2110. application is not received by Mobility Plus.
SECTION C authorizes the release of the CONFIDENTIALITY information you have provided to Mobility Plus All personal information on your application is in order to process your application. collected under the authority of the Municipal Act, 2001, and the Accessibility for Ontarions with SECTION D must be completed for an applicant Disabilities Act, 2005 in accordance with the who attends day programs / work placements Municipal Freedom of Information and Protection and the client waives the hand-to-hand process of Privacy Act. Your information will be used to / from the client’s residence. solely for the purpose of determining eligibility Mobility Plus will review your application for Mobility Plus service. Any questions within 14 days of receipt. If your application concerning this collection can be directed to is incomplete, the application process will be Mobility Plus Eligibility, York Region Transit. delayed. A registration card and number will The application and any supporting documentation be provided upon approval to use the service. will be discussed only with the applicant, the If you are approved and require an mandatory applicant’s legal guardian or appointed substitute support person, this person must be provided by decision-maker. If a release of information form is you and accompany you on all Mobility Plus trips. completed, the application may be discussed with the Your mandatory support person rides for free. individual named in the release. For your convenience, If your application is denied, you may contact a release form can be found on page 13 of this Mobility Plus at 1-866-744-1119 to arrange for application. Application information may also be an assessment with the Transit Ability Coordinator. shared with other transit providers to facilitate your travel between York Region and connecting areas.
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SECTION A: For completion by applicant
LEVEL OF ELIGIBILITY Your level of eligibility will be determined * See page 12 for a listing of accepted health by Mobility Plus based on the information care professionals. provided in your application. If your application is incomplete, it will be It is the responsibility of the customer to inform returned to you or you may be contacted for Mobility Plus if their health condition, personal further information. You answers in section A information and/or mobility aid changes. will ensure that Mobility Plus has a clear You will be required to renew your application understanding of your eligibility and service if changes occur, to ensure current eligibility. requirements. Please fill out this application completely, including verification of medical status by a health care professional in section B.
PLEASE PRINT CLEARLY ¨ Mr. ¨ Mrs. ¨ Ms. ¨ Miss
Applicant name ( Last ) ( First ) ( Middle )
Street address Apartment
City or town Province Postal code
Phone ( Home ) ( Mobile )
TTY / TDD number ( for deaf, deafened or hard of hearing )
Email address ( to assist with response times ) Date of birth ( year / month / day )
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SECTION A: For completion by applicant
EMERGENCY CONTACT INFORMATION In case of an emergency only, please notify ( e.g. family, friend, neighbour, caregiver ):
Name ( primary contact ) Name ( secondary contact )
Relationship to applicant Relationship to applicant
Phone Phone
Email address ( emergency contact ) Please provide the mailing address you would like all Mobility Plus mail sent to if it is different from the information provided on the previous page.
MAILING ADDRESS ¨ Mr. ¨ Mrs. ¨ Ms. ¨ Miss
Applicant name ( Last ) ( First ) ( Middle )
Street address Apartment
City or town Province Postal code
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SECTION A: For completion by applicant
CURRENT MOBILITY ¨ I can never get to or from a conventional AND TRANSPORTATION transit bus stop because:
1. What methods of travel do you currently use? (Check all that apply) ¨ Conventional ¨ I drive myself bus ¨ S omeone drives ¨ M obility Plus me ¨ Taxi ¨ Other 2. Please explain in detail what your everyday mobility is like: 2. Which of the following best describes your ability to get on and off a conventional transit bus? a. I can safely wait for a conventional low-floor bus if there is seating.
¨ Yes ¨ No If no, please explain why:
b. I can safely get on and off a conventional low-floor bus with no steps. ¨ Yes ¨ No If no, please explain why: USE OF CONVENTIONAL PUBLIC TRANSIT BUSES
1. Which of the following best describes c. I can handle a fare, take a transfer or show your ability to get to or from a a pass. conventional public transit bus stop? ¨ Yes ¨ No (Check only one) If no, please explain why: ¨ I am able to walk or roll a city block ( 175 metres ) to a bus stop.
¨ I am only able to walk or roll a city block ( 175 metres ) to a bus stop with a mandatory support person.
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SECTION A: For completion by applicant
3. In order to travel unaccompanied, clients 4a. Do you currently use any of the following must be able to independently recognize assistive devices? ( Check all that apply ) their destination and inform the Mobility ¨ Braces Plus operator if they are about to be Cane dropped off at the wrong location. Clients ¨ Certified service animal must also be able to independently get ¨ help if they were dropped off at the ¨ Crutches wrong location. If they are not able to do ¨ Oxygen tank provide measurements: this independently, they will require a mandatory support person when travelling. ¨ Prosthetics ¨ Scooter 3a. Will you require a mandatory support ¨ Walker ( specify type ): person for medical or behavioural reasons ¨Foldable ¨ Non-Foldable when travelling in a Mobility Plus vehicle? ¨ White cane ¨ Yes ¨ No ¨ Wheelchair ( specify type ): ¨ Manual ¨ Custom power If yes, the client must provide their own ¨Foldable ¨ Transpo foldable personal mandatory support person when travelling on Mobility Plus. The mandatory b. If you use a Mobility device, provide the support person must be capable of meeting outside dimensions of your mobility aid: the applicant’s care needs during travel and getting to and from destinations. The mandatory support person cannot be c. Combined weight of applicant and mobility aid: a Mobility Plus client. ¨ Less then 700 lbs ¨ More than 700 lbs b. Are you applying for transportation to a day program or work placement? Note: All mobility aids must be kept clean and in good repair while travelling on York Region Yes No ¨ ¨ Transit. If the mobility aid can not fit in all York c. If yes, hand-to-hand transfers are Region’s Family of Services vehicles, we may not required for customers who travel to be able to provide service. York Region Transit’s day programs and work placements. wheelchair ramps / lifts vary from 29 to 39 inches This includes signatures at the wide. Equipment larger than this cannot be residence and at the program/work accommodated for safety. The combined weight placement. of the passenger and mobility aid must not exceed 700 lbs. ¨ Yes ¨ No Mobility Plus operators will provide assistance Do you require a hand-to-hand transfer to and from the first set of accessible building from your residence? doors and with the securement of mobility aids ¨ Yes ¨ No If no, fill out section D. and seatbelts.
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SECTION A: For completion by applicant
5. If you have a visual impairment, have you had travel training through the CNIB to ride conventional public transit? ¨ Yes ¨ No
Yes, Please attach your travel training report. No, Six month temporary transportation will be given to allow time to take the training and send Mobility Plus the report.
APPLICATION CHECKLIST Before you mail, fax or deliver this application, please ensure you have: ¨ Fully completed this application and double-checked all information. ¨ Checked that your healthcare professional has completed Section B in full, including certification number and contact information. ¨ Attached a letter from your day program or workplace (if applicable) verifying times and locations. ¨ Made a photocopy of the entire application for your records.
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SECTION A: For completion by applicant
I HEREBY CERTIFY THAT TO THE BEST OF MY KNOWLEDGE, THE INFORMATION PROVIDED IN THIS APPLICATION IS CORRECT. I authorize the health care professional named in section B to complete section B as it relates to my functional limitations.
Signature of applicant Year / month / day
Name of applicant ( please print ) If you are not the applicant but have completed this application on the applicant’s behalf, you must provide the following information:
PLEASE PRINT CLEARLY ¨ Mr. ¨ Mrs. ¨ Ms. ¨ Miss
Name( Last ) ( First ) ( Middle )
Street address Apartment
Phone ( Daytime )
Relationship to applicant
IMPORTANT REMINDER: Please photocopy the entire completed application for your records in case the original application is not received by Mobility Plus.
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SECTION B: For completion by a health care professional
ABOUT YORK REGION TRANSIT MOBILITY PLUS Mobility Plus is a shared ride door-to-door A person who does not qualify for Mobility Plus public transit service for people with disabilities door-to-door service in the summer months who are unable to use conventional public may still be eligible for seasonal registration transit service for all or part of their trip. during the winter months. You are being asked by the applicant named The information you provide will allow us to in Section A to provide information regarding evaluate the request and provide appropriate his / her ability to use conventional public service. Thank you for your assistance. transit service. This section must be completed by a registered Applicants with disabilities are generally health care professional (see page 12). considered eligible for Mobility Plus service if their mobility prevents them from using conventional public transit for all or part of their trip.
TO COMPLETE SECTION B: 1. The applicant ( or representative ) has completed section A. Please read section A in its entirety before completing and signing section B.
2. Sections A and B of the application must be filled out completely or the application process may be delayed.
3. If you have any questions regarding the completion of the forms, call Mobility Plus at 1-866-744-1119.
Please base your evaluation solely on the applicant’s ability or inability to use conventional public transit for all or part of their trip.
Patient’s name ( please print )
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SECTION B: For completion by health care professional
1. I have read section A in its entirety. 3. Severity of disability / limitations: ¨ Yes ¨ Mild ¨ Moderate ¨ Severe 2. Describe the applicant’s diagnosis, 3a. Have you prescribed a mobility aid to the prognosis, impairments and / or applicant? (see page 6 for list) limitations causing disability: ¨ Yes ¨ No
4. Is the applicant able to walk 175 metres with or without the assistance of a mobility aid? Yes No Seasonally ¨ ¨ ¨ 5. Does this applicant have a visual impairment recognized by the Canadian National Institute for the Blind (CNIB)? Yes No 2a. Describe in detail how the applicant’s ¨ ¨ functional limitation affects their ability to 6. Does this applicant have a cognitive board and travel on a conventional low floor limitation? bus with no steps for all or part of their trip: ¨ Yes ¨ No
If yes, can this applicant:
6a. Independently recognize their destination and inform the Mobility Plus operator if they are about to be dropped off at the wrong location? ¨ Yes ¨ No 6b. Independently get help for themselves if dropped off at the wrong location?
¨ Yes ¨ No
7. If the applicant is a person with speech impairment, are they able to communicate verbally and / or with an augmentative device and / or in writing? ¨ Yes ¨ No
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SECTION B: For completion by health care professional
7a. Mobility Plus is a shared ride, linked service. 9c. Usually prevents the applicant from The vehicle may stop and the operator may using conventional public transit unless exit the vehicle to escort another passenger. accompanied by a mandatory support person. Does this applicant have any behavioral ¨ Yes ¨ No concerns or have a risk of exiting the vehicle 9d. Other ( please explain ): and wandering?
¨ Yes ¨ No
8. Will the customer require a mandatory support person for medical or behavioural reasons to all locations excluding day programs, when travelling in a Mobility Plus vehicle? ¨ Yes ¨ No 10. Expected duration of disability / limitations: If yes, the client must provide their own personal mandatory support person when ¨ Temporary: Expected duration until traveling on Mobility Plus. The mandatory ( year / month / day] support person must be capable of meeting ¨ Long-term: No expectation of the applicant’s care needs during travel improvement and getting to and from destinations. The ¨ Seasonal: Limitation impacted by winter mandatory support person cannot be conditions a Mobility Plus client.
9. It is my professional opinion that the applicant has functional limitations that: ( Check one box )
9a. Prevents the applicant from using conventional public transit year-round. ¨ Yes ¨ No 9b. Prevents the applicant from using conventional public transit only in the winter ( from November 1-March 31 ). ¨ Yes ¨ No
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SECTION B: For completion by health care professional
I HEREBY CERTIFY THAT THE INFORMATION PROVIDED IN SECTION B IS TRUE.
PLEASE PRINT CLEARLY ¨ Dr. ¨ Mr. ¨ Mrs. ¨ Ms. ¨ Miss
Name ( Last ) ( First ) ( Middle )
Street address Apartment
City or town Province Postal code
Phone number Licence / Certification number
Date ( year / month / day ) Signature
Profession ( Check only one ) ¨ Nurse practitioner ¨ Licensed physician ¨ Physiotherapist ¨ Registered occupational therapist ¨ Psychologist ¨ Licensed optometrist / opthalmologist ¨ Social worker ( MSW, RSW ) ¨ Registered Kinesiologist ¨ Speech language pathologist ¨ Registered Nurse
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Section C: Authorization for release of information
The applicant (or guardian) must complete this section to authorize the release of information provided to Mobility Plus. This is required in order to process the application, if someone else is speaking or making decisions on behalf of the applicant.
PLEASE PRINT CLEARLY ¨ Mr. ¨ Mrs. ¨ Ms. ¨ Miss
Applicant name ( Last ) ( First ) ( Middle )
Street address Apartment
Phone
Name ( Person allowed to discuss the Mobility Plus account )
All information obtained will be kept CONFIDENTIAL between The Regional Municipality of York and the parties specified above.
Applicant Signature Year / month / day
Substitute decision-maker signature Year / month / day
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Section D: Mobility Plus Service Agreement
FOR DAY PROGRAMS / WORK PLACEMENTS (HAND-TO-HAND WAIVER)
has been approved for Mobility Plus service for travel to / from approved day programs and work placements. By completing and signing this agreement, the client and / or parent / guardian ( if the client is under 18 years of age or has a legal guardian ) acknowledges that the hand-to-hand requirement for a mandatory support person to be in attendance at the point of departure and arrival is deemed unnecessary, and will be waived for departure and arrival at the client’s residence only. York Region Transit Mobility Plus will provide the following: >> Escort the client door-to-door >> Wait until the client crosses the threshold of the first accessible door York Region Transit Mobility Plus does NOT provide the following: >> Unlock or go through the door of the client’s residence >> Wait for a family member to arrive to open the door of the client’s residence By applying for service to / from day programs and work placements without a hand-to-hand attendant, the client or parent / guardian confirms that the passenger is: ¨ Fully capable of leaving / arriving at the ¨ Capable of unlocking and /or locking their residence and entering a Mobility Plus residence door vehicle without any type of assistance ¨ Fully capable of exiting the Mobility Plus ¨ Fully capable of being transported vehicle and entering their residence in a Mobility Plus vehicle without a independently mandatory support person ¨ Able to recognize their own residence and ¨ Consents to wearing a vehicle seatbelt and knows their address and phone number is fully capable of using the seatbelt for safe transport with or without assistance ¨ Able to remain in their residence alone without supervision once dropped off ¨ Able to be left unattended in a vehicle by Mobility Plus if the driver leaves to escort other clients Names of all responsible parents / guardians ( please print clearly ):
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SECTION D: Mobility Plus Hand-to-hand service agreement
Client’s residential address:
Day program name and address:
General days and times of required Mobility Plus service:
CONTINGENCY PLAN: In the event that circumstances arise that require assistance for the Mobility Plus client, please provide the necessary contingency plan details below. The contact information provided must be of a family member / friend that lives in York Region and is able to accept the client as part of your contingency plan. If none of the contacts below can be reached as part of the contingency plan, future rides will be cancelled ( suspended ) until the parent/guardian is contacted and this agreement is discussed with them.
Parent / guardian contact information while client is being transported by Mobility Plus: 1 ) Home / mobile / business: 2 ) Home / mobile / business:
Contingency contacts if parent / guardian is not available: 1 ) Name: Relationship: Address:
Availability as contingency contact: Home / mobile / business:
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SECTION D: Mobility Plus Hand-to-hand service agreement
2 ) Name: Relationship: Address:
Availability as contingency contact: Home / mobile / business:
3 ) Name: Relationship: Address:
Availability as contingency contact: Home / mobile / business:
BY SIGNING THIS AGREEMENT, I / WE ACKNOWLEDGE THAT I / WE HAVE READ, UNDERSTOOD AND AGREE TO ITS TERMS. PLEASE ENSURE ALL FIELDS ARE COMPLETED.
Client ( print name ) Year / month / day
Parent / Guardian ( print name ) Year / month / day
Witness ( print name ) Year / month / day
Please return all completed documents to: If you have any questions, please call: York Region Transit Mobility Plus Mobility Plus Customer Service Representative 55 Orlando Avenue, 2nd Floor 1-866-758-0749 ext. 75653 Richmond Hill, Ontario, L4B 0B4 or fax to: 905-762-2110 or email: [email protected]
IMPORTANT REMINDER: Please photocopy the entire completed application for your records in case the original application is not received by Mobility Plus.
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SECTION E: Client Consent to York Region Transit Mobility Plus
CONSENT*
NOTE TO THE MOBILITY PLUS APPLICANT: By signing below, you give permission to Mobility Plus to contact the health care professional who completed your Mobility Plus application form. The purpose of contacting the health care professional is solely for the purpose of seeking clarification on information provided by the health care professional on the application form and not to discuss your medical condition or personal information. Please complete this form and return it with your Mobility Plus application.
PLEASE PRINT CLEARLY
I, , give permission to Mobility Plus to contact my health care professional to seek clarification regarding information provided in my Mobility Plus application. I understand that if I choose to revoke my consent at a later date, I may do so by contacting Mobility Plus at 1-877-464-9675 ext. 75867
Applicant Signature Year / month / day
Substitute decision-maker signature Year / month / day
* York Region Transit (YRT/Viva) Mobility Plus will keep your information strictly confidential. Mobility Plus complies with the Personal Health Information Protection Act, 2004, and the Municipal Freedom of Information and Protection of Privacy Act in safeguarding your information. Should you have any questions about this consent, please contact Mobility Plus at 1-877-464-9675 ext. 75867
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SIMCOE COUNTY LINX+ ACCESSIBLE TRANSIT ELIGIBILITY APPLICATION This application is for County of Simcoe residents who wish to apply for the County of Simcoe’s specialized transit service. This service is intended for persons with disabilities, either permanent or temporary, which prevent them from being able to access the County of Simcoe’s conventional transit service. The specialized transit service operates within 400 metres, each side of the conventional fixed route service and is a pre- arranged door-to-door service and/or service to and from conventional transit for registered users. The information obtained in this application process will be used by the County of Simcoe only to assess the applicant’s eligibility for the specialized transit service. All information contained in the application will be kept confidential. Failure to complete this application in full will delay the application process. If you have questions, need assistance or an alternate format, please call Service Simcoe at 1-800-263-3199. How to Apply for Simcoe County Linx+ 1. Complete Part B of this application. 2. Have your health-care professional complete Part C. How to Submit the Application Once the application is completed in full, mail, hand-deliver, fax or email the application to:
County of Simcoe Attn. Transit Department 1110 Highway 26, Midhurst, ON L9X 1N6 Phone: 1-866-893-9300 ext. 1003 Fax: 705-727-4276 Email: [email protected]
Eligibility Eligibility for Simcoe County Linx+ service is approved on the basis of three categories: 1. Unconditional – All trips require specialized service, for example a permanent disability. 2. Temporary – All trips require specialized services for a limited duration, for example during recovery from surgery. 3. Conditional – Trips taken by a person with a disability who requires specialized services under certain circumstances, such as extreme weather conditions.
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Part A: Applicant Information PLEASE PRINT Last Name: First Name:
Address: Apt:
Town: Postal Code:
Age: 15-24 25-44 45-64 65+
Phone:
Would you like to receive your correspondence by Email? No Yes
Emergency Contact(s): Name: Phone:
Name: Phone:
I hereby authorize the health-care professional named in Part B to provide information regarding my physical and/or mental limitations by responding to the questions in Part B for the purpose of determining my eligibility or service delivery options for Simcoe County Linx+.
Signature: Date:
If you are not the applicant, but have completed the application on the applicants’ behalf, provide the information below: In accordance with Part A of this application, I hereby confirm, to the best of my knowledge, that the information is true.
Name: Phone:
Signature: Date:
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Part B To be completed by treating Licensed Health-Care Professional Specialized transit is intended for persons with disabilities, either permanent or temporary, which prevent them from being able to access the County of Simcoe’s conventional transit service. The specialized transit service operates within 400 metres, each side of the conventional fixed route service and is a pre-arranged door-to-door service and/or service to and from conventional transit for registered users. You may be contacted if any questions remain. Name and Official Capacity of Health-Care Professional:
Address: Apt:
Town: Postal Code:
Please answer all questions in order for this application to be processed. 1. Can the applicant walk 175 metres (approximately 600 feet) with or without an assistive device? Yes No 2. Can the applicant get on and off the Simcoe County conventional bus unaided? (All vehicles are equipped with a ramp) Yes No If no, describe how the disability prevents them from using conventional transit:
3. Please check the assistive devices the applicant normally travels with: Manual Wheelchair Walker White Cane
Powered Wheelchair Powered ¾ Wheel Scooter Oxygen Bottle (Clients who use a scooter must transfer to a seat) Crutches Cane Other: Note: Vehicle ramps can accommodate wheelchair/scooters that are no larger than 42” long, 30” wide and not exceed a total weight of 800 lbs.
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4. Can the applicant recognize and understand when and where to board the bus, their destination, and when to safely leave the bus? Yes No 5. Can the applicant maneuver their assistive device and/or travel to and from the vehicle independently, and while at their destination? Yes No 6. Does the applicant require a support person when travelling? Yes No 7. Can the applicant communicate with the Operator? Yes No 8. Does the applicant require a service animal? Yes No 9. Does the applicant suffer from vertigo to the degree that he/she would fall? If yes, please consider a support person for applicant’s safety. Yes No 10. How long does the applicant require the service? Unconditional/Permanent – all trips require specialized services. Temporary (up to one year) – all trips require specialized services for a limited duration. Conditional/Seasonal – under certain circumstances, trips require specialized services. Indicate which months are required: Winter (October to April) Summer (May to September) In accordance with Part B of this application, I hereby confirm that the information is true. Health-Care Professional Signature: Stamp, License or Certification Number: Date:
Notice of Collection/Use/Disclosure: Personal information is being collected on this form pursuant to Section 8 and 11 of the Municipal Act and will be used to determine your eligibility for Accessible Public Transit and to provide you with appropriate transit services. We will also use de-identified data to compile statistical information for program planning. Questions regarding the collection of this information and how it is used may be directed to the Transit Operations Supervisor, Transit Department, County of Simcoe, 1110 Highway 26, Midhurst, ON L9X 1N6 1-866-893-9300 ext. 1003.
February 2019
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Attachment 2 – Commonly Used Specialized Vehicles
GO Transit – Grand Caravan
Barrie Transit – Mobility Ventures MV1
YRT – Ram ProMaster – Creative Carriage
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TTC – Ford F-450 – StarTrans
Woodstock – GMC – Glaval Titan II LF
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