Caltrain ADA Discrimination Complaint Form

Caltrain does not discriminate against individuals with disabilities in the provision of transportation services and is committed to ensuring that no person, solely by reason of his or her disability, is excluded from participation in, is denied benefits of, or is subjected to discrimination under any Caltrain programs or activities. Any person who believes they have been discriminated against based on one of these categories may file a complaint. Complaints must be filed within 180 calendar days of the incident.
 

Within 10 working days of receipt of your completed complaint form, Caltrain will contact you to confirm receipt of your complaint form and begin an investigation (unless the complaint is filed with an external entity first or simultaneously). The investigation may include discussion(s) of the complaint with all affected parties to determine the nature of the problem. The investigation generally will be conducted and completed within 60 days of receipt of a complete complaint form. Based upon all information received, an investigation report will be submitted to a Caltrain Deputy CEO. The complainant will receive a letter stating Caltrain’s final decision by the end of the 60-day time limit.

Please complete the information below and send to:

Caltrain, ADA Coordinator
Accessible Transit Services
166 N. Rollins Rd
Millbrae, CA 94030
or: dubostc@samtrans.com

 

SECTION 1 - CONTACT INFORMATION

Name:
Address:
Phone:

[Please note if any of the phone numbers are for a TDD or TTY.]

SECTION 2 – FILING FOR ANOTHER PERSON

Are you filing this complaint on your own behalf?

[If you answered "yes" to this question, go to Section 3.]

Please confirm that you have obtained the permission of the aggrieved party if you are filing on behalf of a third party.

SECTION 3 – DISCRIMINATION COMPLAINT

SECTION 4 – PREVIOUS OR EXISTING COMPLAINTS & LAWSUITS

Have you previously filed an ADA discrimination complaint with Caltrain?
Have you filed this complaint with any other agencies or a court?
Have you filed a claim or lawsuit regarding this complaint?
If yes, please provide a copy of the complaint form and note court where filed:

Please provide contact person information for the agency/court where the complaint was filed.

Address:

SECTION 5 – SIGNATURE

Please sign below to attest to the truthfulness of the above. You may attach any written materials or other information that you think is relevant to your complaint.

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