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https://www.ridematch.info/rp35/AVRSurvey/index/23158?company=22560G&language=English
Submission: On September 21 via manual from US — Scanned from DE
Submission: On September 21 via manual from US — Scanned from DE
Form analysis 1 forms found in the DOM
POST /rp35/AVRSurvey/index/23158?company=22560G&language=English
<form id="surveyForm" method="post" action="/rp35/AVRSurvey/index/23158?company=22560G&language=English">
<fieldset>
<legend>Step 1: Name</legend>
<div class="field">
<label for="FirstName">First Name:</label>
<input data-required-message="Please provide your First Name." id="FirstName" maxlength="20" name="FirstName" required="required" type="text" value="">
</div>
<div class="field">
<label for="LastName">Last Name:</label>
<input data-required-message="Please provide your Last Name." id="LastName" maxlength="20" name="LastName" required="required" type="text" value="">
</div>
<div class="field">
<label for="Mi">Middle Initial:</label>
<input id="Mi" maxlength="1" name="Mi" type="text" value="">
</div>
<div class="field">
<label for="EmployeeId">Employee ID:</label>
<input data-required-message="Please provide your Employee ID." id="EmployeeId" maxlength="40" name="EmployeeId" required="required" type="text" value="">
</div>
</fieldset>
<fieldset>
<legend>Step 2: Home Address - Address is confidential and will not appear on anyone else's RideGuide. *</legend>
<div class="field">
<label for="StreetNumber">Address (street number & street name):</label>
<input id="StreetNumber" maxlength="6" name="StreetNumber" type="text" value="">
<label class="hidden-label" for="StreetName">Address (street number & street name):</label>
<input id="StreetName" maxlength="50" name="StreetName" title="Address (street number & street name):" type="text" value="">
</div>
<div class="field">
<label for="City">City:</label>
<input data-required-message="Please provide your Home City." id="City" maxlength="80" name="City" required="required" type="text" value="">
</div>
<div class="field">
<label for="State">State:</label>
<input data-required-message="Please provide your Home State." id="State" maxlength="2" name="State" required="required" type="text" value="CA">
</div>
<div class="field">
<label for="PostalCode">Zip Code:</label>
<input class="postal-code" data-required-message="Please provide your Home Zip Code." id="PostalCode" maxlength="5" name="PostalCode" required="required" type="text" value="">
</div>
<div class="field">
<label for="XStreet_Street1">Home Cross Streets:</label>
<input id="XStreet_Street1" maxlength="50" name="XStreet.Street1" type="text" value=""> and <label class="hidden-label" for="XStreet_Street2">Second Home Cross Street:</label>
<input id="XStreet_Street2" maxlength="50" name="XStreet.Street2" type="text" value="">
</div>
</fieldset>
<fieldset>
<legend>Step 3: Contact Information</legend>
<div class="field">
<label for="Phone">Area Code, Phone Number and ext:</label>
<input class=" input-type-tel" id="Phone" maxlength="28" name="Phone" type="tel" value="">
</div>
<div class="field">
<label id="PhoneTypeLabel">This phone is my:</label>
<input id="phoneTypeHome" name="PhoneType" value="Home" type="radio" aria-labelledby="PhoneTypeLabel">
<label id="phoneTypeHomeLabel" for="phoneTypeHome" class="label-after">Home Phone Number</label>
<input id="phoneTypeWork" name="PhoneType" value="Work" type="radio" aria-labelledby="PhoneTypeLabel">
<label id="phoneTypeWorkLabel" for="phoneTypeWork" class="label-after">Work Phone Number</label>
<input id="phoneTypeMobile" name="PhoneType" value="Mobile" type="radio" aria-labelledby="PhoneTypeLabel">
<label id="phoneTypeMobileLabel" for="phoneTypeMobile" class="label-after">Cell Phone Number</label>
</div>
<div class="field">
<label for="Email">Email Address:</label>
<input id="Email" maxlength="80" name="Email" type="email" value="">
</div>
</fieldset>
<fieldset>
<legend>Step 4: Work Hours and Commute Information</legend>
<div class="field">
<label for="DepartmentName">Work Department:</label>
<input id="DepartmentName" maxlength="36" name="DepartmentName" type="text" value="">
</div>
<div class="field">
<label for="Typical_CommuteMode">Typical Commute Mode:</label>
<select data-required-message="Please select your Typical Commute Mode." id="Typical_CommuteMode" name="Typical.CommuteMode" required="required">
<option value="">--Select Mode--</option>
<option value="B">Bicycle</option>
<option value="C">Carpool</option>
<option value="D">Drive Alone</option>
<option value="M">Motorcycle</option>
<option value="P">Public Bus</option>
<option value="R">Metrolink / Rail</option>
<option value="T">Telecommute</option>
<option value="V">Vanpool</option>
<option value="W">Walk</option>
</select>
</div>
<div class="field">
<label for="Typical_Work_Hours:">Typical Work Hours:</label>
<label class="label-after" for="Typical_Shift_Start_Hour">Start Time:</label>
<select class="time-select" data-required-message="Please provide your Typical Work Hours." id="Typical_Shift_Start_Hour" name="Typical.Shift.Start.Hour" required="required">
<option value="">--</option>
<option value="1">1</option>
<option value="2">2</option>
<option value="3">3</option>
<option value="4">4</option>
<option value="5">5</option>
<option value="6">6</option>
<option value="7">7</option>
<option value="8">8</option>
<option value="9">9</option>
<option value="10">10</option>
<option value="11">11</option>
<option value="12">12</option>
</select>
<label class="hidden-label" for="Typical_Shift_Start_Minute">Start Time (minutes):</label>
<select class="time-select" id="Typical_Shift_Start_Minute" name="Typical.Shift.Start.Minute">
<option selected="selected" value="0">00</option>
<option value="1">01</option>
<option value="2">02</option>
<option value="3">03</option>
<option value="4">04</option>
<option value="5">05</option>
<option value="6">06</option>
<option value="7">07</option>
<option value="8">08</option>
<option value="9">09</option>
<option value="10">10</option>
<option value="11">11</option>
<option value="12">12</option>
<option value="13">13</option>
<option value="14">14</option>
<option value="15">15</option>
<option value="16">16</option>
<option value="17">17</option>
<option value="18">18</option>
<option value="19">19</option>
<option value="20">20</option>
<option value="21">21</option>
<option value="22">22</option>
<option value="23">23</option>
<option value="24">24</option>
<option value="25">25</option>
<option value="26">26</option>
<option value="27">27</option>
<option value="28">28</option>
<option value="29">29</option>
<option value="30">30</option>
<option value="31">31</option>
<option value="32">32</option>
<option value="33">33</option>
<option value="34">34</option>
<option value="35">35</option>
<option value="36">36</option>
<option value="37">37</option>
<option value="38">38</option>
<option value="39">39</option>
<option value="40">40</option>
<option value="41">41</option>
<option value="42">42</option>
<option value="43">43</option>
<option value="44">44</option>
<option value="45">45</option>
<option value="46">46</option>
<option value="47">47</option>
<option value="48">48</option>
<option value="49">49</option>
<option value="50">50</option>
<option value="51">51</option>
<option value="52">52</option>
<option value="53">53</option>
<option value="54">54</option>
<option value="55">55</option>
<option value="56">56</option>
<option value="57">57</option>
<option value="58">58</option>
<option value="59">59</option>
</select>
<label class="hidden-label" for="Typical_Shift_Start_AP">Start Time (AM or PM):</label>
<select class="time-select" id="Typical_Shift_Start_AP" name="Typical.Shift.Start.AP">
<option value=""> </option>
<option value="AM">AM</option>
<option value="PM">PM</option>
</select>
<label class="label-after" for="Typical_Shift_End_Hour">End Time:</label>
<select class="time-select" data-required-message="Please provide your Typical Work Hours." id="Typical_Shift_End_Hour" name="Typical.Shift.End.Hour" required="required">
<option value="">--</option>
<option value="1">1</option>
<option value="2">2</option>
<option value="3">3</option>
<option value="4">4</option>
<option value="5">5</option>
<option value="6">6</option>
<option value="7">7</option>
<option value="8">8</option>
<option value="9">9</option>
<option value="10">10</option>
<option value="11">11</option>
<option value="12">12</option>
</select>
<label class="hidden-label" for="Typical_Shift_End_Minute">End Time (minutes):</label>
<select class="time-select" id="Typical_Shift_End_Minute" name="Typical.Shift.End.Minute">
<option selected="selected" value="0">00</option>
<option value="1">01</option>
<option value="2">02</option>
<option value="3">03</option>
<option value="4">04</option>
<option value="5">05</option>
<option value="6">06</option>
<option value="7">07</option>
<option value="8">08</option>
<option value="9">09</option>
<option value="10">10</option>
<option value="11">11</option>
<option value="12">12</option>
<option value="13">13</option>
<option value="14">14</option>
<option value="15">15</option>
<option value="16">16</option>
<option value="17">17</option>
<option value="18">18</option>
<option value="19">19</option>
<option value="20">20</option>
<option value="21">21</option>
<option value="22">22</option>
<option value="23">23</option>
<option value="24">24</option>
<option value="25">25</option>
<option value="26">26</option>
<option value="27">27</option>
<option value="28">28</option>
<option value="29">29</option>
<option value="30">30</option>
<option value="31">31</option>
<option value="32">32</option>
<option value="33">33</option>
<option value="34">34</option>
<option value="35">35</option>
<option value="36">36</option>
<option value="37">37</option>
<option value="38">38</option>
<option value="39">39</option>
<option value="40">40</option>
<option value="41">41</option>
<option value="42">42</option>
<option value="43">43</option>
<option value="44">44</option>
<option value="45">45</option>
<option value="46">46</option>
<option value="47">47</option>
<option value="48">48</option>
<option value="49">49</option>
<option value="50">50</option>
<option value="51">51</option>
<option value="52">52</option>
<option value="53">53</option>
<option value="54">54</option>
<option value="55">55</option>
<option value="56">56</option>
<option value="57">57</option>
<option value="58">58</option>
<option value="59">59</option>
</select>
<label class="hidden-label" for="Typical_Shift_End_AP">End Time (AM or PM):</label>
<select class="time-select" id="Typical_Shift_End_AP" name="Typical.Shift.End.AP">
<option value=""> </option>
<option value="AM">AM</option>
<option value="PM">PM</option>
</select>
</div>
<div class="field">
<label for="WorkHoursVary">If your work hours vary from day to day please check here:</label>
<input id="WorkHoursVary" name="WorkHoursVary" type="checkbox" value="true"><input name="WorkHoursVary" type="hidden" value="false">
</div>
<div class="field">
<label for="OneHourFlex">If you have up to one hour flexibility in your start and leave times, please check here:</label>
<input id="OneHourFlex" name="OneHourFlex" type="checkbox" value="true"><input name="OneHourFlex" type="hidden" value="false">
</div>
</fieldset>
<fieldset>
<legend> Step 5: Survey Week Commute Information </legend>
<div id="CommuteHelp" class="help-rollover float-left" style="width: 50px;" data-hasqtip="CommuteHelp" oldtitle="Commute Modes Explained" title=""></div>
<span class="help-rollover-popup" style="line-height: 35px; vertical-align: middle; text-decoration: underline;" data-tooltip-content="<div style="background-color: #add8e6; padding: 10px;">
<div class="CommuteModeRow Odd">
<div class="CommuteMode Name">A. Zero Emission Vehicle</div>
<div class="CommuteMode Explain">Select this mode for every day that you commute to work in a zero emission vehicle. If you drive alone or carpool in a zero emission vehicle, please use this mode on that/those day(s). Employees arriving to work in a Plug-In Hybrid Electric Vehicle (PHEV) meet the definition of a zero emission vehicle provided that the entire trip to work is made exclusively under electric power. This applies to plug-in vehicles with all electric range that can travel exclusively under electric power without use of the gasoline engine or cogeneration system.
</div></div>
<br />
<div class="CommuteModeRow Odd">
<div class="CommuteMode Name">F. Telecommute</div>
<div class="CommuteMode Explain">Select this mode on the day(s) you telecommute. Telecommuting is defined as working at home, or at a telecommuting center during the entire day. Select mode "F" if you work at home, or if your commute to a telecommuting center results in a reduction of 51% or more of your commute distance between your home and your worksite.
</div></div>
<br />
<div class="CommuteModeRow Odd">
<div class="CommuteMode Name">G. Noncommuting</div>
<div class="CommuteMode Explain">Select this mode to indicate the days you are either outside the SCAQMD jurisdiction (all of Orange County and the non-desert portions of Los Angeles, San Bernardino, and Riverside counties) to complete work assignments, or you generate no vehicle trips associated with arriving at the worksite (e.g., hospital employees, fire fighters, airline employees who stay at the worksite over a 24 hour period, etc.).
</div></div>
<br />
<div class="CommuteMode Explain">Compressed Work Week Day(s) Off: Select one of these modes to indicate your compressed work week day off. Select only if you were off during the survey week. Please include your typical start time on the day(s) you are on a compressed work week day(s) off.
</div>
<br />
<div class="CommuteMode Name"> X. 3/36- work 3 days/12 hours each day; 2 days off</div>
<div class="CommuteMode Name"> Y. 4/40- work 4 days/10 hours each day; 1 day off</div>
<div class="CommuteMode Name"> Z. 9/80- work 9 days/80 hours; 1 day off in a 2 week period</div>
</div>" data-hasqtip="0" oldtitle="Commute Modes Explained" title=""> Commute Modes Explained </span>
<p><span class="regular-instructions">Instructions: Please select a time and commute mode for each day that appears below. You should fill out the time you began work.</span><br><span class="important-instructions">If you were on vacation, out
sick or had a regular day off during the survey week, please provide your normal scheduled time for that day.</span></p>
<table id="dayTable">
<thead>
<tr class="even">
<th> Day </th>
<th> Date </th>
<th> Commute Mode </th>
<th> Time You Began Work </th>
<th>
</th>
</tr>
</thead>
<tbody>
<tr class="even">
<td> Monday </td>
<td> 8/2/2021 </td>
<td>
<label class="hidden-label" for="Mon_CommuteMode">Monday Commute Mode</label>
<select id="Mon_CommuteMode" name="Mon.CommuteMode" required="required">
<option value="">--Select Mode--</option>
<option value="A">A. Zero Emission Vehicle</option>
<option value="B">B. Bus</option>
<option value="C">C. Rail / Plane</option>
<option value="D">D. Walk</option>
<option value="E">E. Bicycle</option>
<option value="F">F. Telecommute</option>
<option value="G">G. Noncommuting</option>
<option value="H">H. Drive Alone</option>
<option value="I">I. Motorcycle</option>
<option value="J">J. 2 persons in vehicle</option>
<option value="K">K. 3 persons in vehicle</option>
<option value="L">L. 4 persons in vehicle</option>
<option value="M">M. 5 persons in vehicle</option>
<option value="N">N. 6 persons in vehicle</option>
<option value="O">O. 7 persons in vehicle</option>
<option value="P">P. 8 persons in vehicle</option>
<option value="Q">Q. 9 persons in vehicle</option>
<option value="R">R. 10 persons in vehicle</option>
<option value="S">S. 11 persons in vehicle</option>
<option value="T">T. 12 persons in vehicle</option>
<option value="U">U. 13 persons in vehicle</option>
<option value="V">V. 14 persons in vehicle</option>
<option value="W">W. 15 persons in vehicle</option>
<option value="X">X. 3/36 work week days off (2 days off)</option>
<option value="Y">Y. 4/40 work week day off (1 day off)</option>
<option value="Z">Z. 9/80 work week day off (1 day off)</option>
<option value="AA">AA. Vacation</option>
<option value="BB">BB. Sick</option>
<option value="CC">CC. Regular Day Off, Jury Duty, LOA, etc.</option>
</select>
</td>
<td>
<label class="hidden-label" for="Mon_Shift_Start_Hour">Monday Time You Began Work (hours)</label>
<select class="time-select" id="Mon_Shift_Start_Hour" name="Mon.Shift.Start.Hour" required="required">
<option value="">--</option>
<option value="1">1</option>
<option value="2">2</option>
<option value="3">3</option>
<option value="4">4</option>
<option value="5">5</option>
<option value="6">6</option>
<option value="7">7</option>
<option value="8">8</option>
<option value="9">9</option>
<option value="10">10</option>
<option value="11">11</option>
<option value="12">12</option>
</select>
<label class="hidden-label" for="Mon_Shift_Start_Minute">Monday Time You Began Work (minutes)</label>
<select class="time-select" id="Mon_Shift_Start_Minute" name="Mon.Shift.Start.Minute" required="required">
<option selected="selected" value="0">00</option>
<option value="1">01</option>
<option value="2">02</option>
<option value="3">03</option>
<option value="4">04</option>
<option value="5">05</option>
<option value="6">06</option>
<option value="7">07</option>
<option value="8">08</option>
<option value="9">09</option>
<option value="10">10</option>
<option value="11">11</option>
<option value="12">12</option>
<option value="13">13</option>
<option value="14">14</option>
<option value="15">15</option>
<option value="16">16</option>
<option value="17">17</option>
<option value="18">18</option>
<option value="19">19</option>
<option value="20">20</option>
<option value="21">21</option>
<option value="22">22</option>
<option value="23">23</option>
<option value="24">24</option>
<option value="25">25</option>
<option value="26">26</option>
<option value="27">27</option>
<option value="28">28</option>
<option value="29">29</option>
<option value="30">30</option>
<option value="31">31</option>
<option value="32">32</option>
<option value="33">33</option>
<option value="34">34</option>
<option value="35">35</option>
<option value="36">36</option>
<option value="37">37</option>
<option value="38">38</option>
<option value="39">39</option>
<option value="40">40</option>
<option value="41">41</option>
<option value="42">42</option>
<option value="43">43</option>
<option value="44">44</option>
<option value="45">45</option>
<option value="46">46</option>
<option value="47">47</option>
<option value="48">48</option>
<option value="49">49</option>
<option value="50">50</option>
<option value="51">51</option>
<option value="52">52</option>
<option value="53">53</option>
<option value="54">54</option>
<option value="55">55</option>
<option value="56">56</option>
<option value="57">57</option>
<option value="58">58</option>
<option value="59">59</option>
</select>
<label class="hidden-label" for="Mon_Shift_Start_AP">Monday Time You Began Work (AM or PM)</label>
<select class="time-select" id="Mon_Shift_Start_AP" name="Mon.Shift.Start.AP" required="required">
<option value=""> </option>
<option value="AM">AM</option>
<option value="PM">PM</option>
</select>
</td>
<td>
</td>
</tr>
<tr class="odd">
<td> Tuesday </td>
<td> 8/3/2021 </td>
<td>
<label class="hidden-label" for="Tue_CommuteMode">Tuesday Commute Mode</label>
<select id="Tue_CommuteMode" name="Tue.CommuteMode" required="required">
<option value="">--Select Mode--</option>
<option value="A">A. Zero Emission Vehicle</option>
<option value="B">B. Bus</option>
<option value="C">C. Rail / Plane</option>
<option value="D">D. Walk</option>
<option value="E">E. Bicycle</option>
<option value="F">F. Telecommute</option>
<option value="G">G. Noncommuting</option>
<option value="H">H. Drive Alone</option>
<option value="I">I. Motorcycle</option>
<option value="J">J. 2 persons in vehicle</option>
<option value="K">K. 3 persons in vehicle</option>
<option value="L">L. 4 persons in vehicle</option>
<option value="M">M. 5 persons in vehicle</option>
<option value="N">N. 6 persons in vehicle</option>
<option value="O">O. 7 persons in vehicle</option>
<option value="P">P. 8 persons in vehicle</option>
<option value="Q">Q. 9 persons in vehicle</option>
<option value="R">R. 10 persons in vehicle</option>
<option value="S">S. 11 persons in vehicle</option>
<option value="T">T. 12 persons in vehicle</option>
<option value="U">U. 13 persons in vehicle</option>
<option value="V">V. 14 persons in vehicle</option>
<option value="W">W. 15 persons in vehicle</option>
<option value="X">X. 3/36 work week days off (2 days off)</option>
<option value="Y">Y. 4/40 work week day off (1 day off)</option>
<option value="Z">Z. 9/80 work week day off (1 day off)</option>
<option value="AA">AA. Vacation</option>
<option value="BB">BB. Sick</option>
<option value="CC">CC. Regular Day Off, Jury Duty, LOA, etc.</option>
</select>
</td>
<td>
<label class="hidden-label" for="Tue_Shift_Start_Hour">Tuesday Time You Began Work (hours)</label>
<select class="time-select" id="Tue_Shift_Start_Hour" name="Tue.Shift.Start.Hour" required="required">
<option value="">--</option>
<option value="1">1</option>
<option value="2">2</option>
<option value="3">3</option>
<option value="4">4</option>
<option value="5">5</option>
<option value="6">6</option>
<option value="7">7</option>
<option value="8">8</option>
<option value="9">9</option>
<option value="10">10</option>
<option value="11">11</option>
<option value="12">12</option>
</select>
<label class="hidden-label" for="Tue_Shift_Start_Minute">Tuesday Time You Began Work (minutes)</label>
<select class="time-select" id="Tue_Shift_Start_Minute" name="Tue.Shift.Start.Minute" required="required">
<option selected="selected" value="0">00</option>
<option value="1">01</option>
<option value="2">02</option>
<option value="3">03</option>
<option value="4">04</option>
<option value="5">05</option>
<option value="6">06</option>
<option value="7">07</option>
<option value="8">08</option>
<option value="9">09</option>
<option value="10">10</option>
<option value="11">11</option>
<option value="12">12</option>
<option value="13">13</option>
<option value="14">14</option>
<option value="15">15</option>
<option value="16">16</option>
<option value="17">17</option>
<option value="18">18</option>
<option value="19">19</option>
<option value="20">20</option>
<option value="21">21</option>
<option value="22">22</option>
<option value="23">23</option>
<option value="24">24</option>
<option value="25">25</option>
<option value="26">26</option>
<option value="27">27</option>
<option value="28">28</option>
<option value="29">29</option>
<option value="30">30</option>
<option value="31">31</option>
<option value="32">32</option>
<option value="33">33</option>
<option value="34">34</option>
<option value="35">35</option>
<option value="36">36</option>
<option value="37">37</option>
<option value="38">38</option>
<option value="39">39</option>
<option value="40">40</option>
<option value="41">41</option>
<option value="42">42</option>
<option value="43">43</option>
<option value="44">44</option>
<option value="45">45</option>
<option value="46">46</option>
<option value="47">47</option>
<option value="48">48</option>
<option value="49">49</option>
<option value="50">50</option>
<option value="51">51</option>
<option value="52">52</option>
<option value="53">53</option>
<option value="54">54</option>
<option value="55">55</option>
<option value="56">56</option>
<option value="57">57</option>
<option value="58">58</option>
<option value="59">59</option>
</select>
<label class="hidden-label" for="Tue_Shift_Start_AP">Tuesday Time You Began Work (AM or PM)</label>
<select class="time-select" id="Tue_Shift_Start_AP" name="Tue.Shift.Start.AP" required="required">
<option value=""> </option>
<option value="AM">AM</option>
<option value="PM">PM</option>
</select>
</td>
<td>
</td>
</tr>
<tr class="even">
<td> Wednesday </td>
<td> 8/4/2021 </td>
<td>
<label class="hidden-label" for="Wed_CommuteMode">Wednesday Commute Mode</label>
<select id="Wed_CommuteMode" name="Wed.CommuteMode" required="required">
<option value="">--Select Mode--</option>
<option value="A">A. Zero Emission Vehicle</option>
<option value="B">B. Bus</option>
<option value="C">C. Rail / Plane</option>
<option value="D">D. Walk</option>
<option value="E">E. Bicycle</option>
<option value="F">F. Telecommute</option>
<option value="G">G. Noncommuting</option>
<option value="H">H. Drive Alone</option>
<option value="I">I. Motorcycle</option>
<option value="J">J. 2 persons in vehicle</option>
<option value="K">K. 3 persons in vehicle</option>
<option value="L">L. 4 persons in vehicle</option>
<option value="M">M. 5 persons in vehicle</option>
<option value="N">N. 6 persons in vehicle</option>
<option value="O">O. 7 persons in vehicle</option>
<option value="P">P. 8 persons in vehicle</option>
<option value="Q">Q. 9 persons in vehicle</option>
<option value="R">R. 10 persons in vehicle</option>
<option value="S">S. 11 persons in vehicle</option>
<option value="T">T. 12 persons in vehicle</option>
<option value="U">U. 13 persons in vehicle</option>
<option value="V">V. 14 persons in vehicle</option>
<option value="W">W. 15 persons in vehicle</option>
<option value="X">X. 3/36 work week days off (2 days off)</option>
<option value="Y">Y. 4/40 work week day off (1 day off)</option>
<option value="Z">Z. 9/80 work week day off (1 day off)</option>
<option value="AA">AA. Vacation</option>
<option value="BB">BB. Sick</option>
<option value="CC">CC. Regular Day Off, Jury Duty, LOA, etc.</option>
</select>
</td>
<td>
<label class="hidden-label" for="Wed_Shift_Start_Hour">Wednesday Time You Began Work (hours)</label>
<select class="time-select" id="Wed_Shift_Start_Hour" name="Wed.Shift.Start.Hour" required="required">
<option value="">--</option>
<option value="1">1</option>
<option value="2">2</option>
<option value="3">3</option>
<option value="4">4</option>
<option value="5">5</option>
<option value="6">6</option>
<option value="7">7</option>
<option value="8">8</option>
<option value="9">9</option>
<option value="10">10</option>
<option value="11">11</option>
<option value="12">12</option>
</select>
<label class="hidden-label" for="Wed_Shift_Start_Minute">Wednesday Time You Began Work (minutes)</label>
<select class="time-select" id="Wed_Shift_Start_Minute" name="Wed.Shift.Start.Minute" required="required">
<option selected="selected" value="0">00</option>
<option value="1">01</option>
<option value="2">02</option>
<option value="3">03</option>
<option value="4">04</option>
<option value="5">05</option>
<option value="6">06</option>
<option value="7">07</option>
<option value="8">08</option>
<option value="9">09</option>
<option value="10">10</option>
<option value="11">11</option>
<option value="12">12</option>
<option value="13">13</option>
<option value="14">14</option>
<option value="15">15</option>
<option value="16">16</option>
<option value="17">17</option>
<option value="18">18</option>
<option value="19">19</option>
<option value="20">20</option>
<option value="21">21</option>
<option value="22">22</option>
<option value="23">23</option>
<option value="24">24</option>
<option value="25">25</option>
<option value="26">26</option>
<option value="27">27</option>
<option value="28">28</option>
<option value="29">29</option>
<option value="30">30</option>
<option value="31">31</option>
<option value="32">32</option>
<option value="33">33</option>
<option value="34">34</option>
<option value="35">35</option>
<option value="36">36</option>
<option value="37">37</option>
<option value="38">38</option>
<option value="39">39</option>
<option value="40">40</option>
<option value="41">41</option>
<option value="42">42</option>
<option value="43">43</option>
<option value="44">44</option>
<option value="45">45</option>
<option value="46">46</option>
<option value="47">47</option>
<option value="48">48</option>
<option value="49">49</option>
<option value="50">50</option>
<option value="51">51</option>
<option value="52">52</option>
<option value="53">53</option>
<option value="54">54</option>
<option value="55">55</option>
<option value="56">56</option>
<option value="57">57</option>
<option value="58">58</option>
<option value="59">59</option>
</select>
<label class="hidden-label" for="Wed_Shift_Start_AP">Wednesday Time You Began Work (AM or PM)</label>
<select class="time-select" id="Wed_Shift_Start_AP" name="Wed.Shift.Start.AP" required="required">
<option value=""> </option>
<option value="AM">AM</option>
<option value="PM">PM</option>
</select>
</td>
<td>
</td>
</tr>
<tr class="odd">
<td> Thursday </td>
<td> 8/5/2021 </td>
<td>
<label class="hidden-label" for="Thu_CommuteMode">Thursday Commute Mode</label>
<select id="Thu_CommuteMode" name="Thu.CommuteMode" required="required">
<option value="">--Select Mode--</option>
<option value="A">A. Zero Emission Vehicle</option>
<option value="B">B. Bus</option>
<option value="C">C. Rail / Plane</option>
<option value="D">D. Walk</option>
<option value="E">E. Bicycle</option>
<option value="F">F. Telecommute</option>
<option value="G">G. Noncommuting</option>
<option value="H">H. Drive Alone</option>
<option value="I">I. Motorcycle</option>
<option value="J">J. 2 persons in vehicle</option>
<option value="K">K. 3 persons in vehicle</option>
<option value="L">L. 4 persons in vehicle</option>
<option value="M">M. 5 persons in vehicle</option>
<option value="N">N. 6 persons in vehicle</option>
<option value="O">O. 7 persons in vehicle</option>
<option value="P">P. 8 persons in vehicle</option>
<option value="Q">Q. 9 persons in vehicle</option>
<option value="R">R. 10 persons in vehicle</option>
<option value="S">S. 11 persons in vehicle</option>
<option value="T">T. 12 persons in vehicle</option>
<option value="U">U. 13 persons in vehicle</option>
<option value="V">V. 14 persons in vehicle</option>
<option value="W">W. 15 persons in vehicle</option>
<option value="X">X. 3/36 work week days off (2 days off)</option>
<option value="Y">Y. 4/40 work week day off (1 day off)</option>
<option value="Z">Z. 9/80 work week day off (1 day off)</option>
<option value="AA">AA. Vacation</option>
<option value="BB">BB. Sick</option>
<option value="CC">CC. Regular Day Off, Jury Duty, LOA, etc.</option>
</select>
</td>
<td>
<label class="hidden-label" for="Thu_Shift_Start_Hour">Thursday Time You Began Work (hours)</label>
<select class="time-select" id="Thu_Shift_Start_Hour" name="Thu.Shift.Start.Hour" required="required">
<option value="">--</option>
<option value="1">1</option>
<option value="2">2</option>
<option value="3">3</option>
<option value="4">4</option>
<option value="5">5</option>
<option value="6">6</option>
<option value="7">7</option>
<option value="8">8</option>
<option value="9">9</option>
<option value="10">10</option>
<option value="11">11</option>
<option value="12">12</option>
</select>
<label class="hidden-label" for="Thu_Shift_Start_Minute">Thursday Time You Began Work (minutes)</label>
<select class="time-select" id="Thu_Shift_Start_Minute" name="Thu.Shift.Start.Minute" required="required">
<option selected="selected" value="0">00</option>
<option value="1">01</option>
<option value="2">02</option>
<option value="3">03</option>
<option value="4">04</option>
<option value="5">05</option>
<option value="6">06</option>
<option value="7">07</option>
<option value="8">08</option>
<option value="9">09</option>
<option value="10">10</option>
<option value="11">11</option>
<option value="12">12</option>
<option value="13">13</option>
<option value="14">14</option>
<option value="15">15</option>
<option value="16">16</option>
<option value="17">17</option>
<option value="18">18</option>
<option value="19">19</option>
<option value="20">20</option>
<option value="21">21</option>
<option value="22">22</option>
<option value="23">23</option>
<option value="24">24</option>
<option value="25">25</option>
<option value="26">26</option>
<option value="27">27</option>
<option value="28">28</option>
<option value="29">29</option>
<option value="30">30</option>
<option value="31">31</option>
<option value="32">32</option>
<option value="33">33</option>
<option value="34">34</option>
<option value="35">35</option>
<option value="36">36</option>
<option value="37">37</option>
<option value="38">38</option>
<option value="39">39</option>
<option value="40">40</option>
<option value="41">41</option>
<option value="42">42</option>
<option value="43">43</option>
<option value="44">44</option>
<option value="45">45</option>
<option value="46">46</option>
<option value="47">47</option>
<option value="48">48</option>
<option value="49">49</option>
<option value="50">50</option>
<option value="51">51</option>
<option value="52">52</option>
<option value="53">53</option>
<option value="54">54</option>
<option value="55">55</option>
<option value="56">56</option>
<option value="57">57</option>
<option value="58">58</option>
<option value="59">59</option>
</select>
<label class="hidden-label" for="Thu_Shift_Start_AP">Thursday Time You Began Work (AM or PM)</label>
<select class="time-select" id="Thu_Shift_Start_AP" name="Thu.Shift.Start.AP" required="required">
<option value=""> </option>
<option value="AM">AM</option>
<option value="PM">PM</option>
</select>
</td>
<td>
</td>
</tr>
<tr class="even">
<td> Friday </td>
<td> 8/6/2021 </td>
<td>
<label class="hidden-label" for="Fri_CommuteMode">Friday Commute Mode</label>
<select id="Fri_CommuteMode" name="Fri.CommuteMode" required="required">
<option value="">--Select Mode--</option>
<option value="A">A. Zero Emission Vehicle</option>
<option value="B">B. Bus</option>
<option value="C">C. Rail / Plane</option>
<option value="D">D. Walk</option>
<option value="E">E. Bicycle</option>
<option value="F">F. Telecommute</option>
<option value="G">G. Noncommuting</option>
<option value="H">H. Drive Alone</option>
<option value="I">I. Motorcycle</option>
<option value="J">J. 2 persons in vehicle</option>
<option value="K">K. 3 persons in vehicle</option>
<option value="L">L. 4 persons in vehicle</option>
<option value="M">M. 5 persons in vehicle</option>
<option value="N">N. 6 persons in vehicle</option>
<option value="O">O. 7 persons in vehicle</option>
<option value="P">P. 8 persons in vehicle</option>
<option value="Q">Q. 9 persons in vehicle</option>
<option value="R">R. 10 persons in vehicle</option>
<option value="S">S. 11 persons in vehicle</option>
<option value="T">T. 12 persons in vehicle</option>
<option value="U">U. 13 persons in vehicle</option>
<option value="V">V. 14 persons in vehicle</option>
<option value="W">W. 15 persons in vehicle</option>
<option value="X">X. 3/36 work week days off (2 days off)</option>
<option value="Y">Y. 4/40 work week day off (1 day off)</option>
<option value="Z">Z. 9/80 work week day off (1 day off)</option>
<option value="AA">AA. Vacation</option>
<option value="BB">BB. Sick</option>
<option value="CC">CC. Regular Day Off, Jury Duty, LOA, etc.</option>
</select>
</td>
<td>
<label class="hidden-label" for="Fri_Shift_Start_Hour">Friday Time You Began Work (hours)</label>
<select class="time-select" id="Fri_Shift_Start_Hour" name="Fri.Shift.Start.Hour" required="required">
<option value="">--</option>
<option value="1">1</option>
<option value="2">2</option>
<option value="3">3</option>
<option value="4">4</option>
<option value="5">5</option>
<option value="6">6</option>
<option value="7">7</option>
<option value="8">8</option>
<option value="9">9</option>
<option value="10">10</option>
<option value="11">11</option>
<option value="12">12</option>
</select>
<label class="hidden-label" for="Fri_Shift_Start_Minute">Friday Time You Began Work (minutes)</label>
<select class="time-select" id="Fri_Shift_Start_Minute" name="Fri.Shift.Start.Minute" required="required">
<option selected="selected" value="0">00</option>
<option value="1">01</option>
<option value="2">02</option>
<option value="3">03</option>
<option value="4">04</option>
<option value="5">05</option>
<option value="6">06</option>
<option value="7">07</option>
<option value="8">08</option>
<option value="9">09</option>
<option value="10">10</option>
<option value="11">11</option>
<option value="12">12</option>
<option value="13">13</option>
<option value="14">14</option>
<option value="15">15</option>
<option value="16">16</option>
<option value="17">17</option>
<option value="18">18</option>
<option value="19">19</option>
<option value="20">20</option>
<option value="21">21</option>
<option value="22">22</option>
<option value="23">23</option>
<option value="24">24</option>
<option value="25">25</option>
<option value="26">26</option>
<option value="27">27</option>
<option value="28">28</option>
<option value="29">29</option>
<option value="30">30</option>
<option value="31">31</option>
<option value="32">32</option>
<option value="33">33</option>
<option value="34">34</option>
<option value="35">35</option>
<option value="36">36</option>
<option value="37">37</option>
<option value="38">38</option>
<option value="39">39</option>
<option value="40">40</option>
<option value="41">41</option>
<option value="42">42</option>
<option value="43">43</option>
<option value="44">44</option>
<option value="45">45</option>
<option value="46">46</option>
<option value="47">47</option>
<option value="48">48</option>
<option value="49">49</option>
<option value="50">50</option>
<option value="51">51</option>
<option value="52">52</option>
<option value="53">53</option>
<option value="54">54</option>
<option value="55">55</option>
<option value="56">56</option>
<option value="57">57</option>
<option value="58">58</option>
<option value="59">59</option>
</select>
<label class="hidden-label" for="Fri_Shift_Start_AP">Friday Time You Began Work (AM or PM)</label>
<select class="time-select" id="Fri_Shift_Start_AP" name="Fri.Shift.Start.AP" required="required">
<option value=""> </option>
<option value="AM">AM</option>
<option value="PM">PM</option>
</select>
</td>
<td>
</td>
</tr>
</tbody>
</table>
</fieldset>
<fieldset>
<legend>Step 6: Commuter Information</legend>
<input data-required-message="Please select Yes or No for a RideGuide." id="registerYes" name="Register" required="required" type="radio" value="True">
<label for="registerYes" class="label-after"><strong>Yes:</strong> Please send me a RideGuide which provides a list of commuters (including co-workers) who live near me and are interested in sharing a ride to work. The RideGuide also provides a
list of Park and Ride lot locations and information on other ridesharing options such as Metrolink/rail, vanpools and public bus. By checking yes, I understand that my name, telephone number, and/or email address will be provided to other
commuters who want to carpool to work. *</label><br>
<br>
<input data-required-message="Please select Yes or No for a RideGuide." id="registerNo" name="Register" required="required" type="radio" value="False">
<label for="registerNo" class="label-after"><strong>No:</strong> I do not want to receive a RideGuide at this time. *</label>
</fieldset>
<div id="submitWrapper">
<button id="submitSurveyButton" type="submit" name="submit" value="submit">Submit Form</button>
</div>
</form>Text Content
AVR ONLINE SURVEY COLLECTION Please complete the following form. If you have questions about this survey or you are not an employee of L A Co.-Public Health & DHS Ferguson please email Veronica Franco at VFranco@ph.lacounty.gov or call (213) 369-8992 for assistance. Vista de formulario en español Step 1: Name First Name: Last Name: Middle Initial: Employee ID: Step 2: Home Address - Address is confidential and will not appear on anyone else's RideGuide. * Address (street number & street name): Address (street number & street name): City: State: Zip Code: Home Cross Streets: and Second Home Cross Street: Step 3: Contact Information Area Code, Phone Number and ext: This phone is my: Home Phone Number Work Phone Number Cell Phone Number Email Address: Step 4: Work Hours and Commute Information Work Department: Typical Commute Mode: --Select Mode-- Bicycle Carpool Drive Alone Motorcycle Public Bus Metrolink / Rail Telecommute Vanpool Walk Typical Work Hours: Start Time: -- 1 2 3 4 5 6 7 8 9 10 11 12 Start Time (minutes): 00 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 Start Time (AM or PM): AM PM End Time: -- 1 2 3 4 5 6 7 8 9 10 11 12 End Time (minutes): 00 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 End Time (AM or PM): AM PM If your work hours vary from day to day please check here: If you have up to one hour flexibility in your start and leave times, please check here: Step 5: Survey Week Commute Information Commute Modes Explained Instructions: Please select a time and commute mode for each day that appears below. You should fill out the time you began work. If you were on vacation, out sick or had a regular day off during the survey week, please provide your normal scheduled time for that day. Day Date Commute Mode Time You Began Work Monday 8/2/2021 Monday Commute Mode --Select Mode-- A. Zero Emission Vehicle B. Bus C. Rail / Plane D. Walk E. Bicycle F. Telecommute G. Noncommuting H. Drive Alone I. Motorcycle J. 2 persons in vehicle K. 3 persons in vehicle L. 4 persons in vehicle M. 5 persons in vehicle N. 6 persons in vehicle O. 7 persons in vehicle P. 8 persons in vehicle Q. 9 persons in vehicle R. 10 persons in vehicle S. 11 persons in vehicle T. 12 persons in vehicle U. 13 persons in vehicle V. 14 persons in vehicle W. 15 persons in vehicle X. 3/36 work week days off (2 days off) Y. 4/40 work week day off (1 day off) Z. 9/80 work week day off (1 day off) AA. Vacation BB. Sick CC. Regular Day Off, Jury Duty, LOA, etc. Monday Time You Began Work (hours) -- 1 2 3 4 5 6 7 8 9 10 11 12 Monday Time You Began Work (minutes) 00 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 Monday Time You Began Work (AM or PM) AM PM Tuesday 8/3/2021 Tuesday Commute Mode --Select Mode-- A. Zero Emission Vehicle B. Bus C. Rail / Plane D. Walk E. Bicycle F. Telecommute G. Noncommuting H. Drive Alone I. Motorcycle J. 2 persons in vehicle K. 3 persons in vehicle L. 4 persons in vehicle M. 5 persons in vehicle N. 6 persons in vehicle O. 7 persons in vehicle P. 8 persons in vehicle Q. 9 persons in vehicle R. 10 persons in vehicle S. 11 persons in vehicle T. 12 persons in vehicle U. 13 persons in vehicle V. 14 persons in vehicle W. 15 persons in vehicle X. 3/36 work week days off (2 days off) Y. 4/40 work week day off (1 day off) Z. 9/80 work week day off (1 day off) AA. Vacation BB. Sick CC. Regular Day Off, Jury Duty, LOA, etc. Tuesday Time You Began Work (hours) -- 1 2 3 4 5 6 7 8 9 10 11 12 Tuesday Time You Began Work (minutes) 00 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 Tuesday Time You Began Work (AM or PM) AM PM Wednesday 8/4/2021 Wednesday Commute Mode --Select Mode-- A. Zero Emission Vehicle B. Bus C. Rail / Plane D. Walk E. Bicycle F. Telecommute G. Noncommuting H. Drive Alone I. Motorcycle J. 2 persons in vehicle K. 3 persons in vehicle L. 4 persons in vehicle M. 5 persons in vehicle N. 6 persons in vehicle O. 7 persons in vehicle P. 8 persons in vehicle Q. 9 persons in vehicle R. 10 persons in vehicle S. 11 persons in vehicle T. 12 persons in vehicle U. 13 persons in vehicle V. 14 persons in vehicle W. 15 persons in vehicle X. 3/36 work week days off (2 days off) Y. 4/40 work week day off (1 day off) Z. 9/80 work week day off (1 day off) AA. Vacation BB. Sick CC. Regular Day Off, Jury Duty, LOA, etc. Wednesday Time You Began Work (hours) -- 1 2 3 4 5 6 7 8 9 10 11 12 Wednesday Time You Began Work (minutes) 00 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 Wednesday Time You Began Work (AM or PM) AM PM Thursday 8/5/2021 Thursday Commute Mode --Select Mode-- A. Zero Emission Vehicle B. Bus C. Rail / Plane D. Walk E. Bicycle F. Telecommute G. Noncommuting H. Drive Alone I. Motorcycle J. 2 persons in vehicle K. 3 persons in vehicle L. 4 persons in vehicle M. 5 persons in vehicle N. 6 persons in vehicle O. 7 persons in vehicle P. 8 persons in vehicle Q. 9 persons in vehicle R. 10 persons in vehicle S. 11 persons in vehicle T. 12 persons in vehicle U. 13 persons in vehicle V. 14 persons in vehicle W. 15 persons in vehicle X. 3/36 work week days off (2 days off) Y. 4/40 work week day off (1 day off) Z. 9/80 work week day off (1 day off) AA. Vacation BB. Sick CC. Regular Day Off, Jury Duty, LOA, etc. Thursday Time You Began Work (hours) -- 1 2 3 4 5 6 7 8 9 10 11 12 Thursday Time You Began Work (minutes) 00 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 Thursday Time You Began Work (AM or PM) AM PM Friday 8/6/2021 Friday Commute Mode --Select Mode-- A. Zero Emission Vehicle B. Bus C. Rail / Plane D. Walk E. Bicycle F. Telecommute G. Noncommuting H. Drive Alone I. Motorcycle J. 2 persons in vehicle K. 3 persons in vehicle L. 4 persons in vehicle M. 5 persons in vehicle N. 6 persons in vehicle O. 7 persons in vehicle P. 8 persons in vehicle Q. 9 persons in vehicle R. 10 persons in vehicle S. 11 persons in vehicle T. 12 persons in vehicle U. 13 persons in vehicle V. 14 persons in vehicle W. 15 persons in vehicle X. 3/36 work week days off (2 days off) Y. 4/40 work week day off (1 day off) Z. 9/80 work week day off (1 day off) AA. Vacation BB. Sick CC. Regular Day Off, Jury Duty, LOA, etc. Friday Time You Began Work (hours) -- 1 2 3 4 5 6 7 8 9 10 11 12 Friday Time You Began Work (minutes) 00 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 Friday Time You Began Work (AM or PM) AM PM Step 6: Commuter Information Yes: Please send me a RideGuide which provides a list of commuters (including co-workers) who live near me and are interested in sharing a ride to work. The RideGuide also provides a list of Park and Ride lot locations and information on other ridesharing options such as Metrolink/rail, vanpools and public bus. By checking yes, I understand that my name, telephone number, and/or email address will be provided to other commuters who want to carpool to work. * No: I do not want to receive a RideGuide at this time. * Submit Form *Per California Penal Code section 637.6 this information will be used for carpooling or ridesharing purposes. I understand that my signature allows the information provided to be used for ridesharing purposes in the regional ridematching database sponsored by Los Angeles County Metropolitan Transportation Authority (Metro), Orange County Transportation Authority (OCTA), and Ventura County Transportation Commission (VCTC) and through joint partnerships with local cities and Transportation Management Associations to promote ridesharing programs and reduce congestion. I understand these entities are strictly prohibited from disclosing this information to any other third parties. I acknowledge that my participation in ridematching is voluntary and that I am responsible for my participation in a rideshare arrangement. I understand that the sponsoring agencies shall have no responsibility or liability for any claims, expenses or damages resulting from any individual's participation.