AVR Online Survey Collection

Please complete the following form.

If you are not an employee of College Hospital Cerritos please close this form and contact your Employee Transportation Coordinator for further instructions.

Vista de formulario en espaƱol
Step 1: Name
Step 2: Home Address - Address is confidential and will not appear on anyone else's RideGuide. *
Step 3: Contact Information
Step 4: Work Hours and Commute Information
Step 5: Survey Week Commute Information
A. Zero Emission Vehicle
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.

F. Telecommute
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.

G. Noncommuting
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.).

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.

X. 3/36- work 3 days/12 hours each day; 2 days off
Y. 4/40- work 4 days/10 hours each day; 1 day off
Z. 9/80- work 9 days/80 hours; 1 day off in a 2 week period
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 8/28/2017
Tuesday 8/29/2017
Wednesday 8/30/2017
Thursday 8/31/2017
Friday 9/1/2017
Saturday 9/2/2017
Sunday 9/3/2017
Step 6: Commuter Information

*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.