CitiBus Complaint/Incident Form

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Complainant Contact Information

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Phone # (Enter 999-999-9999, if N/A)*
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Did someone complete or assist with completion of this form?*
 
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Information about the incident/complaint.

Does your complaint involved alleged discrimination? (Race, Color, National Origin, Disability, Religion, Gender)?*
If Yes, what is the alleged discrimination? If no, use N/A from the dropdown.*
Date and Time of Incident*
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Please describe the alleged incident/complaint. Explain what happened. Provide the names and title of all Davenport employees involved, if available. Provide the names of witnesses, if available.
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Have you filed a complaint with any other federal, state, or local agencies?*
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By clicking submit below, you agree that the information provided in this complaint is true to the best of your knowledge, information, and belief.