Wheels for Wellness Ride Checklist Fill Out the Ride Checklist Please fill out the below questionnaire. All questions with a red star are required. Comments can be left at the end but if anything is urgent please call 519-660-1430. Download Printable Copy Please enable JavaScript in your browser to complete this form.1Information2Driver Info3Questions4QuestionsThank you for completing ride. Please fill out the below questionaire. All questions with a red star are required. Comments can be left at the end but if anything is urgent 519-660-1430. NextDriver Name *FirstLastClient Name *FirstLastDate *MM123456789101112/DD12345678910111213141516171819202122232425262728293031/YYYY20232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Ride Start Time *Ride End Time *Ride Location *Is This Ride A Round Trip? *YesNoPreviousNextMask On *YesNoWiped Down All Shared Surfaces (door handles, seatbelt, tongue, buckles, surfaces that have been used by any other individuals in your vehicles) *YesNoHand Sanitizer Available *YesNoMasks Available *YesNoBackseat empty of unnecessary items *YesNoSign About The Spread Of Germs Available *YesNoPreviousNextWash Your Hands And/or Use Hand Sanitizer *YesNoWiped Down Barrier (If One In Place) And All Shared Surfaces *YesNoClient Wore A Mask For The Entire Ride *YesNoDispose Of Mask (Or Put In For Washing) *YesNoDid The Client Take A Mask From You? *YesNoAdditional CommentsSubmit