TransLink Access Pass

Transcription

1 TransLink Access Pass Information and Application Form Effective 1 January _TAP_Applicationbooklet_20pp_Jan_2018_D.indd 1

2 2 TransLink Access Pass About the TransLink Access Pass The TransLink Access Pass is a travel pass for people with a significant permanent disability who can: travel independently on TransLink services, and demonstrate that due to their significant permanent disability they are unable to independently use a go card. For more information about how go card works see page 4. The pass provides users with unlimited travel on all TransLink bus, train, ferry and tram services (except Airtrain), for 12 months, for an annual fee of $72.20 #. Who can apply You can get a TransLink Access Pass if ALL these things apply: you are a permanent Queensland resident you have a significant permanent physical or intellectual disability you can travel independently on TransLink services without the need for a constant companion/guide/carer you've been assessed by a qualified health care professional as being unable to independently use the go card ticketing system. For instance, you may be in a wheelchair and have limited fine hand movement or you may have an intellectual disability that prevents you from using a go card. The TransLink Access Pass is not issued to every person who has a disability. Applying for a pass Step 1: Read all the information contained in this booklet, including the TransLink Access Pass Conditions of Use (see Section 6) and the TransLink Access Pass Privacy Notice (see Section 7). Step 2: Applicant/guardian/agent complete Sections 1 and 3 of the application form. Photocopied applications will not be accepted. Step 3: Obtain a high-quality, colour passport size photograph which can be attached to your application form. Read Section 5 for important instructions. Step 4: Have a health care professional (for example registered doctor, physiotherapist, psychologist or qualified occupational therapist), fill in and sign Section 2 of your application and the back of your photo. Step 5: Select your payment method. Please read Section 4 for important instructions. Please note: Payments are processed once the application is approved. TransLink will return cheques or money orders if an application is not approved. Step 6: Mail your signed passport photo and original application form to: TransLink Access Pass TransLink GPO Box 50 Brisbane Qld 4000 Step 7: Allow up to 15 business days for your application to be processed. Incomplete or unsuccessful applications will be returned to the applicant. # Fee subject to change. 3995_TAP_Applicationbooklet_20pp_Jan_2018_D.indd 2

3 3 TransLink Access Pass Using the pass You must carry your TransLink Access Pass with you at all times while travelling, in case you're asked by a driver or authorised person to show it. You don't need to touch on and off like a go card. Your name, customer reference number (CRN), photo and expiry date are printed on the front of the pass, so it is not transferable. Replacement passes If your TransLink Access Pass is lost, stolen, or damaged contact TransLink immediately. To receive a replacement pass, you must complete the Replacement of Lost, Stolen or Damaged Pass Form, in addition to a Statutory Declaration witnessed by a Justice of the Peace. A replacement fee may apply. Renewing your pass The TransLink Access Pass needs to be renewed every 12 months from the date it was issued. Fines may apply for anyone travelling with an expired pass. It is the pass holder s responsibility to renew their pass, before the expiry date. A medical assessment and new passport photo is only required once every five years. If your current pass expired more than six months ago, you need another medical assessment and a new passport photo. All applications are subject to TransLink's discretion. To renew your pass, simply complete a renewal form, available at translink.com.au or by calling Allow up to 15 business days for your renewal application to be processed. 3995_TAP_Applicationbooklet_20pp_Jan_2018_D.indd 3

4 4 TransLink Access Pass About go card TransLink s go card ticketing system requires customers to correctly touch their go card to a card reader at the beginning and end of their trip. This allows the system to calculate the correct fare and also open ticket gates at certain stations. Some members of the community who travel independently may be unable to touch on or touch off their go card at card readers due to a significant permanent disability. The TransLink Access Pass was developed to assist these people to continue to independently use TransLink services. For more information on go card visit translink.com.au or call Interpreter service call National relay service TTY and modem call Direct TTY call Speech to speech relay service call Card readers Card readers are located on all TransLink bus and ferry services, and train and tram stations in the TransLink network. The area bounded by the yellow circle is the touch zone on the go card reader. This is where the customer touches on and off. On go card readers this touch zone height is between 900mm and 1100mm above the ground. If due to their disability, the applicant is unable to reach the maximum height of the card readers, then they may be eligible for a TransLink Access Pass. 3995_TAP_Applicationbooklet_20pp_Jan_2018_D.indd 4

5 SCREEN SCREEN SCREEN 5 TransLink Access Pass Types of go card readers 900mm approx 1025mm approx 900mm approx Bus reader Train and tram platform reader CityCat and ferry reader go card readers on buses Card readers are located at the front and rear doorways on buses. The distance of the touch zone above the floor surface can vary slightly depending on the make and model of the bus. The touch zone on the card reader is 82mm in diameter, and is between mm from the floor surface. go card readers at train and tram stations Card readers are located on station platforms and major stations have card readers attached to fare gates. Standard fare gates are 620mm wide. Wider gates for wheelchair access are 1080mm wide. The touch zone on the platform card reader is 110mm in diameter and is approximately 1025mm above the floor surface. The touch zone on fare gates is located on the right hand side of the barrier and is 95mm in diameter and is approximately 990mm from the floor surface. go card readers on CityCats and ferries Card readers are located onboard CityCats and ferries and also where you embark or disembark. The touch zone on the card reader is 110mm in diameter and is approximately mm above the floor surface. 3995_TAP_Applicationbooklet_20pp_Jan_2018_D.indd 5

6 6 TransLink Access Pass TransLink Access Pass application form Important information for completing your application: Incomplete or unsuccessful applications, including those without signatures or signed photographs cannot be processed and will be returned. Applications take approximately 15 business days to process once TransLink receives your completed form. Applicants/guardians/agents All applicants are required to complete Sections 1 and 3. Where an applicant is unable to complete and/or sign the form, a parent/guardian or agent needs to complete the relevant sections and sign the application on behalf of the applicant. Health care professional assessment A qualified health care professional must complete Section 2 and sign the back of the applicant's passport photo. This may be the applicant s: registered doctor qualified occupational therapist registered physiotherapist or registered psychologist/psychiartrist. Additional information from specialists may also be required upon request. Where eligibility is unclear, TransLink may seek additional independent medical or specialist advice. Any additional testing required by TransLink will be undertaken at the applicant s expense. 3995_TAP_Applicationbooklet_20pp_Jan_2018_D.indd 6

7 7 TransLink Access Pass Section 1: Applicant information Please print clearly using a black or blue pen. One application must be completed per applicant. Questions marked with are mandatory. 1.1 Applicant s details Customer reference number (CRN) (if known): (This is the number printed above your name on the card) Title: (please tick) Mr Mrs Miss Ms Other: Surname: First or given name: Date of birth: / / Male Female Residential address: Suburb: State: Postcode: Postal address (if different to residential): Suburb: State: Postcode: Home phone: Mobile: Note: If paying by credit card please ensure you have supplied a contact phone number and/or address. 1.2 Are you a permanent resident of Queensland? Yes No If no, then you are not eligible for the pass. 1.3 Do you have a current TransLink Access Pass? Yes If yes, you do not need to complete this form. You need to complete a Translink Access Pass Renewal Form. No Continue to next question. 1.4 Are you able to travel independently on TransLink s public transport network? (please tick one) Yes Go to question 1.5. No You are ineligible for the TransLink Access Pass. However, you may be eligible for a Companion Card. For more information visit translink.com.au or call _TAP_Applicationbooklet_20pp_Jan_2018_D.indd 7

8 8 TransLink Access Pass 1.5 What is your specific diagnosis or condition? Note: If you have a formal diagnosis, please use the space below to briefly describe your condition. 3995_TAP_Applicationbooklet_20pp_Jan_2018_D.indd 8

9 9 TransLink Access Pass 1.6 Describe how your disability stops you from independently touching on and touching off with a go card. To receive a TransLink Access Pass you must demonstrate that your disability prevents you from independantly touching on or touching off with a go card at go card readers when using TransLink s public transport network. The following two questions will in no way affect your application and will be used to assist TransLink in the provision of resources. 1.7 How many times (approximately) per week do you use TransLink services? 1.8 How many zones do you travel on your average journey? 3995_TAP_Applicationbooklet_20pp_Jan_2018_D.indd 9

10 10 TransLink Access Pass Health care professional assessment Important information for health care professionals: In order for the applicant to be eligible for the TransLink Access Pass, all of the following must apply. The applicant must: have a significant permanent disability be able to travel independently on public transport without the assistance of a companion or carer be unable to independently touch on and off with a go card. For more information about how go card works see pages 4 and 5. This pass will only be issued to the person with the disability. You must complete all of Section 2. Your answers are critical in the assessment of the applicant s eligibility. Print clearly using a black or blue pen. Section 2: Assessment Questions marked with are mandatory. 2.1 I am currently practising as one of the following (please tick): Registered doctor Registered psychologist Registered physiotherapist Qualified occupational therapist eligible for membership of OT AUSTRALIA, Queensland. 2.2 I have seen the applicant in a professional capacity for: years months. 2.3 My diagnosis of the applicant s disability is: a. Primary: 3995_TAP_Applicationbooklet_20pp_Jan_2018_D.indd 10

11 11 TransLink Access Pass b. Secondary: c. Other: 2.4 Grade the severity of each disability (mild, moderate, severe) a. Primary Mild Moderate Severe b. Secondary Mild Moderate Severe c. Other Mild Moderate Severe 2.5 Is the disability or disabilities permanent? a. Primary: Yes No b. Secondary: Yes No c. Other: Yes No 2.6 Describe in detail the functional impact of the applicant s disability. 3995_TAP_Applicationbooklet_20pp_Jan_2018_D.indd 11

12 SCREEN SCREEN SCREEN 12 TransLink Access Pass 2.7 Does the applicant s disability stop them from independantly touching on and touching off with a go card correctly at the go card readers? (please tick) Yes Complete question 2.8 No The applicant is not eligible for the TransLink Access Pass. Do not continue completing this form. 2.8 Tick one of the following: The applicant is unable to reach the maximum touch zone height of 1100mm. (Please check the heights on the go card device diagrams below.) The applicant is unable to independantly use a go card because: 900mm approx 1025mm approx 900mm approx Bus reader Train and tram platform reader CityCat and ferry reader 3995_TAP_Applicationbooklet_20pp_Jan_2018_D.indd 12

13 13 TransLink Access Pass 2.9 In order to assess the eligibility of the applicant, in your professional opinion is the applicant able to travel independantly (without a carer) on public transport: Yes Continue to question 2.10 No The applicant is not eligible for a Translink Access Pass My signature on the next page confirms all of the following: I have read all the information provided by the applicant on this form and verify that it is correct to the best of my knowledge. I verify that the applicant has a significant permanent disability. I verify that the applicant is able to travel independently on TransLink s public transport network; however, is unable to touch on or touch off using a go card at go card readers independently in all cases. I am not the applicant, or an immediate family member of the applicant. I agree to offer all reasonable information to assist TransLink to determine the applicant s eligibility. I have signed the reverse of the applicant's photograph and confirm it is a true likeness of the applicant. 3995_TAP_Applicationbooklet_20pp_Jan_2018_D.indd 13

14 14 TransLink Access Pass 2.11 Health care professional details Name: Employer/business name: Business address: Suburb: State: Postcode: Business phone: Signature: Date: / / Medicare Provider number* or Australian Health Provider Regulation Agency registration number (AHPRA): Professional stamp: (please stamp here) Reminder to health professional: Please ensure you sign the back of the applicant's passport photo. * If you don't have a Medicare Provider number, you need to supply your AHPRA or Authorised Association Registration number. 3995_TAP_Applicationbooklet_20pp_Jan_2018_D.indd 14

15 15 TransLink Access Pass Section 3: Applicant/guardian/agent declaration 3.1 I confirm that the signature below verifies the following: I have a significant permanent disability. I am able to travel independently on TransLink s public transport network. However, I am unable to independently touch on or touch off using a go card. I authorise TransLink or TransLink s representative to verify the information contained in this form, and to obtain and disclose any information relating to this application for the purpose of assessing my eligibility for a TransLink Access Pass. I agree that the health care professional in Section 2 may disclose information about me to TransLink or TransLink s representative to assist with the assessment of my application. I declare that the information in this application is correct. I accept the TransLink Access Pass Conditions of Use outlined in Section 6. I have read the TransLink Access Pass Privacy Notice outlined in Section Please provide the following signatures: Applicant signature (must be 18 years and over): OR Date: / / Guardian/agent signature for applicants unable to sign (must be 18 years and over): Date: / / 3.3 Guardian/agent details if relevant Guardian/agent name: Relationship to the applicant: Guardian/agent phone: 3995_TAP_Applicationbooklet_20pp_Jan_2018_D.indd 15

16 16 TransLink Access Pass Section 4: Payment options There are two payment options to choose from: credit card or cheque/postal order. Please complete your preferred payment option. Note: Cash payments and credit card details are not accepted by mail. 4.1 Credit card TransLink complies to the Payment Card Industry Data Security Standard (PCI DSS). This means your credit card details are only processed, stored or transmitted in a secure environment. Improved security for customers mean we no longer accept credit card details using this form. Please tick if you wish to pay using credit card. Please ensure you have supplied a current phone number or address in Section 1. I have supplied a current phone number in Section 1. I have supplied a current address in Section 1. When your application has been processed you will receive a phone, sms or message. This message advises you to call between 7am to 7pm (Monday-Friday) to arrange your secure credit card payment. Once TransLink receives your payment you will receive your TransLink Access Pass within 10 business days. Credit card amount: $72.20 # 4.2 Cheque or postal order Please make the cheque or postal order payable to TransLink Division and post along with this application to: TransLink Access Pass TransLink GPO Box 50 Brisbane Qld 4000 Cheque or postal order amount: $72.20 # # Fee subject to change. 3995_TAP_Applicationbooklet_20pp_Jan_2018_D.indd 16

17 17 TransLink Access Pass Section 5: Photograph A photograph is MANDATORY for ALL applicants. Affix ONE passport-size colour photograph to the form. Your full name must be printed on the reverse of the photograph and signed by the same health care professional who completed Section 2. The photograph must be a clear head shot taken front on. Photocopies or black and white photographs will not be accepted. The photograph is kept on file to make it easier for you to get a replacement TransLink Access Pass in the event it is lost, stolen or damaged. Photo specifications 45 50mm high and 35 40mm wide. Show head and top of shoulders close up, so the measurement of the face from the bottom of the chin to the crown (i.e. top of head without hair) is between 32mm and 36mm. Min 32mm Size Max 36mm Section 6: Conditions of use 1. This pass is issued subject to the Transport Operation (Passenger Transport) Act 1994 and the TransLink Conditions of Travel. 2. The TransLink Access Pass entitles the pass holder to unlimited travel on TransLink bus, train, ferry and tram services (excluding Airtrain) until the expiry date printed on the front of the pass. 3. This pass is not transferable or refundable. Only the person whose photograph and details appear on the TransLink Access Pass can use the pass. 4. The pass holder must be able to present their TransLink Access Pass to a driver or authorised persons when travelling on TransLink services. 5. The TransLink Access Pass remains the property of the TransLink Division. 6. TransLink may change these conditions of use from time to time. The current version of the conditions of use may be obtained by calling TransLink on Where TransLink reasonably considers that any such change will have more than a minor effect on TransLink Access Pass holders generally, TransLink will notify pass holders in advance in writing. 7. The pass holder must not alter, tamper, or interfere with the TransLink Access Pass or knowingly use a defective pass. 8. The pass holder agrees to advise TransLink as soon as possible if the TransLink Access Pass is lost, stolen or damaged. For replacement passes, you must complete the Replacement of Lost, Stolen or Damaged Pass Form, in addition to a Statutory Declaration witnessed by a Justice of the Peace. A replacement administration fee is payable. 9. Failure to comply with these conditions of use may result in a penalty. 10. Translink Division reserves the right to cancel or revoke any passes issued. 3995_TAP_Applicationbooklet_20pp_Jan_2018_D.indd 17

18 18 TransLink Access Pass Section 7: Privacy notice If personal information sought by TransLink is not provided, TransLink may not be able to provide a TransLink Access Pass. TransLink is committed to protecting the privacy, accuracy and security of your personal information in accordance with the Information Privacy Act 2009 (Qld). To obtain the full TransLink Privacy Statement call or visit translink.com.au. Section 8: Contacts for further information For all TransLink Access Pass enquiries you can call or visit translink.com.au. Credit card payments call Interpreter service call National relay service TTY and modem call Direct TTY call Accessible transport visit translink.com.au/accessibletransport Speech to speech relay service call _TAP_Applicationbooklet_20pp_Jan_2018_D.indd 18

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20 The State of Queensland (Department of Transport and Main Roads) 2018 Updated December 2017 Download MyTransLink app, visit translink.com.au or call _TAP_Applicationbooklet_20pp_Jan_2018_D.indd 20