translink access pass3 t pass using the pass you must carry your translink access pass with you at...

TransLink Access PassInformation and Application Form

Effective 1 August 2018

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 free travel on all TransLink bus, train, ferry and tram services (except Airtrain), for five years.

Who can applyYou 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 passStep 1: Read all the information contained in this booklet, including the TransLink Access Pass Conditions of Use (see Section 5) and the TransLink Access Pass Privacy Notice (see Section 6).

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 4 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: Mail your signed passport photo and original application form to:

TransLink Access Pass TransLink GPO Box 50 Brisbane Qld 4000

Step 6: Allow up to 15 business days for your application to be processed.

Incomplete or unsuccessful applications will be returned to the applicant.


Using the passYou 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 passesIf 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 or Commissioner for Declarations.

Renewing your passIf your TransLink Access Pass has expired or is due to expire soon, you will need to complete this application form. You will need a new medical assessment and passport photo. Please allow up to 15 business days for a new pass to be delivered. It is the pass holder’s responsibility to renew their pass before it expires. Fines may apply for anyone travelling with an expired pass. The expiry date is printed on the pass.


About go cardTransLink’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 13 12 30. Interpreter service call 13 12 30

National relay service TTY and modem call 13 36 77

Direct TTY call 07 3369 3377

Speech to speech relay service call 1300 555 727

Card readersCard 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.


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Bus reader Train and tram – platform reader CityCat and ferry reader

go card readers on busesCard 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 900–1100mm from the floor surface.

go card readers at train and tram stationsCard 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 ferriesCard 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 900–1100mm above the floor surface.

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Types of go card readers


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.


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

Title: (please tick) Mr Mrs Miss Ms Other:

Surname:

First or given name:

Date of birth: / /

Postal address

Suburb: State: Postcode:

Home phone: Mobile:

Email:

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, please supply your Customer reference number (CRN) (if known)

(This is the number printed above your name on the card)

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.


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.


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?


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: AssessmentQuestions 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:


b. Secondary:

c. Other:

2.4 Grade the severity of each disability (mild, moderate, severe)a. Primary

Mild Moderate Severe

b. Secondary


c. Other


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.


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:

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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.

2.10 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.


2.11 Health care professional details Name:

Employer/business name:

Business address:

Suburb: State: Postcode:

Business phone:

Email:

Signature:

Date: / /

Medicare Provider number* or Australian Health Provider Regulation Agency registration number (AHPRA):

Professional stamp: (please stamp here)

* If you don't have a Medicare Provider number, you need to supply your AHPRA or Authorised Association Registration number.

Reminder to health professional:Please ensure you sign the back of the applicant's passport photo.


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 5.

I have read the TransLink Access Pass Privacy Notice outlined in Section 6.

3.2 Please provide the following signatures: Applicant signature (must be 18 years and over):

Date: / /

OR

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:


Section 5: 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) in South East Queensland until the expiry date printed on the front of the pass.

3. This pass is not transferable. 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 13 12 30. 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.

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.

Section 4: 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.

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Section 6: 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 13 12 30 or visit translink.com.au.

Section 7: Contacts for further information For all TransLink Access Pass enquiries you can call 13 12 30 or visit translink.com.au.Interpreter service call 13 12 30

National relay service TTY and modem call 13 36 77

Direct TTY call 07 3369 3377

Accessible transport visit translink.com.au/accessibletransport

Speech to speech relay service call 1300 555 727

© The State of Queensland (Department of Transport and Main Roads) 2018Updated August 2018

Download MyTransLink app, visit translink.com.au or call 13 12 30

translink access pass3 t pass using the pass you must carry your translink access pass with you at...

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