Author: Ellen

County Board of Elections
Polling Place Accessibility Checklist
Location Name/Address: _______________________________________________ Election: _______________________
Town: ___________________________ Ward: ___________ District: ___________

Compliant with
Temporary Measures

Prior to the opening of polls at 6:00 am, you must inspect and certify that this
polling location provides full ADA accessibility for all voters.
Instructions to Board Workers:
Walk the path of travel to confirm there are no obstructions preventing ADA accessibility. This location requires temporary modifications and these remedies must be in place to provide full ADA accessibility at the polls. Use the photos to determine compliance. If you check NO to any of these questions, please contact your County Board of Elections immediately.

Yes No

Yes No

Yes No

Yes No

Yes No

If off-street parking is available—is there at least one ADA accessible parking space marked with ADA accessible parking signs?
If off-street parking is available—Is the parking sign marked “van accessible”?
Is the path of travel to the front door free of any large cracks or holes?
Is the path of travel from the parking area to the voting area free of any obstructions?
Is there at least a 6 foot area in front of the sign-in table and the voting machines?
If you checked NO to any of the above questions, please provide the name of the person you notified at your
County Board of Elections: ____________________________________________________________________

Yes No

Cones & ADA accessible parking sign are in place to create temporary ADA van accessible parking space.

ED Notes: ___________________________________________________________________________________
____________________________________________________________________________________________

Yes No

“Van Accessible” sign has been posted in the ADA accessible parking space.

ED Notes: ___________________________________________________________________________________
____________________________________________________________________________________________

Yes No

Any large cracks or holes are filled or covered by a slip resistant mat to provide a stable and firm surface.

ED Notes: ___________________________________________________________________________________
____________________________________________________________________________________________

Yes No

A temporary doorbell has been posted outside to remedy a non-compliant ramp or entrance issue.

ED Notes: ___________________________________________________________________________________
____________________________________________________________________________________________

Yes No

A temporary ramp has been installed over steps or high thresholds.

ED Notes: ___________________________________________________________________________________
____________________________________________________________________________________________

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County Board of Elections
Polling Place Accessibility Checklist
Location Name/Address: _______________________________________________ Election: _______________________
Town: ___________________________ Ward: ___________ District: ___________

Compliant with
Temporary Measures

Yes No

The exterior entrance is non-compliant and the door must be propped open.

ED Notes: ___________________________________________________________________________________
____________________________________________________________________________________________

Yes No

The interior entrance is non-compliant and the door must be propped open.

ED Notes: ___________________________________________________________________________________
____________________________________________________________________________________________

Yes No

The middle bar is removed in doorway to expand width of opening.

ED Notes: ___________________________________________________________________________________
____________________________________________________________________________________________

Yes No

A cone or other object is placed underneath the object that extends more than 4” into the path of travel.

ED Notes: ___________________________________________________________________________________
____________________________________________________________________________________________

Yes No

Other issue:

ED Notes: ___________________________________________________________________________________
____________________________________________________________________________________________

This polling location has been inspected & determined to be in compliance by the County Board of Elections with the above temporary modifications. If an unforeseen event creates an ADA inaccessible condition, please contact your County Board of Elections immediately.

Election Day Certification
I/we hereby certify that the above identified polling location has been inspected and found compliant for ADA accessibility. All temporary modifications are in place providing fully ADA accessibility at this polling location.
I/we certify that the foregoing statements made by me are true. I/we are aware if any of the foregoing statements made by me are willfully false, I am subject to punishment.
______________________/_________________________ _______________________/_________________________
Boardworker Printed Name / Signature Boardworker Printed Name / Signature
______________________/_________________________ _______________________/_________________________
Boardworker Printed Name / Signature Boardworker Printed Name / Signature
Master Board Worker Verification _________________________________________ Page 2