The Survey Instrument contained in Attachment 5 of this agreement, which is to be used to assess the accessibility of Philadelphia polling place locations, was designed solely for use under this particular agreement.  For further information on accessible polling places please consult the ADA Checklist for Polling Places.

 

ATTACHMENT 5

SURVEY INSTRUMENT

 

Number of Ramp Forms: ____________________   Number of Elevator/Lift Forms:  ____________

What is the building in which the polling place is located normally used as?  (CHECK ONE)

[  ]    House of worship (e.g., church, parish, synagogue, mosque, temple)
[  ]    School
[  ]    Library
[  ]    Courthouse
[  ]    Fire station
[  ]    Recreational or community center
[  ]    City Hall
[  ]    Private home
[  ]    Other  (PLEASE SPECIFY):  ____________________________________________________

Entrance location __________________________________________________________________
Is there an Alternate Accessible Entrance?  Yes ____ No ____
Can the Alternate Accessible Entrance be re-designated as the exclusive entrance? Yes ___ No ___

 

 

A.

Sidewalks and Walkways

Yes

No

Comments

A-1.

If parking is provided to voters, is there an accessible route from accessible parking spaces to the accessible entrance of the building? [ADA Stds 4.1.2(1), 4.3]

 

   

A-2.

Is an accessible route provided from public sidewalks and public transportation stops on the polling site (if provided) to the accessible entrance of the building? [ADA Stds 4.1.2(1)]

 

 

 

A-3.

Is the accessible route at least 36 inches wide? If No, the accessible route may narrow to 32 inches wide for up to 2 feet in length.

 

 

 

A-4.

Is the accessible route free of steps and abrupt level changes over 1/2 inch?

 

 

 

A-5.

Where an accessible route crosses a curb is a curb ramp provided? If yes,

 

 

 

A-5a.

Is the curb ramp surface at least 36 inches wide, excluding flared sides? [ADA Stds 4.7.3]

 

 

 

A-5b.

Is the slope (up or down the ramp) no more than 1:12? [ADA Stds 4.7.2]

 

 

 

A-6.

Is the slope of part of the accessible route greater than 1:20? If yes, please fill out the ramp form.

 

 

 

A-7.

 

Is there a remedy for removing any barriers permanently?

 

 

 

A-8.

Is there a remedy for removing any barriers temporarily?

 

 

 

 

B.

Building Entrance

Yes

No

Comments

B-1. Is there at least one accessible exterior entrance?  [ADA Stds 4.1.3(1)]      
B-2. On the pull side of the door, is there at least 18 inches clearance provided to the side of the latch if the door is not automatic or power-operated? [ADA Stds 4.13.6, figure 25]      
B-3. Is the door hardware usable with one hand without tight grasping, pinching, or twisting of the wrist? [ADA Stds 4.13.9]      
B-4. Does at least one door or one side of a double leaf door at the accessible entrance provide at least 32 inches clear passage width when the door is open 90 degrees?      
B-4a. If No, does another entrance have an accessible door or can both doors be propped open during voting?      
B-5. If there is a raised threshold, is it no higher than 3/4 inch at the door and beveled on both sides? [ADA Stds 4.1.6(3)(d)(ii), 4.13.8]      
B-6. If an entry has a vestibule, is there a 30-inch by 48-inch clear floor space inside the vestibule where a wheelchair or scooter user can be outside the swing of a hinged door? [ADA Stds 4.13.7]      
B-7. Is there a remedy for removing any barriers permanently?      
B-8. Is there a remedy for removing any barriers temporarily?      

C.

Hallways and Corridors

Yes

No

Comments

C-1. Is the accessible route at least 36 inches wide? If No, the accessible route may narrow to 32 inches wide for up to 2 feet in length.      

C-2.

Is the accessible route free of steps and abrupt level changes over 1/2 inch? [ADA Stds 4.1.3(1), 4.3.8]

 

 

 

C-3.

Does the route from the accessible entrance to the voting area change levels using a ramp, lift or elevator? If yes, go to Ramp, Elevator, or Lift form and complete for each element present.

 

 

 

C-4.

At each location on the way to the voting area where the accessible route passes through a door or doors, does at least one door meet the following requirements?

 

 

 

C-4a.

Is the clear width for the door opening at least 32 inches measured when the door is open 90 degrees? [ADA Stds 4.1.3(7), 4.13.5]

 

 

 

C-4b.

 

Is the door hardware usable with one hand, without tight grasping, pinching, or twisting of the wrist? [ADA Stds 4.13.9]

 

 

 

C-4c.

Is there clear maneuvering floor space in front of each accessible door and on the pull side, is there at least 18 inches clear floor space beyond the latch side of the door? [ADA Stds 4.13.6]

 

 

 

C-4d.

Is no more than 5 pounds force needed to push or pull open the accessible door?

 

 

 

C-4e.

If the answers to questions (b) thru (d) are no, can the door be propped open to provide an accessible route on election day?

 

 

 

C-5.

Is there a remedy for removing any barriers permanently?

 

 

 

C-6.

Is there a remedy for removing any barriers temporarily?

 

 

 

D.

Voting Area

Yes

No

Comments

D-1.

Is there an accessible entrance to the voting area?

 

 

 

D-2.

Within the voting area, is adequate space available on the accessible level for check-in tables, a voting demonstration area (if provided), and at least one voting station accessible to persons in wheelchairs?

 

 

 

D-3.

 

 

Is there a remedy for removing any barriers permanently?

 

 

 

D-4.

Is there a remedy for removing any barriers temporarily?

 

 

 

E.

RAMP

Yes

No

Comments

E-1.

Is the ramp slope no greater than 1:12? [ADA Stds 4.8.2] Note: For existing ramps, the slope may be 1:10 for a 6 inch rise and 1:8 for a 3 inch rise in special circumstances (see ADA Stds 4.1.6(3)).

 

 

 

E-2.

Is the ramp width, measured between handrails, at least 36 inches? [ADA Stds 4.8.3]

 

 

 

E-3.

Does the ramp have a level landing at the top and bottom of each ramp section that is at least 60 inches long? [ADA Stds 4.8.4]

 

 

 

E-4.

If a ramp is more than 30 feet long, is a level landing at least 60 inches long provided every 30 feet of horizontal length? [ADA Stds 4.8.4] Note: When the running slope is less than 1:16 and more than 1:20, each ramp segment may be up to 40 feet long followed by a level landing.

 

 

 

 

E-5.

Is a level landing at least 60 inches by 60 inches, provided where a ramp changes direction? [ADA Stds 4.8.4]

 

 

 

 

E-6.

If the ramp is more than six feet long or has a rise of more than 6 inches, are there handrails on both sides of the ramp, mounted between 34 and 38 inches above the ramp surface? [ADA Stds 4.8.5]

 

 

 

E-7.

Do the handrails extend 12 inches beyond the top and bottom of the ramp surface, parallel to the ground or floor surface?  [ADA Stds 4.8.5]

 

 

 

E-8.

If the ramp or landing has a vertical drop-off on either side of the ramp, is edge protection provided? [ADA Stds 4.8.7]

 

 

 

E-9.

Is there a remedy for removing any barriers permanently?

 

 

 

E-10.

Is there a remedy for removing any barriers temporarily?

 

 

 

F.

ELEVATOR

Yes

No

Comments

F-1.

If an elevator is provided to access the voting area level, does it meet the following requirements:

 

 

 

F-1a.

Are the elevator call buttons mounted in an accessible location with the centerlines at 42 inches above the floor? [ADA Stds 4.10.3]

 

 

 

F-1b.

Does the floor area of the elevator car provide space for wheelchair users to enter, reach the controls, and exit the car? [ADA Stds 4.10.9]

 

 

 

F-1c.

Are the highest floor control buttons in the elevator cab mounted no more than 54 inches above the floor for a side reach or 48 inches for forward reach?

 

 

 

F-2.

Is there a remedy for removing any barriers permanently?

 

 

 

F-3.

Is there a remedy for removing any barriers temporarily?

 

 

 

G.

LIFT

Yes

No

Comments

G-1.

If a wheelchair lift is provided, does it meet the following requirements:

 

 

 

G-1a.

Is the lift operational at the time of the survey?

 

 

 

G-1b.

Is the change in level from the floor to the lift surface ramped or beveled?

 

 

 

G-1c.

Is there at least a 30-inch by 48-inch clear floor space on the wheelchair lift?

 

 

 

G-1d.

Does the lift allow a wheelchair user unassisted entry, operation, and exit? [ADA Stds. 4.11.3]

 

 

 

G-1e.

Are the controls and operating mechanisms mounted no more than 54 inches above the floor for a side reach or 48 inches for a forward reach?

 

 

 

G-1f.

Are the controls and operating mechanisms usable with one hand without tight grasping, pinching, or twisting?

 

 

 

G-2.

Is there a remedy for removing any barriers permanently?

 

 

 

G-3.

Is there a remedy for removing any barriers temporarily?

 

 

 

 

ADDITIONAL INFORMATION REQUESTED BY THE CITY OF PHILADELPHIA

 

Size of room used as polling place. _____ ft. _____ in. _____ ft. _____ in.

Height of Polling Place? _____ ft. _____ in.

On what floor is the polling place? Basement ___ 1st Floor ___ Garage ___ Enclosed Porch _____

There are _____ steps up _____ steps down to the polling place.

If one step, height of step? _____________ft. ________________ in. __________ width of step? ______________ft. ____________ in.

There are _____ floor sockets, _____ electric lights.

Toilet is located: in basement _____ 1st Floor _____ 2nd floor _____

Is light and heat available? _____ Yes _____ No

Are chairs and a table available at the polling place? _____ Yes _____ No

Could the building accommodate an additional division? Yes _____ No ______

Where would the additional division be located in the building? _____________________________

Size of room to be used as polling place. _____ ft. _____ in. _____ ft. _____ in.

Height of Polling Place? _____ ft. _____ in.

Garage ___ Enclosed Porch _____

There are _____ steps up _____ steps down to the polling place.

If one step, height of step __________ ft. ________________ in. _________ width of step? __________ ft. _____________ in.

There are _____ floor sockets, _____ electric lights.

Toilet is located: in basement _____ 1st Floor _____ 2nd floor _____

Is light and heat available? _____ Yes _____ No

Are chairs and a table available at the additional division? _____ Yes _____ No

 

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