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Voter Report Form for
Polling Place Accessibility Concerns

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I had a difficult time voting at the following polling place:

Street Address: (required)
Building Name: (required)
City/Town: (required)
County: (required)
I had a difficult time voting for the reasons selected below.
Exterior access to the polling place was prohibitive due to:
    
a poorly or unlit parking space
 
a lack of accessible parking
  a lack of access aisles
 
site access not being clearly marked
 
a lack of ramps or curb cuts
 
an unpaved parking space
 
available parking not closest route to building
 
no clear path of travel to the building
 
other:
 
explain:
The building is not ADA compliant in the following areas:
    
steps
 
width of walkways
 
doors hinder or stop access
 
no elevators
 
no wheel chair ramps
  ramp was too steep or no turn around space
  no hand rails
 
no assistance available
 
accessible entrance not marked
 
no accessible entrance
 
entrance not near accessible parking
 
other:
 
explain:
Poll workers...
    
were unaware of my special needs
 
refused to assist me
 
were not available to assist me
 
other:
 
explain:
The voting booth...
    
signage was unclear or unreadable
 
was inaccessible
  offered little or no privacy
 
Registration table incorrect height
 
did not have enough leg room
 
Lighting inadequate
 
other:
 
explain:
The voting equipment...
    
was unusable
 
was confusing
 
had no audio
 
other:
 
explain:
The sample ballot was...
    
confusing
 
unreadable
 
in the wrong language
 
different than the voting machine ballot
 
not made available in an alternate format
 
other:
 
explain:
Contact Information:
Name: (required)
Street Address: (required)
 
City/Town: (required)
Zip: (required)
Telephone:
e-mail:
Additional
Comments:

 

 

 

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Department of State, Division of Elections, P.O. BOX 304, Trenton, NJ 08625

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