General InformationName(Required) First Last Email(Required) Date of Inspection(Required) MM slash DD slash YYYY Cross Street(Required)Corner or quadrant(Required) A B C DSidewalksSidewalk problem codes (select all that apply)(Required) 1. Widths less than 36” 2. Interruptions to the sidewalk (large cracks, gaps, uneven spots) 3. Debris Sidewalks around here look great! N/A OtherSidewalk commentsRampsRamp problem codes (select all that apply)(Required) 4. Width less than 36” 5. Missing detectible warning surface (tactile warning strips) at intersections 6. Too steep 7. Debris Ramps here look great! N/A OtherRamp commentsPedestrian SignalsAccessible pedestrian signal codes (select all that apply)(Required) 8. No signal equipment 9. Button doesn’t activate walk/don’t walk light 10. Button doesn’t activate speech message (a voice saying "walk") 11. No beeping locator tone 12. Beeping locator tone too loud 13. Beeping locator tone too quiet 14. Audible speech message giving inaccurate information 15. Push button too far from crosswalk (more than 5 feet) 16. Timing to cross too short 17. Tactile arrow on button not lined up with outside edge of crosswalk 18. Tactile arrow on button does not vibrate during walk signal 19. Two Accessible Pedestrian Signals are on one pole Accessible pedestrian signals here are great! NA OtherAccessible pedestrian signal commentsClosing Statements/FilesWhat would you like us to know about this assessment process or reporting form?Supporting Documents Drop files here or Select filesMax. file size: 256 MB. 98687
