ADA Title II Self-Evaluation Worksheet (Local Government)
This ADA Title II Self-Evaluation Worksheet helps a local government document barriers in services, policies, practices, and digital access, then track needed modifications and follow-up.
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Overview
This ADA Title II Self-Evaluation Worksheet is a structured form for local government teams to review a public service, policy, practice, or digital offering and record what needs to change. It is built to capture the basics first: who reviewed the issue, what program or service was examined, what barriers were found, which people are affected, and what accommodations or interim measures already exist.
Use it when a department needs to document an accessibility review under ADA Title II, especially when the issue could involve a physical location, a public-facing process, or a website, portal, or online form. The worksheet also supports a policy and practice review, including a field for the WCAG version reviewed when the issue is digital. That makes it useful for public entities that need one record tying together service access, policy changes, and remediation ownership.
Do not use it as a generic incident log or a substitute for a full legal analysis. If the review is unrelated to public access, does not involve a government service, or needs a broader procurement or project tracker, a different template may fit better. This worksheet works best when the reviewer can name the barrier clearly, identify the affected users, and assign a concrete corrective action with a target completion date and follow-up.
Standards & compliance context
- This worksheet supports ADA Title II self-evaluation documentation under 28 CFR 35.105 by recording the service reviewed, barriers identified, and modifications needed.
- For digital services, the WCAG review field helps teams document the accessibility standard used during evaluation and remediation planning.
- The form should follow data minimization by collecting only the reviewer, issue, and follow-up details needed to document the accessibility review.
- If any PII is collected in the submission, the form should include clear disclosure language about how the information will be used and retained.
- For public-facing intake or complaint workflows, an anonymous submission option may be appropriate when the entity does not need to identify the reporter.
General regulatory context for orientation only — verify current requirements with counsel or the relevant agency before relying on this template for compliance.
What's inside this template
Review Scope and Submission Details
This section anchors the review by identifying exactly what was evaluated, when it was reviewed, and who is responsible for the record.
- Public Entity Name
- Department or Division
- Review Date
-
Review Period
Optional. Enter the time period covered by this self-evaluation, such as FY 2025 or Q1 2026.
- Program, Service, Policy, or Practice Reviewed
- Review Type
- Reviewer Name
- Reviewer Title
Access and Program Analysis
This section captures the real-world barrier, who it affects, and what accommodations already exist so the issue can be prioritized correctly.
- Is the service or program accessible as currently operated?
-
Observed Barriers to Access
Select all that apply. Use only the categories needed to document the barrier.
-
Barrier Description
Describe the specific barrier, including where it occurs and how it affects access.
-
Who Is Affected?
Select the groups impacted by the barrier, if known.
- Existing Accommodations or Modifications Already in Place
Policy, Practice, and Digital Accessibility Review
This section connects the accessibility finding to the underlying policy, practice, or digital service that needs to change.
- Policy or Practice Reviewed
-
Digital Service or Web Content Reviewed
Optional. Use this field when the review includes a website, portal, form, or other digital service.
- Was WCAG 2.1 AA used as the accessibility benchmark for digital content?
- Does the policy, practice, or procedure require modification?
-
Modification Summary
Describe the proposed modification, including the operational change needed to improve access.
Corrective Actions and Timeline
This section turns the review into action by assigning ownership, setting dates, and documenting interim measures and follow-up.
- Corrective action required?
-
Action Owner
Name or role responsible for implementing the modification.
- Target Completion Date
-
Interim Measures
Describe any temporary measures that will be used until the modification is complete.
- Follow-up review required?
- Follow-up Review Date
Certification and Audit Trail
This section preserves accountability by recording who submitted the worksheet and what notes support the final record.
- Submitter Name
- Submitter Email
- Certification
-
Audit Trail Notes
Optional. Add reference numbers, meeting notes, or document links needed to support the audit trail.
How to use this template
- Enter the entity, department, review date, review period, and the specific program, service, or policy being evaluated so the record is tied to one review scope.
- Describe whether the review covers a physical service, policy, practice, or digital service, and note the reviewer’s name and title for accountability.
- Record any access barriers, who is affected, and what accommodations or workarounds already exist so the form reflects the actual user experience.
- Document the policy or practice reviewed, the WCAG version if a digital service is involved, and whether a modification is needed with a short summary of the change.
- Assign the corrective action owner, set a target completion date, list any interim measures, and specify whether follow-up is required.
- Complete the certification and audit trail notes after submission so the worksheet shows who confirmed the review and what happened next.
Best practices
- Name the exact service, policy, or digital page being reviewed instead of writing a broad department label.
- Use conditional logic so digital accessibility fields appear only when a website, portal, or online form is in scope.
- Describe barriers in plain language and tie each one to a real user impact, such as limited navigation, inaccessible forms, or unclear communication paths.
- Mark required versus optional fields clearly so reviewers do not over-collect information that is not needed for the evaluation.
- List interim measures whenever a fix will take time, especially when the barrier affects public access or time-sensitive services.
- Keep the modification summary specific enough that the action owner can implement it without guessing.
- Use the audit trail notes to capture escalation, handoffs, and closure rather than leaving those details in email.
What this template typically catches
Issues teams running this template most often surface in practice:
Common use cases
Frequently asked questions
What is this worksheet used for?
This worksheet is used by a public entity to record an ADA Title II self-evaluation of a service, policy, practice, or digital property. It captures what was reviewed, what barriers were found, who is affected, and what modification is needed. It also creates a clear audit trail for follow-up and certification.
Who should complete the self-evaluation?
It is usually completed by a department lead, ADA coordinator, accessibility specialist, or another designated reviewer with enough context to assess the program or service. The certification section helps confirm who reviewed the issue and who is accountable for next steps. For cross-department issues, the reviewer should coordinate with legal, IT, facilities, or program staff as needed.
How often should a local government use this template?
Use it whenever a service, policy, or digital offering is being reviewed for accessibility, and again when a barrier is reported or a program changes. Many entities also use it on a scheduled basis to keep a record of periodic reviews. The review period field makes it easier to compare findings over time.
Does this template cover digital accessibility and WCAG?
Yes, the template includes a section for digital service review and a field for the WCAG version reviewed. That makes it useful for websites, portals, forms, and other public-facing digital services that may need accessibility testing or remediation. It should be paired with the entity’s own testing method and internal accessibility standards.
What are the most common mistakes when filling it out?
Common mistakes include describing the barrier too vaguely, failing to name the people affected, and skipping interim measures when a fix will take time. Another issue is marking a service as accessible without noting the specific evidence used to support that conclusion. The worksheet works best when each field is specific and tied to an actual review.
Can this be customized for different departments or programs?
Yes, it is designed to be adapted for parks, permitting, libraries, public meetings, transit-related services, benefits intake, or digital services. You can add department-specific fields, conditional logic, or separate versions for physical and digital reviews. Keep the core fields intact so the audit trail stays consistent across departments.
How does this compare with ad-hoc email or spreadsheet tracking?
Ad-hoc tracking often loses context, omits follow-up dates, and makes it hard to prove what was reviewed and when. This worksheet standardizes the review, captures the modification decision, and assigns ownership in one place. That makes it easier to route issues, document progress, and maintain a defensible record.
What should happen after the worksheet is submitted?
After submission, the reviewer or ADA coordinator should confirm the corrective action owner, set or verify the target completion date, and decide whether interim measures are needed. If the issue affects public access, the follow-up date should be used to verify the fix or document why more time is needed. The audit trail notes should reflect any escalation or closure.
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