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ADA Title II Self-Evaluation Worksheet (Local Government)

Use this ADA Title II Self-Evaluation Worksheet to document which public services, programs, and practices were reviewed, what barriers were found, and what corrective actions are needed.

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Overview

This ADA Title II Self-Evaluation Worksheet is built for local government teams that need to document a formal review of public services, programs, and practices. It gives you a structured place to record the evaluation scope, the areas reviewed, the barriers found, the legal reference used, and the corrective actions assigned.

Use it when your entity is assessing accessibility across departments, public contact points, forms, notices, facilities, or digital services. The worksheet is especially useful when multiple people contribute to the review and you need a clear audit trail showing who consulted, what evidence was collected, and what changes were approved. It also helps keep the review focused on actual services and practices rather than broad statements about compliance.

Do not use this as a generic intake form or as a substitute for legal review. If you are not conducting an ADA Title II self-evaluation, or if the issue is unrelated to public access, this template is not the right fit. It is also not meant to collect unnecessary personal data; keep fields limited to what you need for the review, use conditional logic where possible, and document only relevant supporting materials. The result should be a usable record that supports follow-up, accountability, and future audits.

Standards & compliance context

  • The worksheet supports ADA Title II self-evaluation documentation under 28 CFR 35.105 by capturing reviewed services, barriers, and planned modifications.
  • The documentation and consultation fields help create an audit trail that shows the entity reviewed its programs and considered corrective action in good faith.
  • Keep the form aligned with data minimization by collecting only the information needed to document the evaluation and implement fixes.
  • If the worksheet includes staff names, emails, or other PII, provide a clear disclosure about how that information will be used and who can access it.
  • For public-facing digital services, use accessibility-aware field design that supports WCAG 2.1 AA, including labels, validation, and keyboard-friendly controls.

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

Evaluation Scope and Submission Details

This section identifies who is submitting the review, what period it covers, and which department owns the record.

  • Public entity name (required)
  • Department or division (required)
  • Evaluation period (required)
  • Submission owner (required)

    Person responsible for this worksheet and follow-up actions.

  • Owner email (required)
  • Review type (required)

Services, Programs, and Practices Reviewed

This section defines the exact public services and contact points that were examined so the review stays specific.

  • Areas reviewed (required)
  • Service, program, or practice name (required)
  • Brief description of the service, program, or practice (required)

    Describe what the public entity provides and how the public interacts with it.

  • Public contact points

ADA Title II Compliance Review

This section captures the access barriers found and ties each finding to the relevant compliance area and legal reference.

  • Were any access barriers identified? (required)
  • Barrier summary

    Summarize the barrier or noncompliance issue in observable terms.

  • Compliance area (required)
  • Evaluation result (required)
  • Relevant legal reference

    Reference the applicable ADA Title II requirement or related standard, such as 28 CFR 35.105, when known.

Required Modifications and Corrective Actions

This section turns findings into assigned work by naming the fix, owner, priority, and due date.

  • Are modifications or corrective actions needed? (required)
  • Planned modifications or corrective actions
  • Priority level
  • Target completion date
  • Responsible party

Documentation, Consultation, and Audit Trail

This section preserves the evidence behind the review, including consultation notes, attachments, and certification.

  • Consulted with ADA coordinator? (required)
  • Consultation notes

    Summarize any consultation, review comments, or decision rationale.

  • Supporting documents

    Upload relevant policies, screenshots, meeting notes, or other supporting records.

  • Certification (required)

How to use this template

  1. Enter the public entity name, department or division, evaluation period, submission owner, and review type so the worksheet clearly identifies the scope of the self-evaluation.
  2. List the services, programs, and practices reviewed, then describe each service and its public contact points so reviewers know exactly what was assessed.
  3. Record each access barrier found, summarize the issue, select the compliance area, and note the legal reference that applies to the finding.
  4. Assign each required modification with a specific action, priority level, target completion date, and responsible party so the worksheet turns findings into work items.
  5. Document who was consulted, add consultation notes and supporting documents, and complete the submitter certification to preserve the audit trail.

Best practices

  • Use specific service names instead of broad department labels so the review shows exactly what was evaluated.
  • Mark required fields clearly and keep optional evidence fields separate so staff do not over-collect information.
  • Write barrier summaries in plain language and tie each one to a single compliance area to avoid duplicate or vague findings.
  • Set target completion dates only after the responsible party has confirmed the fix is feasible and resourced.
  • Use conditional logic to show only the modification fields that apply to the selected review type or barrier category.
  • Attach only supporting documents that are relevant to the finding and avoid unnecessary PII in notes or uploads.
  • Include a clear what happens after I submit line so staff know who reviews the worksheet and how corrective actions are routed.

What this template typically catches

Issues teams running this template most often surface in practice:

A public service is listed too broadly, making it hard to tell what was actually reviewed.
Barrier summaries are written as general observations instead of concrete access issues.
The compliance area is left blank or does not match the barrier described.
Required modifications are listed without a responsible party or target completion date.
Consultation with the ADA coordinator or subject matter experts is not documented.
Supporting documents are missing, making it difficult to verify the basis for the finding.
The submitter certification is completed without confirming that the review period and scope are accurate.

Common use cases

City Clerk Office Review
A city clerk uses the worksheet to review public notices, meeting access, and counter service procedures. The form captures barriers, consultation notes, and the corrective actions needed to improve access.
County Parks Accessibility Audit
A county parks division documents barriers in registration, facility access, and program participation. The worksheet helps separate each reviewed area and assign fixes to the right responsible party.
Transit Customer Service Evaluation
A transit agency reviews rider communications, complaint channels, and service policies for ADA Title II issues. The worksheet records the review scope and creates a trackable list of modifications.
Library Program Access Review
A public library evaluates event registration, public computer use, and in-person assistance practices. The worksheet helps staff document what was reviewed and what changes are needed for equal access.

Frequently asked questions

What is this worksheet used for?

This worksheet helps a public entity document its ADA Title II self-evaluation of services, programs, and practices. It captures what was reviewed, what barriers were identified, and what modifications are needed. It also creates an audit trail for consultation and follow-up. Use it as the record of the review, not just a checklist.

Which departments or programs should be included?

Include any department, division, or public-facing service that affects access to programs, facilities, communications, or digital services. That can include permitting, parks and recreation, libraries, transit, clerk services, and online forms. The scope should match the actual review period and the services you are evaluating. If a service is public-facing, it belongs in scope.

How often should a Title II self-evaluation be completed?

Use it whenever your entity is conducting a formal ADA Title II review, updating policies, or documenting changes after a complaint or accessibility audit. Many organizations also run it on a scheduled cycle so the review stays current. The key is to tie the worksheet to a defined evaluation period. If services or systems change, the worksheet should be updated rather than left stale.

Who should complete the worksheet?

The submission owner is usually the department lead, ADA coordinator, compliance manager, or another designated staff member who can gather facts and route follow-up actions. Input from service owners, facilities staff, IT, HR, and legal or risk teams may be needed depending on the review. The person completing it should be able to confirm what was reviewed and who is responsible for fixes. The consultation field helps show that the review was not done in isolation.

Does this worksheet replace legal review?

No. It documents the self-evaluation process and the corrective actions identified, but it does not replace counsel or formal legal advice. The legal reference field helps anchor the review to the applicable ADA Title II standard. If a barrier raises policy, facilities, or digital accessibility questions, route it through the appropriate review process. Use the worksheet as evidence of diligence, not as a legal conclusion by itself.

What are the most common mistakes when using this form?

Common mistakes include listing services too broadly, leaving barrier descriptions vague, and marking every item as compliant without evidence. Another frequent issue is failing to assign a responsible party or target completion date for each corrective action. Teams also sometimes skip consultation notes, which weakens the audit trail. The worksheet works best when each finding leads to a specific next step.

Can this be customized for digital accessibility or physical access reviews?

Yes. The reviewed areas and compliance area fields can be tailored for digital services, facilities, communications, policies, or program access. You can add conditional logic so only relevant barriers and corrective actions appear for each review type. That keeps the form focused and avoids collecting unnecessary details. It also supports progressive disclosure for easier completion.

What should be attached in supporting documents?

Attach the materials that support the review, such as inspection notes, screenshots, policy excerpts, meeting notes, accessibility test results, or correspondence showing consultation. Keep the attachments relevant to the specific barrier or corrective action. Avoid uploading unnecessary PII. The goal is to preserve the evidence behind the evaluation and the audit trail.

How does this compare with ad hoc notes or email threads?

Ad hoc notes and email threads are easy to lose and hard to audit. This worksheet standardizes the fields needed to show what was reviewed, what was found, and who owns the fix. It also makes it easier to track priorities and completion dates across departments. For a public entity, that structure is often the difference between an informal discussion and a usable compliance record.

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