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Run: 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 ...

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Evaluation Scope and Submission Details

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

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

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

Are modifications or corrective actions needed? (required)

Planned modifications or corrective actions

Priority level

Target completion date

Responsible party

Documentation, Consultation, and Audit Trail

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)

Yes No N/A

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Email (required)

Your name (optional)

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