Appendix 2: Survey Forms: Curb Ramps
Curb Ramps Construction/Alteration Date (circle one): Before 1/26/92 After 1/26/92
| Facility Name/Address: | Date: |
| Location: | Surveyors: |
Record your measurements in the blanks when they are provided. Do not circle a response for a question you are directed to skip. If your answer to a question is no, but the choices are “Y” and “n/a,” circle “n/a” (not applicable). (A circled “N” signifies a violation).
| Describe each curb ramp’s location: | Curb Ramp D: |
| Curb Ramp A: | Curb Ramp E: |
| Curb Ramp B: | Curb Ramp F: |
| Curb Ramp C: | Curb Ramp G: |
| Refer to # |
Curb Ramp (CR) Questions |
Curb Ramp A |
Curb Ramp B |
Curb Ramp C |
Curb Ramp D |
Curb Ramp E |
Curb Ramp F |
Curb Ramp G |
|||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1 | Is ramp of CR at least 36" wide (not including flared sides)? |
Y | N | Y | N | Y | N | Y | N | Y | N | Y | N | Y | N |
| 2 | Does CR have a running slope of 8.33% or less? | Y | N | Y | N | Y | N | Y | N | Y | N | Y | N | Y | N |
| 3 | Does CR have a cross slope of 2% or less? | Y | N | Y | N | Y | N | Y | N | Y | N | Y | N | Y | N |
| 4 | Does CR have a gutter slope of 5% or less? | Y | N | Y | N | Y | N | Y | N | Y | N | Y | N | Y | N |
| 5 | Are transitions on and off CR flush and free of abrupt level changes? Record the height of any level changes. |
Y | N | Y | N | Y | N | Y | N | Y | N | Y | N | Y | N |
| 6 | Does CR have detectable warnings? | Y | N | Y | N | Y | N | Y | N | Y | N | Y | N | Y | N |
| 7 | Can CR be blocked by legally parked cars? | Y | N | Y | N | Y | N | Y | N | Y | N | Y | N | Y | N |
| 8 | Is the sidewalk at the “top” of CR at least 36" wide? | Y | N | Y | N | Y | N | Y | N | Y | N | Y | N | Y | N |
| 9 | Does CR have flared sides? If yes, answer one of the next two questions. If not, skip to question 10. |
Y | n/a | Y | n/a | Y | n/a | Y | n/a | Y | n/a | Y | n/a | Y | n/a |
| 9.a | If the sidewalk at the “top” of CR is 48" wide or more, is the slope of the flared sides 10% or less? | Y | N | Y | N | Y | N | Y | N | Y | N | Y | N | Y | N |
| 9.b | If the sidewalk at the “top” of CR is less than 48" wide, is the slope of the flared sides 8.33% or less? | Y | N | Y | N | Y | N | Y | N | Y | N | Y | N | Y | N |
| 10 | If no flared sides, is there an obstruction or grass on each side of CR that discourages pedestrians from traveling across ramp? If the CR has flared sides, skip this question. |
Y | N | Y | N | Y | N | Y | N | Y | N | Y | N | Y | N |
| 11 | If CR is built-up to the curb, is it outside the path of cars? If CR is not built-up to curb, skip this question. |
Y | N | Y | N | Y | N | Y | N | Y | N | Y | N | Y | N |
| Answer the last two questions only if the CR is located at a marked crossing: | |||||||||||||||
| 12 | Is ramp of CR contained in markings? | Y | N | Y | N | Y | N | Y | N | Y | N | Y | N | Y | N |
| 13 | If corner-type CR, is bottom landing at least 48" long and contained in crosswalk? If not corner-type CR, skip this question. |
Y | N | Y | N | Y | N | Y | N | Y | N | Y | N | Y | N |
Comments:
This survey form is designed to assist you in identifying common barriers to access – not all barriers. To identify all barriers, you must survey for compliance with §§ 4–10 of the ADA Standards.
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