Thank You September 9, 2014 Individual Voting Survey 1. CIDNY's September 9, 2014 Individual Voting Survey Question Title * 1. Poll Site Information Borough or County: Poll Site Name: Poll Site Address: Question Title * 2. If you have a Disability, please check all that apply: (OPTIONAL - used for demographic purposes only) Physical Hearing Sensory Visual Cognitive Mental Health Other (please specify) Question Title * 3. How did you vote on September 9th? In-person By absentee ballot Question Title * 4. Did you have any problems voting? Yes No If 'yes', please explain Question Title * 5. Did you have trouble reading the ballot? Yes No If 'yes', please explain Question Title * 6. How did you mark your ballot? By Hand By Ballot Marking Device (BMD) Question Title * 7. Did the poll worker mention that you could use a BMD? Yes No Question Title * 8. Did you understand how to use the voting equipment (scanner, BMD)? Yes No If 'no', please explain further Question Title * 9. Were you able to vote privately and independently? Yes No If 'no', please explain. Question Title * 10. Did you have any problems getting to your poll site? Yes No Question Title * 11. If 'yes' to the above question, did you have problems with? Transportation Wrong poll site Other Other (please specify) Question Title * 12. Did you experience any of the following when you voted? (Check all that apply) Confusing or missing signs outside the poll site Hard to find the accessible entrance Locked doors at accessible entrance Doors that were hard to open Doors/paths that were too narrow Problem ramps Confusing path to voting Long path to voting Items blocking access to accessible entrance Items blocking access in voting area BMD not accessible or not working Question Title * 13. Was your polling site crowded when you went to vote? Yes No Question Title * 14. Were there enough poll workers at your site to help you? Yes No Question Title * 15. How would you rate your interactions with poll workers? Positive Neutral Negative Question Title * 16. How would you rate your overall experience voting on September 9th, 2014? Positive Neutral Negative Comment Question Title * 17. Any suggestions for making improvements for the next election? Question Title * 18. Do you have any other comments you would like to make about your voting experience on September 9th? Question Title * 19. Optional: Your information will be kept confidential. In order to present a report of findings to the Board of Elections, we may want to contact you for further information about your voting experience. Name: Address: Address 2: City/Town: ZIP: Email Address: Phone Number: Done