Online Election Incident Report Form

Online Election Incident Report Form

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Part One

State:

County:

Date:

Time:

Precinct Number:

Poll Address:

Voter Name:

Contact Information:

Witness Present:

Contact Information:

Part Three
Please Write a detailed description of the incident (include names of election officials involved)

Part Two
Check Incident Type(s)
Voter's name NOT on the voter rolls/roster. (If you are a first-time voter, please describe where and when you registered in Part Three.)
Voter received sample ballot or letter from Registrar of Voters but was not on roster
Voter not notifed of precinct change:
Voter found correct precinct
Voter never found correct precinct
Voter forced to vote provisional ballot
Voter concerned that his/her vote will not count
Vote by Mail (Absentee Ballot) problems. (Describe in detail in part three)
Polling Place Problems:
Lacked proper signage
Poll not open on time
Not enough parking
Voting booth problems
Not enough supplies (ballots, pens, etc.)
Voter forced to wait a long time (Exactky how long? Describe in part three)
Police presence outside of polls
Disability issues:
No handicapped access
Problem with the audio unit
Precinct Ballot Recorder (scanner) problems:
Not working
Voter forced to use it over objections
Pollworker Problems:
Voter asked to provide ID
Language problems
Voter treated differently than others (felt discrimination)
Voters right to cast a ballot challenged by someone other than a pollworker