Community Services Programs
Americans with Disabilities Act Requirements; ADA Checklist For Existing Facilities
Agency Name:____________________________ Program_______________________
Address of Site_________________________________________________________
Person completing form ________________________ Telephone _________________
Signature of Agency Director_____________________________ Date_____________
INTERPRETATIVE GUIDELINES FOR ADA SELF-EVALUATIONS
Please be sure to read the instructions on pages 2 and 3 of the Checklist. In addition, the following guide may assist you in completing this instrument.
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Deficiencies
Every question that you check off as "no" needs to be identified in your Plan of Correction, as well as in the Summary of Inaccessible Features page. If you have checked a box in the "possible solutions" column; this information still needs to be carried forward to your Plan of Correction.
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Parking and Drop-off Areas (ADAAG 4.6), pg. 5,6
Agencies with on-street parking only, can obtain accessible parking through the city or town. Contact the appropriate person within your municipality to request this.
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Stalls (ADAAG 4.17), pg 13,14
Questions regarding grab bars and height of toilet pertain to all toilets, not just stalls. Please complete these questions, even if the restrooms do not have stalls.
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Telephones (ADAAG 4.31), pg. 15
With regard to TTY's (Telecommunication Device for the Deaf),
if your agency has a fixed client base whereby you have personal
knowledge that clients, relatives or friends are not deaf or
hearing impaired, you can use the Maine Relay system for incidental
communication when needed. Please be sure to review the attached
information about the Maine Relay System. However, if your agency
has a changing client base, (i.e., community mental health center,
shelter, crisis center, etc.) you will need to purchase TTY's.
Also, if your contract with DHHS stipulates the purchase of
TTY's under Rider A, then you will need to purchase this equipment.
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Summary of Inaccessible Features and Plan of Correction
Pease use the back of these forms if needed, or attached an additional page. Make a copy of the completed documents for your records before submission.
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Costs to Construct Common Modifications
The attached documents provide an idea of costs for common barrier removal.
Checklist for Existing Facilities Version 2.1* is a PDF file. If you can not access the file, a hard copy is available by contacting:
Maine Department of Health and Human
Services
Division of Licensing
11 State House Station
Augusta, Maine 04333-0165
For a free viewer or to request a hard copy
