Appendix 2

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
		"		"		"		"		"		"		"