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POST-ELECTION FEEDBACK FORM 2016

VOTER DETAILS

POLLING STATE & CONSTITUENCY DETAILS

AS - POLLING STATION

Voters with polling location in Assam

KE - POLLING STATION

Voters with polling location in Kerala

PY - POLLING STATION

Voters with polling location in Pondicherry

TN - POLLING STATION

Voters with polling location in Tamil Nadu

WB - POLLING STATION

Voters with polling location in West Bengal

PLACES & PEOPLE - ACCESSIBILITY & EXPERIENCE

Q & A : GETTING THERE

1) Select options that apply from checkboxes 2) Elaborate details / reasons in ADD. DETAILS box that follows or type NA if nothing further to add

Q & A : POLLING STATION FACILITIES

INSTRUCTIONS : 1) Select options that apply from question's checkboxes 2) Elaborate details / reasons in ADD. DETAILS box that follows or type NA if nothing further to add TIPS ON BASIC MINIMUM FACILITIES TO BE PROVIDED = -> Information and direction sign visibility and display readability (high contrast picture + local language text in large sans serif font, at wheelchair height) -> Safe obstacle-free egress movement and turning space of at least 1.2 m or 4 feet width (Obstacles = Low hanging objects- trees- poles- debris- potholes- sandy surface - level changes etc.) -> Ramp Width 1 to 1.2 m (3.5 to 4 feet (flat anti-slippery surface- gentle slope of at least 1:10 gradient - hand rails on both sides) -> Wheelchair-friendly tables should be at 675-775 mm height from floor allowing kneespace depth of 540-600 mm with EVM equipment operation controls no higher than 1200 mm from ground. -> EVM should have Braille numbered stickers adjacent to buttons which can be referred to with Braille candidate ordered list. An extension cord of 750 mm should be provided to enable angled viewing and selection. Excessive force should not be required to press button and feedback should include audio / visual / tactile feedback. -> Accessible Toilet : (Western closet with easily reachable hand shower- grab bars- low hand wash- dry anti-slippery surface- ample lighting)

VOTING PROCESS : HUMAN INTERACTION / INTERFACE

Q&A: PRE-VOTING ACCESS TO INFORMATION / OFFICIAL MECHANISMS

1) Select options that apply from the question's checkboxes 2) Elaborate details / reasons in ADD. DETAILS box that follows or type NA if nothing further to add

Q&A: ASSISTANCE DURING VOTING PROCESS

1) Select the option that applies from the questions' dropdown list 2) Elaborate details / reasons in ADD DETAILS box that follows or type NA if nothing further to add

Q&A : FEEDBACK / DIFFICULTY IN THE FOLLOWING HUMAN INTERFACE AREAS

INSTRUCTIONS : 1) Select whichever options apply from question's checkboxes 2) Elaborate details / reasons in ADD. DETAILS box that follows or type NA if nothing further to add TIPS ON DIFFICULTIES FACED WITH HUMAN INTERFACE INTERACTIONS Eg : -> Barriers you encountered inside your polling booth that prevented you from voting privately and independently in a dignified way.(for example, attitudes of poll workers, assistance required etc.) -> Any difficulty faced in voting because of state’s ID requirement. -> If your eligibility to vote was questioned, how did the poll worker handle the situation? -> Were the election officials communicating with or guiding on any information request? -> Please describe pros and cons of overall experience

ANY OTHER COMMENTS : SUGGESTIONS / COMPLIMENTS / CRITIQUE

TO FINISH FORM : Select SUBMIT button below to send your feedback to DRA