Poll Watcher Access Denial Report Form
Report incidents where a poll watcher was denied access. Please provide accurate details to assist with follow-up and compliance.
Date of Incident
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Time of Incident
*
Hour Minutes
AM
PM
AM/PM Option
Location of Polling Place
*
Type of Election
*
Please Select
General Election
Primary Election
Runoff Election
Special Election
Other
Poll Watcher's Name
*
Organization or Affiliation (if any)
Describe the Circumstances of Denial
*
Reason Given for Denial (if any)
Names or Roles of Individuals Involved in Denial
Your Name and Contact Information
*
Submit Report
Should be Empty: