County of Del Norte - ADA Self-Evaluation and Transition Plan Survey

1.Do you use County programs, services or activities? (Select Yes or No below)
(Required.)

Yes

No

2.Choose the top five (5) County facilities that you access most frequently. A facility list is provided below for you to select which facilities you use.(Required.)

Select Up to 5

Recreation Gymnasium @ 1005 H Street, Crescent City

Select Up to 5

Pyke Field @ 202 E Macken Ave, Crescent City

Select Up to 5

Florence Keller County Park & Campground @ 3400 Cunningham Lane, Crescent City

Select Up to 5

Ruby Van Deventer County Park @ CA‐197 Crescent City

Select Up to 5

Clifford Kamph Memorial Park @ 15100 US‐101 Smith River

Select Up to 5

Klamath Townsite Boat Ramp and Park @ 41°31'52.6"N 124°02'37.4"W, Highway 101 in Klamath

Select Up to 5

Agricultural Commissioner @ 236 Williams Drive, Crescent City

Select Up to 5

Veteran Memorial Hall @ 810 H Street, Crescent City

Select Up to 5

Manual Arts @ 840 9th Street Suite #12, Crescent City

Select Up to 5

Flynn Administration Center @ 981 H Street, Crescent City

Select Up to 5

Farm Advisor Office (Co-Op Extension) @ 586 G Street, Crescent City

Select Up to 5

Sheriff's Office/Jail @ 650 5th Street, Crescent City

Select Up to 5

Del Norte County Courthouse @ 450 H Street, Crescent City

Select Up to 5

Community Development Dept: Roads Division Office @ 500 E Cooper Ave, Crescent City

Select Up to 5

Juvenile Hall @ 1115 Williams Drive, Crescent City

Select Up to 5

Child Support Services @ 1225 Marshall Street Suites #8 and #18, Crescent City

Select Up to 5

Wavecrest Beach Access and Parking Lot @ 120 Wavecrest Drive, Smith River

Select Up to 5

Animal Services @ 2650 W Washington Blvd, Crescent City

Select Up to 5

Department of Health and Human Services @ 880 Northcrest Drive, Crescent City

Select Up to 5

DHHS Behavioral Health Service Center @ 1125 Burtchell Street, Crescent City

Select Up to 5

DHHS Behavioral Health Branch @ 455 K Street, Crescent City

Select Up to 5

DHHS Public Health Branch @ 400 L Street, Crescent City

Select Up to 5

DHHS Coastal Connections @ 475 K Street, Crescent City

Select Up to 5

DHHS WIC @ 440 K Street, Crescent City

Select Up to 5

DHHS Medication Support Services-Telepsychiatry @ 405 K Street, Crescent City

Select Up to 5

3.In your experience with the County of Del Norte, have you encountered physical barriers or difficulties in accessing County facilities (parks, parking lots, buildings, sidewalk or bus stops, etc.)? (Select Yes or No below)
(Required.)

Yes

No

If yes, please describe the facility and the condition(s) or situation(s) that caused the difficulty.

4.Have you encountered policies or practices that make it difficult to access County programs, services or activities? (Select Yes or No below)
(Required.)

Yes

No

If yes, please describe the policy or practice and its impact.

5.Have you encountered barriers or difficulties at County facilities that prevented or complicated access to programs, activities or services provided? (Select Yes or No below)
(Required.)

Yes

No

If yes, please describe the situation(s), the response and/or outcome (if any).

6.Are you aware of any successful solutions to accessibility issues that have been used at other facilities that could serve as a model for the County? (Comment box provided below)(Required.)

7.Do you have other suggestions for improving accessibility or mobility around or at County facilities to support full participation in programs, services or services? (Comment box provided below)(Required.)

Thank you for taking the time to fill out this questionnaire!

We would appreciate completion of the information below. This information is optional. If completed, it will provide our team with the opportunity to contact you for further comment and to notify you of future disability-related events.

8.Please select below

My responses may be published

9.Please fill in your contact information below. Order of contact information is as follows: Name, Address, Phone Number, and Email

Name

Address

Phone Number

Email Address

10.Are you affiliated with any organizations that specifically serve people with disabilities (example: California Council for the Blind, Etc.)? Please list any affiliations. (Comment box provided below)

County of Del Norte - ADA Self-Evaluation and Transition Plan

COMMUNITY OUTREACH QUESTIONNAIRE