SURVEY FORM 28: TRANSIENT LODGING IN HOMELESS SHELTERS, HALFWAY HOUSES, TRANSIENT GROUP HOMES, AND OTHER SOCIAL SERVICES ESTABLISHMENTS

Section	Item	Technical Requirements	Comments	Yes	No
9.5.1	Public/ Common Use Areas -- New Construction:	In new construction, do all public and common use areas comply with 4.1 through 4.35? (Use Forms 1 to 22 as applicable)
9.5.1	Amenities:	Is at least one of each type of amenity (e.g., washers, dryers, and similar equipment) in each common area accessible and located on an accessible route to any accessible sleeping room? EXCEPTION: Where a building is exempt from the elevator requirement (see 4.1.3(5)), accessible amenities are not required on inaccessible floors as long as one of each type is provided in common areas on accessible floors.
9.5.3 9.1.2	Accessible Sleeping Accommodations:	In new construction, does the number of accessible sleeping rooms comply with Table A? OR In facilities with multi-bed rooms or spaces, are accessible beds complying with 9.2.2(1) (see below) provided in a number equal to Table A?
9.5.3 9.2.2	Accessible Route:	Do the accessible sleeping rooms on an accessible route comply with 4.3? (Use Form 12: Building Lobbies and Corridors)
9.5.3 9.2.2(2)	Accessible Route:	Does an accessible route complying with 4.3 connect all accessible spaces and elements within the accessible sleeping rooms, including telephones? Note: An elevator is not required in a multi-story facility, if at least one of each type of space identified in 9.2.2(6) and (7) below is on an accessible level.
9.5.3 9.2.2(1)	Maneuvering Space at Beds:	Do accessible sleeping rooms have maneuvering space at least 36 inches wide located along both sides of a bed? OR Where two beds are provided, is there at least a 36 inch wide maneuvering space located between the two beds?
9.5.3 9.2.2(3)	Doors:	Do the doors into and within the accessible sleeping rooms comply with 4.13? (Use Form 11: Doors and Gates)
9.5.3 9.2.2(4)	Storage:	If fixed or built-in storage facilities are provided, does at least one of each type provided comply with 4.25? (Use Form 14: Rooms and Spaces) Note: Additional storage may be provided outside the dimensions required by 4.25.
9.5.3 9.2.2(5) 9.2.2(7)	Controls:	Do all controls, including those on amenities provided in the accessible sleeping rooms comply with 4.27? (Use Form 14: Rooms and Spaces)
9.5.3; 9.2.2(6)	Accessible Areas and Spaces:	If provided as part of an accessible unit, are the living area; dining area; at least one sleeping area; and patio, terrace, or balcony accessible? EXCEPTION: The requirements of 4.13.8 (thresholds at doors) and 4.3.8 (changes in level) do not apply where it is necessary to utilize a higher door threshold or a change in level to protect the integrity of the unit from wind/water damage. Where this exception results in patios, terraces or balconies that are not at an accessible level, equivalent facilitation shall be provided. (e.g., equivalent facilitation at a patio or balcony might consist of providing raised decking or a ramp to provide accessibility).
9.5.3 9.2.2(6)	Bathrooms:	Is at least one full bathroom accessible? OR If only half baths are provided is at least one half bath accessible? (Use Form 16: Toilet Rooms and Bathrooms and Form 17: Bathtubs and Showers)
9.5.3 9.2.2(6)	Parking:	If parking is provided, is the carport, garage or parking space accessible? (Use Form 1: Parking)
9.5.3; 9.2.2(7)	Kitchens:	If provided as part of an accessible unit, are kitchens, kitchenettes, or wet bars accessible?
		Is clear floor space at least 30 inches by 48 inches provided for a front or parallel approach to cabinets, counters, sinks, and appliances?
		Are countertops and sinks mounted no more than 34 inches above the floor?
		Is at least 50% of the shelf space in cabinets or refrigerator/freezers within the reach ranges of between 15 inches and 48 inches for a front approach and between 9 inches and 54 inches for a parallel approach?
9.5.3 9.2.2(8)	Accommodations for Persons with Hearing Impairments:	In rooms required to be accessible under Table A, are visual alarms, notification devices and telephones complying with 9.3 (see below) provided?
9.5.3 9.1.3 9.3	Additional Rooms for Persons with Hearing Impairments:	Are additional sleeping rooms for persons with hearing impairments provided in compliance with Table B?
9.5.3 9.3	Visual Alarms:	Are auxiliary visual alarms complying with 4.28.4 provided in the accessible rooms required in Tables A and B? (Use Form 20: Alarms) OR Are electrical outlets provided (including one connected to the facility's central alarm system) to enable room occupants to utilize portable devices provided by the operator of the facility?
9.5.3 9.3.1 9.3.2	Visual Notification Devices:	Are visual notification devices to alert room occupants of incoming telephone calls and a door knock or bell provided in the accessible sleeping rooms required in Tables A and B? OR Are electrical outlets provided to enable room occupants to utilize portable devices provided by the operator of the facility?
		Are visual notification devices not connected to the auxiliary visual alarm signal devices?
9.5.3 9.3.1	Telephones:	If a permanently installed telephone is provided in the accessible rooms, does it have a volume control capable of a minimum of 12 dbA and a maximum of 18 dbA above normal? If an automatic reset is provided, then 18 dbA may be exceeded.
		Is there an accessible electrical outlet within 4 feet of a telephone connection to facilitate the use of a text telephone?
9.5.2(1) 9.5.3 9.5.1	Alterations in Social Service Establishments (Excluding Homeless Shelters):	In alterations to social service establishments that are not homeless shelters, are accessible sleeping rooms or beds provided in a number consistent with Tables A and B above considering the total number of altered rooms?
		Are other altered areas consistent with 9.5.1 (See above)?
9.5.2(2)	Alterations in Homeless Shelters:	In homeless shelters, if altered, is at least one public entrance accessible to persons with mobility impairments so that they can approach, enter and exit?
	Door Width:	Does the accessible public entrance(s) have a clear door opening of at least 32 inches?
	Sleeping Space:	If sleeping areas are altered, do the doors to the sleeping areas required to be accessible in Table A have a clear door opening of at least 32 inches?
	Maneuvering Space at Beds:	If sleeping areas are altered, does the maneuvering space around the beds required to be accessible in Table A comply with 9.2.2(1) (See above)?
	Toilet Rooms and Bathing Areas:	If toilet rooms are altered, is there at least one toilet room for each gender, or one unisex toilet room that complies with the requirements below?
		Does the altered toilet room have a clear door opening of at least 32 inches?
		Does the altered toilet room have an unobstructed turning space (a 60 inch diameter circle or T-shaped space)? (See Figure 3(b) included in Form 16: Toilet Rooms and Bathrooms) (The clear floor space at fixtures and controls, the accessible route, and the turning space may overlap.)
		Does the altered toilet room have one water closet complying with 4.16? (Use Form 16: Toilet Rooms and Bathrooms)
		Does the altered toilet room have one lavatory complying with 4.19? (Use Form 16: Toilet Rooms and Bathrooms)
		Does the door to the altered toilet room (without toilet stalls) have a privacy latch?
		If bathing facilities are provided in the altered toilet room, does at least one bathtub or shower comply with 4.20 or 4.21, respectively? (Use Form 17: Bathtubs and Showers)
	Common Areas:	If common areas (e.g., day rooms or lounges) are altered, is there at least one common area where persons with mobility impairments can approach, enter and exit, (including an opening of at least 32 inches wide)?
		Is there at least one route connecting an accessible entrance with accessible sleeping rooms or beds, accessible toilet room(s), and accessible common area(s) that a person with a mobility impairment can use which includes minimum clear width of 36 inches, passing space complying with 4.3.4, turning space complying with 4.2.3 and changes in levels complying with 4.3.8? (Use Form 12: Building Corridors and Lobbies) Note: Homeless shelters can comply with the provisions of 9.5.2(2) (see above) by providing all elements on one accessible floor.

Table A: Number of Rooms/Beds Required to be Fully Accessible		Table B: Number of Rooms/Beds Required to be Accessible to People with Hearing Impairments
Number of Rooms/Beds	Accessible Rooms/Beds	Number of Rooms/Beds	Accessible Rooms/Beds
1 to 25	1	1 to 25	1
26 to 50	2	26 to 50	2
51 to 75	3	51 to 75	3
76 to 100	4	76 to 100	4
101 to 150	5	101 to 150	5
151 to 200	6	151 to 200	6
201 to 300	7	201 to 300	7
301 to 400	8	301 to 400	8
401 to 500	9	401 to 500	9
501 to 1000	2% of total	501 to 1000	2% of total
1001 and over	20 plus 1 for each 100 over 1000	1001 and over	20 plus 1 for each 100 over 1000

Facility Name:	Except as specified in ADAAG 9.5, transient lodging in homeless shelters, halfway houses, transient group homes, and other social service establishments must comply with the applicable provisions of ADAAG 4.1 through 4.35.
Facility Location: