Submit VA Poll Watcher Report – Prince William County

Name *

Location *

Date: *

Time Shift Start *

Time Shift End *

Name of Chief

Hart Verity Scanner 1 Serial Number *

Thumb Drive Compartment Security Seal Number 1 *

Hart Verity Scanner 1 Ballot Count (for AM before polls open and PM after polls close):

Ballot Box Seal Number 1 *

Hart Verity Scanner 1 Lifetime Number (for AM before polls open and PM after polls close):

Hart Verity Scanner 2 Serial Number *

Thumb Drive Compartment Security Seal Number 2 *

Hart Verity Scanner 2 Ballot Count (for AM before polls open and PM after polls close):

Ballot Box Seal Number 2 *

Hart Verity Scanner 2 Lifetime Number (for AM before polls open and PM after polls close):

PROCEDURES DURING VOTING - Select N/A if you did not witness that part of the process during your shift

Has anyone been told they already voted? *

Yes
No

Are there ZERO TAPES on the walls for each scanner? *

Yes
No

Were you allowed inside prior to voting start in the morning per the code of Virginia? *

Yes
No
N.A

Were you able to see and hear voter check-ins, receive answers to your questions, and was check-in done according to the Code of Virginia? *

Yes
No

Did voters wishing assistance sign their own request for assistance form, and did the assistant also sign their own form? *

Yes
No
N/A

Were you allowed to observe curbside voting and were curbside voters processed correctly? *

Yes
No
N/A

Any voter intimidation noticed (outside most likely if a lively election, as you watch curbside voting)? *

Yes
No

Any poll watcher intimidation noticed (outside most likely if a lively election, as you watch curbside voting)? *

Yes
No

Any election officer intimidation noticed (by another election officer or voter) *

Yes
No

If you answered yes to any of the last 3 questions, please give details below: *

Were same day registrations noted with special color paper, a provisional ballot, NOT SCANNED, with all paperwork placed in an envelope for the electoral board? *

Yes
No
N/A

How frequently are Confirmation of ID statements being used? *

For early voting: Were Gold Forms used correctly? *

Yes
No
N/A

How were absentee ballots spoiled? *

AFTER POLLS CLOSE - IMPORTANT: Language that the chiefs use after closing may not match exactly what is on this sheet. You may want to write them with terms before entering them in the form. List the terms and number you wrote at the bottom of the form in the comments.

Were You Present After Polls Close? *

Yes
No

Scanner 1 End of Shift Ballot Count *

Scanner 1 End of Shift Lifetime Number *

Scanner 2 End of Shift Ballot Count *

Scanner 2 End of Shift Lifetime Number *

PM Post close pollbook count: *

Does the pollbook count equal the ballots scanned count (ballot count for the day for both scanners, post polls closing)? *

Yes
No

Were ballot boxes emptied at end-of-shift and did you see the empty ballot box under the scanners (post polls closing only)? *

Yes
No

Were the ballots counted at the end of day to be sure they match the pollbook check-ins and the ballot count number on the scanner (post polls closing only)? *

Yes
No

Are there ballot chain of custody sheet for ballots by dropbox and by scanner (post polls closing only)? *

Yes
No

Are the number of ballots counted being placed on the boxes and envelopes (post polls closing only)? *

Yes
No

Did Thumb Drives from the Ballot Scanners have chain of custody sheet with serial numbers for each Thumb Drive (post polls closing only)? *

Yes
No

Enter the number of absentee drop box ballots *

Was anything reported to the Legal Hotline? *

Yes
No

If yes, enter details below:

Was anything reported to the Electoral Board? *

Yes
No

If yes, enter details below:

Please note below any unresolved questions, problems, technical issues with pollbooks or scanners or reports to the General Registrar or Electoral Board. Other comments / notes from above can be entered here:

Verify Correctness and Submit

Please verify all entries for correctness, enter the answer to the question below, and click submit

Are you a robot? Please answer the following question. *

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PROCEDURES DURING VOTING - Select N/A if you did not witness that part of the process during your shift

AFTER POLLS CLOSE - IMPORTANT: Language that the chiefs use after closing may not match exactly what is on this sheet. You may want to write them with terms before entering them in the form. List the terms and number you wrote at the bottom of the form in the comments.

Verify Correctness and Submit

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