FL Poll Watcher Report Submission

NOTE: The current version of this form is a draft. This capability is still under development.

It is suggested that you print out a paper copy of this report form in order to take handwritten notes during your shift. You can then copy your notes into the matching online form as time allows.

You should also make sure to have a print out of your party or candidates legal hotline and points of contact.

Poll Watcher team leads that are interested in receiving e-mail updates whenever a report is submitted for their locality, please contact us to have your name, contact info and affiliation be verified and then setup to receive e-mail alerts. We humbly ask for donations to cover our site costs and the labor to set this up.

Your information

Name *

First

Last

Email *

Phone *

Affiliation? *RepublicanDemocratOther

General Information

Report Type: *

• First shift report
• Mid-day shift report
• Evening shift report
• Other / Specific Incident Report

Locality *Alachua CountyBaker CountyBay CountyBradford CountyBrevard CountyBroward CountyCalhoun CountyCharlotte CountyCitrus CountyClay CountyCollier CountyColumbia CountyDeSoto CountyDixie CountyDuval CountyEscambia CountyFlagler CountyFranklin CountyGadsden CountyGilchrist CountyGlades CountyGulf CountyHamilton CountyHardee CountyHendry CountyHernando CountyHighlands CountyHillsborough CountyHolmes CountyIndian River CountyJackson CountyJefferson CountyLafayette CountyLake CountyLee CountyLeon CountyLevy CountyLiberty CountyMadison CountyManatee CountyMarion CountyMartin CountyMiami-Dade CountyMonroe CountyNassau CountyOkaloosa CountyOkeechobee CountyOrange CountyOsceola CountyPalm Beach CountyPasco CountyPinellas CountyPolk CountyPutnam CountySanta Rosa CountySarasota CountySeminole CountySt. Johns CountySt. Lucie CountySumter CountySuwannee CountyTaylor CountyUnion CountyVolusia CountyWakulla CountyWalton CountyWashington County

Facility Address *

Address Line 1

City

AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingState

Zip Code

When did you arrive on site? *

Date

Time

Type of issues or concerns encountered (if any)

• Voters told they already voted
• Equipment issues or concerns
• Data discrepancies
• Ran out of ballots or other supplies
• Improper procedures or illegality
• Disruptions +/or unruly behavior
• Electioneering inside the polling place
• Other

First shift information:

What are the identification numbers for each scanner machine?

Separate multiple entries with commas.

What are the start-of-day protected count total for each scanner machines?

Separate multiple entries with commas.

What are the start-of-day public count total for each of the scanner machines?

Separate multiple entries with commas.

Mid-day shift information:

Report any non-standard events and their resolutions.

Evening shift information:

What was the total daily Poll Book count from the poll pads?

How many in-person ballots were cast?

How many curbside ballots were cast?

How many completed mail-in ballots were dropped off in drop-box?

How many absentee (mail-in) ballots were surrended?

How many provisional ballots were there?

Of the provisional ballots cast, how many same day registrations were there?

How many voters checked in only using the voter attestation form?

How many Goldenrod forms for the day?

What are the identification numbers for each scanner machines?

Separate multiple entries with commas.

What are the end-of-day protected count total for each scanner machines?

Separate multiple entries with commas.

What are the end-of-day public count total for each of the scanner machines?

Separate multiple entries with commas.

Issues and General Comments

Describe any issues that arose during your shift:

Describe any issues that provide evidence to support possible future legislation:

For example, to support arguments for requiring photo ID, document cases of no photo ID and use of ID confirmation statement. To support arguments for ending same day registration and for cleaning up voter rolls, document instances a where voter is told he’s already voted. Document instances when a voter given opportunity to remove name from permanent absentee list.

General Comments or other concerns?

Any Additional Images or files?

Click or drag files to this area to upload. You can upload up to 10 files.

Electronic Signature *

• By electronically signing this form I attest that I am an authorized poll watcher and that the statements made here are truthful and accurate to the best of my ability.

Submit