wheelchair iconAmericans with Disabilities Act (ADA) 
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ADA Grievance Form

All fields with an asterisk (*) are required for submittal.

Your Contact Information

Description of grievance or barrier (what is it, why is it a barrier?)

The description of the grievance should provide the general details of the access barrier including your concern and how it affects your daily activities.

Where is the location of grievance or area of barrier?

This information will allow us to pinpoint the grievance location. This allows us to coordinate with local government personnel as well as Caltrans district personnel.

 

Alternate Formats

This form is also available in alternate formats upon request by phone or in writing to:

Caltrans ADA Program
Phone (866) 810-6346/(916) 324-1999
TTY:711
Email: ada.compliance.office@dot.ca.gov