Request for ADA Inspection Form

Legal Form Number1331
SectionOffice of Congressional Workplace Rights (United States)
I wish to remain anonymous.
I do not wish to remain anonymous.
Yes
No
I do not know.
Continually
Other frequency
I do not know.
advancing workplace rights, safety and health, and accessibility in the legislative branch
Office of Congressional Workplace Rights
AMERICANS WITH DISABILITIES ACT (ADA) INSPECTION FORM
See instructions for filling out this form below (page 5).
Attach additional sheets if needed, numbered according to the box(es) to
which they pertain.
FORM 1331
DO NOT WRITE IN THIS SPACE
Case No.
Date Filed
1. I am requesting this inspection because I believe that access to a public service, program, activity, accommodation,
or facility covered by the Congressional Accountability Act has been or is being denied to persons with disabilities.
Note: If you wish to remain anonymous, your name will not be revealed to others unless the Office of Congressional
Workplace Rights (OCWR) is explicitly notified in writing.
2A. Do the barriers to access described below (page 2)
continue to exist?
2B. If they continue, how often is access being denied?
Please define the frequency:
3A. Name of individual filing this request:
Office:
Address:
Tel. #: Ext.
Fax #:
E-mail:
3B. Contact person(s) from these offices, if known.
Contact person:
Address:
Tel. #: Ext.
Fax #:
E-mail:
Note: If you need to list additional points of contact,
please attach additional sheets, numbered accordingly.
Room LA-200, John Adams Building · 110 Second Street, SE · Washington, DC 20540-1999 · t/202.724.9250 · f/202.426.1913
www.ocwr.gov
1

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