2025 Microshifter Report Form

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Enter the data for each precinct in a single form. If you are observing 5 precincts, you will need to complete 5 forms.

Email *

MICROSHIFTER AND SITE INFORMATION:

Last Name *

First Name

Cell Phone *

Time Arrival at Site

Time

Time Departure from Site *

Time

Microshifts Group #

Precinct Name (One Report per Precinct)

Chief Name *

Asst Chief Name *

INCIDENT REPORT:

Complete with details about any incident or event that occurred during your shift or earlier in the day.

Incident: Did any incidents with equipment, processes, voters, official visitors or personnel occur during your visit? Did Chief/Asst Chief/any one else report any earlier issues? Enter "NONE" if none. *

MIDDAY REPORT 10:00 AM - 6:00 PM:

Report numbers from your equipment observation, Machine Certification Form, & from conversation with Chief/Asst Chief

DS300 Ballot Scanner #1 Red Tape Seal #

DS300 Ballot Scanner #1 Public Count *

DS300 Ballot Scanner #1 Protected Count *

DS300 Ballot Scanner #2 Red Tape Seal #

DS300 Ballot Scanner #2 Public Count *

DS300 Ballot Scanner #2 Protected Count

DS300 Ballot Scanner #3 Red Tape Seal #

DS300 Ballot Scanner #3 Public Count *

DS300 Ballot Scanner #3 Protected Count *

DATA FROM VOTER COUNT WORKSHEET (If no data is recorded, write "NONE")

Last Time Voter Count Worksheet Completed *

Total Check-ins on all e-pollbooks *

Minus Voters Checked-in who have not yet cast a ballot *

Minus Total Ballots cast on all DS300 Ballot Scanners *

Difference (should be zero, if not they're off-track) *

SAME DAY REGISTRATIONS/NON-SDR PROVISIONALS

Chief/Asst Chief will provide the information.

SAME DAY REGISTRATIONS (SDR) TOTAL # *

NON-SDR PROVISIONALS TOTAL # *

GREETER TABLE REPORT:

Any information shared by Greeters on your arrival or departure from the polling place: *

Thanks for completing the Microshifter Report for this precinct. Please complete the forms for the other precincts in your Group.

To report any legal issues call the Republican Party of Virginia legal helpline 804-600-4809 or email help@virginia.gop. For local/procedural issues call our hotline at 703-397-8129 or email pollwatchers@fairfaxgop.org.

A copy of your responses will be emailed to the address you provided.

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