Workplace Accessibility Feedback Form
Please provide your feedback to help us improve workplace accessibility.
Full Name
First Name
Last Name
Email Address
example@example.com
How accessible do you find the workplace?
1
1
2
3
4
Best
5
1 is , 5 is Best
What accessibility features do you use or need?
Wheelchair ramps
Accessible restrooms
Elevators
Assistive technology
Reserved parking
Sign language interpreters
Other
Please describe any accessibility challenges you have faced.
Suggestions for improvement
Submit
Should be Empty: