Language Access Barriers Report Form
Report language access barriers encountered in services. Your feedback helps us improve communication support and access for everyone.
Date and time the barrier was encountered
*
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Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Location or service where the barrier occurred
*
Department or area involved
Please describe the language access barrier you encountered
*
Who was affected by this barrier?
*
Language(s) involved
*
What communication support was available?
What communication support was needed but not available?
What was the outcome or impact of this barrier?
*
What follow-up or resolution do you request?
Submit Report
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