Municipal Accessibility Survey Form
Please help us improve accessibility in municipal spaces and services by sharing your feedback. Your responses to the Municipal Accessibility Survey Form will guide future improvements.
How would you like to be identified?
*
Provide my name
Submit anonymously
Your Name
Would you like municipal staff to follow up with you?
*
Yes, please contact me
No, I do not need follow-up
Preferred Contact Method
Email
Phone
No contact needed
Email Address
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Which municipal facility or location are you evaluating?
*
Date of your visit
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Please rate the following accessibility areas:
*
Rows
Excellent
Good
Fair
Poor
Not Applicable
Entrances and Exits
1
2
3
4
5
Restrooms
6
7
8
9
10
Parking
11
12
13
14
15
Pathways/Sidewalks
16
17
18
19
20
Signage and Information
21
22
23
24
25
Customer Service/Staff Assistance
26
27
28
29
30
Describe any accessibility barriers you encountered.
Overall, how would you rate the accessibility of this facility/location?
*
1
2
3
4
5
What improvements would you suggest to enhance accessibility?
Submit Feedback
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