Disability Screening Tools Quiz Form
Complete this quiz to assess general experiences and perceptions related to disability using common screening tools. This form does not collect sensitive personal or medical information.
Which statement best describes your comfort level navigating public spaces?
*
Very comfortable
Somewhat comfortable
Neutral
Somewhat uncomfortable
Very uncomfortable
How often do you find it difficult to complete daily tasks independently?
*
Never
Rarely
Sometimes
Often
Always
Please rate your agreement with the following statements:
*
Rows
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
I feel supported by my community.
1
2
3
4
5
I have access to necessary resources.
6
7
8
9
10
I can participate in activities I enjoy.
11
12
13
14
15
On a scale of 1 to 5, how would you rate your current overall well-being?
*
1 (Very low)
1
2
3
4
5 (Very high)
5
1 is 1 (Very low), 5 is 5 (Very high)
How frequently do you encounter barriers in your daily environment?
*
Never
Rarely
Sometimes
Often
Always
Which of the following best describes your ability to access public transportation?
*
No difficulty
Minor difficulty
Moderate difficulty
Severe difficulty
Do not use public transportation
How satisfied are you with the accessibility of your workplace or school?
*
1
2
3
4
5
Do you use any assistive devices to support your daily activities?
*
Yes, regularly
Yes, occasionally
No
Prefer not to say
How confident are you in finding help when you need it?
*
Very confident
Somewhat confident
Neutral
Somewhat unconfident
Very unconfident
Please select the statement that best describes your current level of independence.
*
Completely independent
Mostly independent
Somewhat independent
Require some assistance
Require significant assistance
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