Retail Accessibility Feedback Survey
Share your experience regarding accessibility at our retail store. Your feedback helps us create a more inclusive shopping environment.
Store Name or Location
*
Date of Visit
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Overall Accessibility Rating
*
1
2
3
4
5
Which accessibility features did you use or notice during your visit? (Select all that apply)
Accessible entrance
Wide aisles
Accessible restrooms
Clear signage
Staff assistance
Accessible parking
Other
Please rate your agreement with the following statements:
*
Rows
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
The entrance was easy to access.
1
2
3
4
5
Aisles were wide and unobstructed.
6
7
8
9
10
Restrooms were accessible.
11
12
13
14
15
Signage was clear and easy to understand.
16
17
18
19
20
Staff were available and helpful regarding accessibility.
21
22
23
24
25
Were there any barriers to accessibility you encountered?
*
Yes
No
If yes, please describe the barriers you encountered.
How likely are you to recommend this store to someone with accessibility needs?
*
Not likely
1
2
3
4
5
6
7
8
9
Very likely
10
1 is Not likely, 10 is Very likely
Additional comments or suggestions
Submit Feedback
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