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Customer Accessibility Feedback Questions (English)
Customer Accessibility Feedback Questions
1. Which of the following best describes you?
Customer (those who use our programs and services, such as stakeholders)
Service Provider (those who provide services to our organization, such as suppliers, vendors, etc.)
Other
2. Do you identify as a person with a disability?
Yes
No
No, but someone I am close to has a disability
3. What type of disability do you have (check all that apply)?
Physical
Hearing
Vision
Intellectual/Cognitive
Mental Health
Neurodiversity (includes Autism, ADHD, learning disabilities)
Chronic pain
Prefer not to disclose
4. Have you personally encountered accessibility barriers when interacting with us? A barrier means anything—including anything physical, architectural, technological or attitudinal, anything that is based on information or communications or anything that is the result of a policy or a practice—that hinders the full and equal participation in society of people with a disability.
Yes (please specify the barrier(s) to accessibility)
No
4. Additional info
5. Have you noticed any barriers to accessibility in the following categories at our organization?
5a. The built environment (includes our physical office locations and buildings)
Yes (please specify)
No
5a. Additional info
5b. Information and Communication Technologies (includes our website, social media, electronic forms, and newsletters, etc.)
Yes (please specify)
No
5b. Additional info
5c. Communications (includes access to Sign Language interpreters, captioning on videos, how easy our information is to understand, etc.)
Yes (please specify)
No
5c. Additional info
5d. Programs, Products and Services (includes accessing standards, receiving certification, etc.)
Yes (please specify)
No
5d. Additional info
6. Do you have any suggestions for how we could improve accessibility?
Yes (please specify)
No
6. Additional info
7. Is there anything else about accessibility that you want to share with us?
Yes (please specify)
No
7. Additional info
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