JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
SAMPLE: Individual Access Audit
This is an example of an individual access audit created to support the Circus for Everybody - The trainers toolkit.
Create a new form and amend as required.
You can also create screen-readable versions
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Email
*
Your email
Your Name
*
Your answer
Do you need to be met from public transport?
*
Yes
No
Required
If yes please give us a phone number or mobile to phone or text you
Your answer
Do you need audio description/building orientation/sighted guide/BSL interpreter?
*
Yes
No
If yes please tell us more
BSL
SSE
Palantypist
Loop
Sighted guide
Audio Description
Other:
Do you require wheelchair access?
*
Yes
No
Do you have a mobility impairment that restricts the use of steps?
*
Yes
No
What written format do you prefer for information (confirmation, transport, tour details, etc etc):
*
Standard
Large Print
Easy Read
Braille
Other:
Do you use email?
*
Yes
No
Do you use text messaging?
*
Yes
No
Will you bring an access support worker with you?
*
yes
no
Do you need adapted or special seating?
*
Your answer
Do you need frequent breaks that would affect scheduling?
*
Your answer
Will you be bringing an assistance dog?
yes
no
Clear selection
Do you require child care facility/Crêche?
*
Yes
No
If yes what is the age of your child/ren?
Your answer
Is there anything that you would like to tell us about your access requirements?
Your answer
Thank you for completing this form
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Diverse City.
Report Abuse
Forms
