Your full name:

Your email address: (e.g.: you@hotmail.com)

Your business/company name:

Your business address including nearest main intersection?

Type of business:

Phone number including area code.

If you have a website please type it here:

Do you have an automatic (push button) disabled entry door?
yes
no

How many times has the door been broken in the past 6 months?

Is your disabled entry at the main entrance of your business?
yes
no

If your disabled entrance is not at the main entry, where is it situated? (back of bldg, side, down an alley??)

Is there a ramp into your business or the entry is absolutely sidewalk level and accessible? (NO stairs - not even one!)
yes
no

Does your business have adequate isle widths or between product displays for wheelchairs/scooters? Minimum width is 45".
yes
no
this doesn't apply to our business

Does your business use free standing product displays that are placed in store isles?
yes we do use them and place them in the isles.
yes we do use them but they are NOT placed in the isles.
we do not use free standing product displays.

Do you have a washroom for the disabled IN your business?
yes
no

If your business is in a mall/building and you don't have a washroom on the premise, is there a disabled washroom in the mall/building your business is situated in?
yes
no
I don't know

Is your disabled washroom easily accessed? (down always clear isles, ample width hallway, etc)
yes
no

Is the main door(s) entry to the disabled washroom an automatic (push button access) door?
yes, it is
no, it requires someone to 'push' the door
no, it requires someone to turn a doorknob

Do you use a 'freight' elevator for your disabled patrons?
yes
no
our business does not require an elevator

Can your elevator fit 2 wheelchairs/scooters with no problems?
yes
no
we don't have elevators

At a sitting level, are ALL your elevator buttons reachable?
yes
no
we do not have elevators

Are there turnstiles used in your store anywhere?
yes
no

Is there any kind of 'gate' your patrons must pass through to enter your business? (do you use a 'gate' system of some kind instead of turnstiles?)
yes
no

Do you have a regular clientelle of disabled patrons?
yes
no

If your store floors are on split levels, are there ramps so patrons can freely shop the entire floor?
yes
no
we do not have split level floors

If you have stock on shelves, is there adequate staff available to help reach products for those that can't reach for themselves? (this means no hunting down staff and 10 minute waits)
yes
no
we do not have stock on shelves

Will your staff help customers pack their parcels on their wheelchair/scooter or help them situate their parcels so they have a secure grip on them?
yes
no

If your staff are willing to help with parcels does the patron have to ask for assistance or does your staff inquire?
patron has to ask for assistance
staff will ask if assistance is needed
staff just automatically helps

If your business has payphones for your patrons to use, is at least one of them at a lower level for the disabled to access?
yes
no
we do not have payphones

If your business has an ATM machine for your patrons, is it at a lower level for disabled to access?
yes
no
we do not have an ATM machine

If you are within reach would you have a problem if I or another disabled person dropped by your business?
yes, I have a problem with that
no, I have no problem with that

We would like your opinion on the following please. If your business/building made our thumbs up list would you consider advertising with us for a reasonable yearly fee?

no
yes