Disability Resources Of Central Virginia

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ADA Access Survey

Do you or someone you know have difficulty accessing a business or building ?
Please help us help you by taking a moment to complete this survey. Click on Submit when ready to send.

Directions: Please answer each item. An appropriate response might be a number (such as number of handicapped parking spaces); a yes or no or N/A for not applicable or your own statement for any comments.

PARKING:
	# of handicapped parking spaces
	Above-ground signs
	Marked access space for a van
ENTRANCE:
	Paved walkway
	Closest to handicapped parking spaces
	Level or ramp and without steps
ACCESSIBLE BATH/REST ROOMS:
	32" wide door (female)
	32" wide door (male)
	32" wide door (unisex)
	Grab bars for commodes
	Room for wheelchair use
EATING OR LODGING PLACES:
	Eating area with open or moveable seating
	# of accessible bedrooms
	Audible and visual alarm systems
PATHWAYS:
	36" wide customer service aisles
OTHER ACCOMMODATIONS:
	Assistive listening devices for the hearing impaired
	Benches/seating for waiting
	Braille materials (menus, signs, etc.)
	Elevator/lift
	Knowledge of sign language
	Lowered water fountain or one with cup dispenser
	Notice posted: "Special assistance available on request"
	Outside door opener
	Public telephone with volume control
SERVICES:
	Delivery
	Drive-through
	Drive-up
	Pick-up
	Take out
	Wheelchair/powered cart for shopping, etc.
	TTY/TTD

List any additional accommodations:

Other comments, such as anticipated alterations or accommodations, which are planned:

Date:
Name:
E-Mail Address:
Name of business/agency/organization:
Business address:

Directions To Business:

I would like additional ADA information:
Yes No.

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DISCLAMER: This site is not part of any organization or agency. It is created by one disabled individual whom understands the needs of the disabled and is dedicated to enhancing their quality of life.