Accessibility Feedback
For Canadian Municipalities
Municipality:
Facility:
*
Province:
*
Date
-
Month
-
Day
Year
Date Picker Icon
Facility Features Rating (1=worst, 5=best)
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1
2
3
4
5
Features were easily accessible
Features were clear, clean and maintained
Entire facility accessible and inclusive
We had the ability to do what we wanted with little or no difficulty
We were treated with dignity and respect by facility staff
Comments / Concerns
May we contact you for further information?
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Yes
No
Name
First Name
Last Name
Email
example@example.com
Phone Number
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Please verify that you are human
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