Closed Captioning Complaint Form
Instructions
Please use this form to provide information regarding instances where businesses with televisions did not turn on closed captioning as required by Section 8-18 of the Code of Ordinances.
Name of Business where incident occurred
*
Address of Business
*
Date of Incident
*
-
Month
-
Day
Year
Date
Time of Incident
*
Hour Minutes
AM
PM
AM/PM Option
Are you a member of the Commission for Persons with Disabilities?
*
Yes
No
Did you ask an employee to turn on closed captioning?
*
Yes
No
Other
If yes, what was their reponse?
*
Turned on captioning
Refused to turn on captioning
Did not know how to turn on captioning
Stated that captioning was not available on devices
N/A
Other
If yes, please briefly describe your interaction with the business and the steps taken to educate on the closed captioning ordinance.
*
Please include the name and title of the person you spoke to, if available.
*
Did you ask an employee to turn on closed captioning?
*
Yes
No
Other
If yes, what was their reponse?
*
Turned on captioning
Refused to turn on captioning
Did not know how to turn on captioning
Stated that captioning was not available on devices
N/A
Other
Please include the name and title of the person you spoke to, if available.
Provide additional information about the incident here:
Please include additional supporting documentation (i.e. pictures or videos)
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Contact Information
Please provide your contact information below, this information will not be shared with the reported business.
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
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