Medical Office & Equipment Accessibility Audit
Please note that this checklist does not cover every element listed in the ADA guidelines, such as parking and outside entrances. This is meant only to assess the physical accessibility of waiting rooms and exam rooms in hospitals or clinics and should be used as a supplement to the full ADA checklist for existing facilities, which can be found at adachecklist.org.
Name of clinic or facility
*
Address of clinic or facility
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Name of clinic or facility point of contact (POC)
*
POC Email
*
example@example.com
POC Phone number
Please enter a valid phone number.
Format: (000) 000-0000.
Auditor 1
*
First Name
Last Name
Please select the statement that best describes you:
*
Healthcare Provider/Professional
Clinic or Hospital staff
Someone with a mobility disability
Other
Email
*
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Auditor 2
First Name
Last Name
Please select the statement that best describes you:
Healthcare Provider/Professional
Clinic or Hospital staff
Someone with a mobility disability
Other
Email
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Waiting Room: Is there at least one space at least 36" wide by at least 48" long for a person in a wheelchair to sit where they are outside the circulation path?
*
Yes
No
Optional: Image(s) of waiting room(s)
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Front desks/Checkout stations: Is a portion of every type of counter (e.g., check in and bill payment) no higher than 36" and at least 36" wide? Is the accessible portion of the counter free of clutter?
*
Yes
No
Optional: Image(s) of front desk(s)
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Door(s): Is the door opening width at least 32" clear, between the face of the door and the stop, when the door is opened to 90 degrees?
*
Yes
No
Optional: Image(s) of door opening(s)
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Door Hardware: Can the door be opened easily with one hand without tight grasping, tight pinching, or twisting of the wrist?
*
Yes
No
Optional: Image(s) of door hardware
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Door Maneuvering Clearance: Is there space on both sides of doors along the accessible route for maneuvering and opening the door?
*
Yes
No
Optional: Image(s) of door/doors maneuvering clearance space
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Hallways and Corridors: Are circulation paths free of obstructions like of boxes, chairs, or equipment that interferes with the accessible route?
*
Yes
No
Optional: Image(s) of hallway(s)
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Wheelchair Accessible Weight Scale: Is there a wheelchair accessible roll-on scale with a platform large enough to fit a wheelchair?
*
Yes
No
Optional: Image(s) of wheelchair accessible weight scale(s)
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Exam room: Is there at least 30" by 48" clear floor space adjacent to the exam table and adjoining accessible route to make it possible to do a side transfer?
*
Yes
No
Optional: Image(s) of floor space around exam table(s)
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Exam room: Is there enough turning space for an individual using a wheelchair to make a 180-degree turn, using a clear space of 60" in diameter or a 60" by 60" T-shaped space?
*
Yes
No
Optional: Image(s) of turning space in exam room(s)
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Exam Tables and Chairs: Does the height-adjustable exam table or chair have elements to stabilize and support a person during transfer and while on the table, such as rails, straps, stabilization cushions, wedges, or rolled up towels?
*
Yes
No
Optional: Image(s) of height adjustable exam table element(s) or chair element(s)
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Staff Training: Are staff trained on how to operate equipment and on safe patient handling techniques?
*
Yes
No
Optional: upload training materials used to train your staff
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Do you have any additional comments or information you would like to share?
This checklist was adapted from the following sources:
1) Department of Justice, Civil Rights Division (2020, June 26). Access to Medical Care for Individuals with Mobility Disabilities. ADA.Gov. Retrieved September 12, 2023, from https://www.ada.gov/resources/medical-care-mobility/#; 2) New England ADA Center - A Project of the Institute for Human Centered Design (2016, January 1). ADA Checklist for Existing Facilities. ADAChecklist.org. Retrieved September 12, 2023, from https://www.adachecklist.org/index.html
This checklist and toolkit are part of a health equity project developed with a sponsorship from Genentech, A Member of the Roche Group.
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