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Format: (000) 000-0000.
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- Please select the statement that best describes you:*
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Format: (000) 000-0000.
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- Please select the statement that best describes you:
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Format: (000) 000-0000.
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- 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?*
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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?*
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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?*
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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?*
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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?*
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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?*
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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?*
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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?*
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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?*
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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?*
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- Staff Training: Are staff trained on how to operate equipment and on safe patient handling techniques?*
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- Should be Empty: