Barrier Identification Form

Type of Barrier Identified (please check all that apply): *

Physical/Architectural (ie. Location of chairs or other items obstructing pathways for the visually impaired or hallway too narrow for a wheelchair)

Information (ie. Font size too small for those with low vision)

Communication/Attitude (ie. Method of communication for important information is not appropriate or municipal employee ignores person in wheelchair)

Technological (ie. Office equipment requires use of physical strength and both hands to operate)

Policy or Practice (ie. Not having audible signals at major intersections)

None of the above/Not sure

Please describe the barrier (Who, What, Where, When...) *

Please identify the department(s) in which you identified the barrier *

Do you have a recommendation for removing the barrier? Please describe:

Would you consider the barrier Low, Medium or High priority? And Why? *

Your Name

Address

Phone

Email address

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