Disability Inclusion Awards Nomination Form

2017 Business Awards for Disability Inclusion & Access

Celebrating International Day of People with Disability
Nomination Form

The 2017 Business Awards for Disability Inclusion and Access recognise businesses, who are already working towards an inclusive community. Involvement in the awards as a nominator or nominee spreads the message that not only is social inclusion a human right, but that inclusion also benefits the whole community. Therefore it is up to the entire community to make this possible.

To make a nomination please fill in the below form. Entries close 17th November 2017.
Nominating a business for an award

The more information you provide assists the judges in their assessment of your/ your nominee’s achievements.
Your Details
Name

First Name Last Name
Phone Number

Area Code Phone Number
Email
example@example.com
Nominee's details
If you are nominating a business please provide a name of a contact person.
Nominee

First Name Last Name
Contact Person
Phone Number

Area Code Phone Number
Email
example@example.com
Universal access

If your nominee provides a service from a building how accessible are the premises? Accessible means that anyone can get to and go into the building and use the facilities.
Does the building have an identified accessible car park?

Yes No
Continuous step free path from the car park to the main entrance?

Yes No
A level step free entry through the main entrance?

Yes No
Entry and internal doorways and corridors wide enough for a wheelchair?

Yes No
Accessible toilet?

Yes No
Serving counters with a lower section for a person in a wheelchair, of short stature or who needs to sit?

Yes No
If yes, please give examples and additional information
Is there signage on the inside or outside of the building that is easy to understand for people with vision impairment or who have cognitive challenges such as dementia?
Signs in large plain font with good contrast between the text and background

Yes No
Signage at a height that people in a wheelchair or with short stature can easily read

Yes No
Signage in braille

Yes No
Has your nominee produced information in formats that are accessible for people with hearing and vision impairment, have cognitive or mobility challenges?
Large print information

Yes No
Easy read information

Yes No
Access to electronic information in voice activated format

Yes No
Information in braille

Yes No
Inclusive service
Has your nominee taken action to provide a more inclusive service? For example staff/volunteer training, arranging furniture to facilitate ease of access, communication methods for people with hearing or vision impairment.

Yes No
If yes, please give examples and additional information
Areas of achievement
In what areas has your nominee's achievements supported inclusion?

Advocacy Employment Creative Arts Education Sport and leisure Tourism Service access Other
Please give examples and additional information.
Additional information
Is there any additional information including photographs you would like to add?
Upload photograph (if required)

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2017 Business Awards for Disability Inclusion & Access