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 NameLast Name
Phone Number

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

First NameLast Name
Contact Person
Phone Number

Area CodePhone 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?

YesNo
Continuous step free path from the car park to the main entrance?

YesNo
A level step free entry through the main entrance?

YesNo
Entry and internal doorways and corridors wide enough for a wheelchair?

YesNo
Accessible toilet?

YesNo
Serving counters with a lower section for a person in a wheelchair, of short stature or who needs to sit?

YesNo
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

YesNo
Signage at a height that people in a wheelchair or with short stature can easily read

YesNo
Signage in braille

YesNo
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

YesNo
Easy read information

YesNo
Access to electronic information in voice activated format

YesNo
Information in braille

YesNo
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.

YesNo
If yes, please give examples and additional information
Areas of achievement
In what areas has your nominee's achievements supported inclusion?

AdvocacyEmploymentCreative ArtsEducationSport and leisureTourismService accessOther
Please give examples and additional information.
Additional information
Is there any additional information including photographs you would like to add?
Upload photograph (if required)

Browse Files

Cancelof
Should be Empty:

2017 Business Awards for Disability Inclusion & Access