Website Compliance Intake Survey

Business Information

Let's start by getting some basic information about you and your business.

Business Name*

Full Name*

First Last

Email Address*

Phone Number

This will be a call-back number, so please include a direct phone-line.

Property Address*

We need the physical/mailing address of the property.

Street Address Address Line 2 City State ZIP

Website URL*

Please submit a survey for each individual property/website.

Did you complete the "Website Compliance Disclosure Agreement"?*

I did not receive it / I did not sign it.
I received, understand, signed and returned the "Website Compliance Disclosure Agreement".

Wheelchair Accessibility

The following questions apply to all questions apply to publicly accessible spaces, or private spaces you provide patrons access to. It does not include restricted areas exclusively for employees/staff.

Wheelchair & Handicap Parking

Does your property or the surrounding roads within a 1 mile radius have clearly identifiable handicap parking spots?

Yes, on-site handicap parking spaces are available on our property.
Yes, off-site handicap parking spaces are available on public property.
No, there's no handicap accessible parking nearby.

Wheelchair Accessible Shared Spaces

Which of the following features do you have in any of your general shared spaces?

Lobby/Reception area has low-rise counters, desks, and/or table-tops available.
Wheelchair accessible restrooms are available in these spaces.

Wheelchair Accessible Elevators

Do you have wheelchair accessible elevators which reach all levels from the ground-floor?

Yes, and it accommodates a wheelchair.
Yes, but it does not accommodate a wheelchair.
No, we do not have an elevator and our upper floors are inaccessible by wheelchairs.
N/A—our building is ground floor only.

Wheelchair Accessible Routes

Do you have wheelchair accessible doorways, walk-ways, hallways, indoor-routes, etc.?

Yes, all doorways and/or walk-ways are wide enough to fit a wheelchair.
No, all doorways and/or walk-ways are too narrow to fit a wheelchair.

Wheelchair Accessible Vehicles

Yes, our shuttle(s) and/or vehicle(s) have a wheelchair accessible ramp/lift.
Yes, our shuttle(s) and/or vehicle(s) have a wheelchair accessible ramp/lift; however, this must be requested in advance.
Yes, but they are not wheelchair accessible.
N/A—we do not provide a shuttle or vehicular service.

Wheelchair & Handicap Accessible Images

Upload images of each ADA-compliant parking spot(s), entrance(s), exit(s), space(s), route(s), or vehicle(s) to visually present these features. Please make sure the image files are properly named so we know what feature is which.

Drop files here or

Regarding Service Animals

All questions apply to publicly accessible spaces, or private spaces you provide patrons access to. It does not include restricted areas exclusively for employees/staff.

Service Animal Permission

According to “Title II of the ADA”, service animals are permitted on our property with no imposed costs/fees.

Agree
We provide a fully-refundable deposit
Disagree

Service Animal Damages

If any damages are caused by the service animal, a fee of $______ may be charged.

Additional Features for Service Animals

Do you provide any other/additional accommodations for service animals?

Seeing & Hearing Impaired Accessibility

All questions apply to publicly accessible spaces, or private spaces you provide patrons access to. It does not include restricted areas exclusively for employees/staff.

Features for the Seeing-Impaired

Do you provide any other/additional accommodations for the seeing-impaired?

Features for the Hearing-Impaired

Do you provide any other/additional accommodations for the hearing-impaired?

ADA Compliant Lodging Facilities

These questions pertain to businesses such as: hotels, motels, hostels, and other forms of lodging facilities. If your place of business does not provide these products/services to customers, please skip this.

List of ADA-Compliant Rooms

Please list each room type, what accessibility feature(s) it has, and the quantity of that room.

For example:

Premium King Room	Roll-In Shower	3
Queen Suite	Bed-Side Lift, In-Shower Seat	1

Room	Features	Quantity

Guest Room / Bathroom Images

Upload images of every ADA-compliant guest bedroom and bathroom to visually present the features listed above. Please make sure these image files are properly named so we know which room is which.

Drop files here or

General Facility / Amenity ADA-Compliant Features

Please add facility features which are available at your business.

For example:
Swimming Pool(s) with accessible ladders/steps

General Facility / Amenity Images

Upload images of every ADA-compliant facility and/or amenity to visually present these features. Please make sure these image files are properly named so we know what is what.

Drop files here or

Website Terms of Service

We will be placing our standard Terms of Service ("TOS") policies on your website. If you would like to request any modifications to the policies please indicate them below:

Please make the following revisions to our Website TOS:

Final Questions

Additional Information

Did we miss something? Please let us know if there are any additional accessibility features at your business.

Additional Media

If you have additional photos, documents, or videos you'd like us to implement on your website regarding ADA compliancy features please upload them here. Please make sure the image files are properly named so we know what feature is which.

Drop files here or

For 3rd Parties*

A copy of this survey will be emailed to you at the address you provided for your convenience. It's your responsibility to deliver this information to any other business entities that will need to display this information (such as booking engines, reservation systems, or other websites) managed by them.

I understand and agree

Thank You!

We will review your completed survey and implement the information on your website. We'll contact you once it's completed. Afterwards, we highly recommend you have a legal advisor verify your website provides enough information to be ADA compliant.

Feedback

We want to do the best we can! Is there anything we can do to improve this process?

Consent to Personal Data Collection*

I agree to the website privacy policy and consent to my personal data being collected.