Fillable Accessibility at UHN University Health Network (UHN) is (University Health Network)

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Accessibility at UHN University Health Network (UHN) is (University Health Network)

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Accessibility at UHN
University Health Network (UHN) is committed to providing a respectful, accessible and inclusive environment for
everyone.
You may choose to take part or not take part in this Accessibility Feedback Survey.
Your care at UHN will not be affected in any way whether you choose to fill out this survey or not.
How we will use the information you share with us:
If you choose to take part in this feedback survey, do not write anything on the survey that may identify you. UHN will
keep the information you share confidential. We will only share what you tell us with teams at UHN. No one will be able
to identify you from the information in our reports. The information you share in this survey will help UHN improve
our services for future patients and visitors who live with disabilities.
Thank you for taking the time to fill in this feedback survey.
1. Do you self-identify as a person with a disability?
Yes
No * If you do not self-identify as a person with a disability, you do not have to take part in this survey.
Not Sure
2. Please let us know if you are:
Patient
Family Member of Patient
Friend of Patient
Visitor
Community Member
3. What is your type of disability? (Check as many as may apply to you)
Physical Disability, be specific:
Mobility Disability, be specific:
No Visible Disability, be specific:
Other, be specific:
Deaf, Deafened or Hard of Hearing
Intellectual Disability
Development Disability
Learning Disability
Mental Illness
Speech or Communication
Blind, Low Vision or Vision Impairment
Do not write anything on this survey
that may identify you.
Please enter today's date:
In what area(s) do you need to be accommodated?
4. What hospital and department do you work in?
Princess Margaret Cancer Centre Enter Dept:
Toronto General Hospital Enter Dept:
Toronto Rehabilitation Institute -
Enter Dept:
Bickle Centre
Lyndhurst Centre
Rumsey Centre
University Centre
Toronto Western Hospital Enter Dept:
Other
5. Did you find it easy to get around in the hospital or department where you visited or were given
care?
Yes
No
If you answered "No", please tell us
why?
6. Do you use an assistive device or assistive devices?
Yes
No
Not Sure: Please tell us why?
If so, what type of assistive device?
8. Do you use a service animal?
Yes
No
9. Was your service animal able to accompany you at UHN?
Yes
No
If no, why was your service animal not able to
accompany you at UHN?
10. Were you able to find and use an accessible washroom? (check as many as apply)
Yes, easy to find
No, not easy to find
Yes, accessible to use
11. Were the services during your visit respectful and helpful for people with disabilities?
Yes
No
12. As a person who has a disability, do you know that UHN's emergency evacuation plan is
available in alternate formats, upon request?
Yes
No
Were you able to use your own assistive device at UHN?
Yes
No
If no, why were you not able to use your own
assistive device at UHN?
7.
Do you use a support person?
Yes
No
If no, why were you not able to be accompanied by your support
person at UHN?
Were you able to be accompanied by your support person at UHN?
Yes
No
No, not accessible to use
I did not use the washroom
Does not apply to me as I can us ea regular washroom
If "No", please tell us more:
Not sure, please explain:
13. Do you have any other comments or
suggestions to help us improve
Accessiblity at UHN?
Thank you for completing this feedback survey!
This survey aligns with the principles of the Accessibility for Ontarian Disability Act, 2005
You may submit the form electronically or mail the completed survey to:
University Health Network
Toronto Western Hospital
Diversity and Mediation Services
399 Bathurst St., Room MP5-323
Toronto, ON
M5T 2S8
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Completed 29 July 2020

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