Short Test „Barrier-free surgery“
physician:
*
e-mail
example@example.com
adress
streetname and number
streetname and number (second line)
city
country
city postcode
phone number
-
surgery:
*
specific field:
Questions for patients with mobility disabilities
1) A disabled parking space is available close by the entrance to the doctor`s surgery
Yes
No
2) There are steps to be climed to reach the surgery
Yes
No
Number of steps up to the surgery entrance door or the surgery room
3) In the entrance and the exit area there is a handrail on the right/ left
Yes, there is a handrail on both sides
Yes, there is a handrail on the left
Yes, there is a handrail on the right
No
4) To reach the surgery there is a ramp with handrail and wheel base deflector available
Yes
The slope of the range is ....%.
5) An elevator is available on the level entrance (no steps)
Yes
No
The elevator is available but a ramp must be used
Yes
No
The width of the entry doors in cm: (minimum 90 cm)
The depth in cm …(minimum 140 cm)
The width in cm …(minimum 110 cm)
There are operating elements in the elevator at a height of ….cm available
6) The entrance door of the surgery is ….cm wide
7) Some areas oft the reception desk are lowered to a maxium height of 85 cm
Yes
No
8) A wheelchair accessible changing room is available
Yes
No
9) A accessible toilet is available
Yes
No
10) The entrance door to the toilet is …wide
11) The toilet room is ….wide
The toilet room is …long
12) The toilet seat can be apporached from the side
13) A handle is provided to the toilet door (from inside)
Yes
No
14) A fixed handle is on the right/left side on the wall side available
Yes
No
15) A hinged fixed handle is available on the right/ left
Yes
No
Questions for visually impaired and blind patients
1) Intercom,bell and door switch in braille script with capital letters (minimum 1,5 m)
Yes
No
2) The front side of the steps are marked with high contrast (preferably yellow)
Yes
No
3) The operating elements in the elevator are raised and rich in contrast (braille)
Yes
No
4) A handrail with tactile information for blind and visually impaired people is available
Yes
No
5) Glass doors or glass surfaces are provided with continuous high constrast and optical markings from 90 – 100 cm and also in the range from 150 – 160 cm above the floor
Yes
No
6) Automatic doors are available
Yes
No
Send
Should be Empty: