Contact information

First name
Last name
Relation	Guest Wheelchair user Guest Visitor without booking Hotel Management Travel Agency Interest group disables Otherwise (Use remarks for relation)
Telephone
Email

Adjudication hotel/apartment/camping:
Automatic entrance doors Hotel/Apartment/Reception	Yes, automatic door No, but swing doors No, need help
Entrance with a ramp	Steep - need help Light Ramp, no help needed No Ramp - horizontal
Wheelchair accommodation present	None 1 2 3 4 5 6 7 8 9 10 More then 10
Door width	<75 cm 75-90cm >90cm I don't know
Reserved places in restaurant	Yes No N.A.
Outdoor café/court	Total levelly Stairs with ramps without help Stairs with ramps help needed Stairs, cannot pass
Swimming pool	Hoist Slope down with grab rails Slope down without grab rails Stairs with grab rails Stairs without grab rails Vertical steps
Toilets for disables on grand floor	Yes, fully made suitable room Yes, but smal room with only grab rails No
Accessibility of the common rooms	Yes, all rooms A few room not, I enumerate by remarks
Reserved parking places available	Yes No
Accommodation facilities:
Raised toilet	Yes No
Grab rails toilet	Yes No
Grab rails bath	Yes No
Grab rails shower	Yes No
Shower chair	Yes No
Free space under the Washbasin	Yes No
Mirror useful for wheelchair users	Yes No
Raised bed	Yes No
Room big enough to turn around with wheelchair	Yes No
Can you go on the balcony with the wheelchair	No balcony present Yes, and no sill Yes, with a sill No, not possible
Light switch on wheelchair level	Yes No
Total accessibility of the hotel/apartment/camping	10 9 8 7 6 5 4 3 2 1 0 (Assessment of above, 10=best 0=worst)
Access pavements near the accommodation (radius 500 mtr)	Yes everywhere and good Yes, but bad quality (with increases >3cm) Yes, but not enough Not present at all
Accessibility of the stores in the surrounding (radius 500 mtr)	Over 75% accessible Between 50 en 75% accessible Between 25 en 50% accessible Less then 25% accessible
Total accessibility of the surrounding (radius 500 mtr)	10 9 8 7 6 5 4 3 2 1 0 (Assessment of above, 10=best 0=worst)
Access pavements in the holiday destination (place)	Yes everywhere and good Yes, but bad quality (with increases >3cm) Yes, but not enough No present at all
Accessibility of the stores in the holiday destination (place)	Over 75% accessible Between 50 and 75% accessible Between 25 and 50% accessible Less then 25% accessible
Reserved parking for disabled in the holiday destination (place)	Enough You had to seek them Not at all in the tourist part
Wheelchair accessibility of the holiday destination	10 9 8 7 6 5 4 3 2 1 0 (Assessment of above, 10=best 0=worst)

End judgment

	Accessible for independent wheelchair users and  crippled people
	Accessible for wheelchairs with help and crippled people
	Not accessible for wheelchairs but accessible for crippled people with rollators
	Not accessible at all for crippled people or wheelchairs

Remarks