Blind Low Vision NZ Access Barrier Register
We want to hear about your lived experience.
Use this form to give feedback about access barriers you have encountered.
Fields marked with a red asterisk (*) must be completed.
Please give us your contact information.
Name
Phone
Email
Select the best option:
I
wish to give feedback about an access barrier that I am experiencing at Blind Low Vision NZ.
I wish to give feedback about an access barrier that I am experiencing in my community.
I am a(n)
Employee of Blind Low Vision NZ
Client of Blind Low Vision NZ
Visitor to Blind Low Vision NZ
Describe the access barrier
Is the Access Barrier also a Health and Safety Hazard?
Yes
No
If Yes, please briefly describe the hazard.
Has this been reported on the Health & Safety Register?
Yes
No
Access Barrier Category
Built environment
Digital environment
Systems (incl. IT systems)
Processes
Communications
Resources and Equipment
Other (please specify)
Please state the access barrier category
How is the barrier impacting your access?
How can this access barrier be resolved?
Is the Access Barrier directly impacting clients/members?
Yes
No
If Yes, how?
I am available to participate in resolving this accessiblity issue.
Yes
No
Region
Please select...
Northland
Auckland
Waikato
Bay of Plenty
Gisborne
Hawke's Bay
Taranaki
Manawatū-Whanganui
Wellington
Tasman
Nelson
Marlborough
West Coast
Christchurch
Canterbury
Chatham Islands
Southland
Dunedin
Otago
Other
If "Other", please state.
What area/s of life does this issue involve?
(You can select more than one)
Education
Built Environment
Transport
Health
Social Inclusion & Attitudes
Leisure, Sports & Recreation
Employment
Retail / Goods & Services
Financial Services
Government & Public Services
Political & Democratic Processes
Justice System
Tourism & Hospitality
Housing & Accommodation
Digital, Communications & Information Systems
Media & Broadcasting
Proof of Identity
Other
If "Other", please state.
Does this issue involve guide dog discrimination?
Yes
No
Describe the issue.
Please use this field if you wish to include a photo of the barrier.
Add another image
Please use this field if you wish to include a photo of the barrier.
How has this issue impacted you?
Please use this field if you wish to include a photo of the barrier.
Add another image
Please use this field if you wish to include a photo of the barrier.
What changes would you like to see?
Have you reported this issue to another organisation
?
Yes
No
If possible please list any organisations you have reported this issue to besides us.
Are you blind, low vision, or deafblind, and/or a carer of someone who is?
Yes
No
Privacy Notice
Blind Low Vision NZ is committed to protecting your privacy. The ‘Community Issues Log’ online form asks you to disclose some personal information, including your name, email and phone number. Blind Low Vision NZ may use this information for the purpose of contacting you if we need to find out more about the issue you are registering.
Please see our privacy policy for more information.
I agree to the terms of Blind Low Vision NZ’s
privacy policy.
Yes
No
Contact Information