Accessibility Audit Survey Form แบบฟอร์ มตรวจสอบการเข้ าถึง
APCD/JAIF PROJECT
โครงการ APCD/JAIF
Date:
วัน เดือน ปี
(English translation)
Team Leader:
ชื่อหัวหน้ าทีม
Target Village:
ชื่อสถานที่ตรวจสอบ
(English translation)
Team Members:
รายชื่อสมาชิก
(English translation)
Building Name:
ชื่ออาคาร/บ้ าน
(English translation)
Owner of the Building:
ชื่อเข้ าของอาคาร/บ้ าน
(English translation)
Location of Building:
ระบุบริเวณที่ตรวจสอบ
(English translation)
(English translation)
I.
RAMP ทางลาด
1. Is there a ramp in the building? อาคาร/บ้ าน มีทางลาดหรือไม่
ตอบ.......................................................................................................................................................................................................................
(English translation of answer)
2. How many ramps are in the building? มีทางลาดกี่จดุ
ตอบ.......................................................................................................................................................................................................................
(English translation of answer)
3. Location of the ramp: สถานที่ตรวจสอบ
ระบุ........................................................................................................................................................................................................................
(English translation of answer)
a. Is the gradient 1:12?
Yes ใช่
No, if no please state the actual gradient
measurement. โปรดวัด
ไม่ใช่ โปรดระบุ...................................................................................................
ระดับทางลาด 1:12 หรือไม่
(English translation)
b. Are there handrails on both sides? มีราวจับหรือไม่
Yes, if yes please write the height and width.
No ไม่มี
มี โปรดระบุความสูงและความกว้ าง...................................................
(English translation)
4. By using the Simplified Ramp Gradient Finder (Auditor you can identify if the ramp gradient is 1:12
or not). กรุณาใช้ ตัว Finder (เครื่องมือวัด) วัดระดับความลาดชันของทางลาดว่าอยูใ่ นระดับ 1:12 หรือไม่
ตอบ....................................................................................................................................................................................................................
a. Is there signage? มีสญ
ั ลักษณ์บอกหรือไม่
ตอบ...................................................................
(English translation)
b. Is the ramp non-skid? ทางลาดเรียบหรือไม่
ตอบ...................................................................
(English translation)
1
5. Can a wheelchair user go up and down) the ramp by her/himself? คนพิการใรถเข็นขึ ้น-ลงทางลาดได้ เองหรื อไม่
Difficult ยาก
 Fair พอได้
 Easy ง่ายมาก
(English translation)
6. If it’s difficult, please state the reason why ถ้ าตอบว่ายาก กรุ ณาให้ เหตุผลประกอบ
ตอบ..................................................................................................................................................................................................................
(English translation)
7. Is the ramp often used by PWDs? (PWD ) คนพิการมีโอกาสทางลาดนี ้บ่อยหรื อใช่หรื อไม่
Yes ใช่ No, if no please state the reason why by encircling the letter below.
ไม่ใช่ โปรดระบุ เพราะอะไร จงเลือกคาตอบจากข้ างล่างนี ้
a. Wrong location ทาไว้ ผิดจุด b. Unsafe ไม่ปลอดภัย c. ไม่ทราบว่ามี d. Not needed ไม่จาเป็ นต้ องใช้
e. Other reasonอื่นๆ ระบุ _____________________________
(Thai)
TOILET
II.
1. Is there an accessible toilet(s) in the building?
Yes
No
(Thai)
(English translation)
2. How many toilet(s) are accessible?
(Thai)
(English translation)
3. If yes, what accessible features are installed in the toilet? (Circle one or more answers)
(Thai)
0.45m
a. Grab bars
b. Non-skid flooring
c. Sliding Door
(Thai)
d.
Others please specify ____________________.
0
.
8
0
m
(Thai)
(English translation)
4. Is there at least one accessible route (ramp(s)) from the entrance of the buildings going to the accessible
toilet?
(Thai)
a.
Yes, if yes please state the location ___________________________
(Thai)
(English translation)
b.
No, if no please state the barriers (circle one or more answers if available)
(Thai)
i. Stairs
ii. Threshold (>25mm)
iii. Narrow doorway (<80cm)
(Thai)
iv. d. Other please specify ___________________.
(Thai)
2
(English translation)
5. Is the doorway of the accessible toilet at least 80 cm wide?
specify actual width: ________ cm.
(Thai)
(English translation)
Yes
No, if no please
6. Can the door of the accessible cubicle be opened and closed easily from the inside?
(Thai)
Yes
No, please state why? _________________________________
(Thai)
a. Actual Dimension of the cubicle ________ x _______ cm.
(Thai)
7. Can a wheelchair user transfer from the wheelchair to the toilet by her/himself?
(Thai)
If No, reasons for difficulty (multiple choices)
(Thai)
a.
Small space b.
No grab bar c.
Only one grab bar
d.
Wrong location of the grab bar
e.
Unfixed grab bar
f.
Wrong height of the toilet bowl
g.
Other reason please state ______________
(Thai)
(English translation)
8. Is there signage to indicate the location of the accessible toilet?
Yes
No
(Thai)
9. Is the toilet floor non-skid?
Yes
No
(Thai)
10. Is the toilet often used by the PWDs? )
Yes
(Thai)
a. Wrong location b. Unsafe c. Not been aware
(Thai)
d. Not needed
e. No signage
(Thai)
Other reason _____________________________
(Thai)
(English translation)
3
No, if no please state the reason why by circling
the letter below.
III.
PARKING SPACE
1. Is there an accessible parking space(s)?
Yes
No
(Thai)
2. How many accessible parking spaces are there? _________
Location: _____________________________
(Thai)
(English translation)
3. Is the accessible parking space located at the nearest entrance?
Yes
No
Yes
No
(Thai)
4. Is there signage for the accessible parking space?
(Thai)
SIGNAGE
IV.
Location of the Signage and Use of International Symbol for Access (e.g. blue color)
(Thai)
1. Is there a signage?
Yes
No
(Thai)
2. Is the international symbol for access (e.g. blue color) used for the signage?
Yes
No
(Thai)
3. Is the signage mounted at a maximum height of 1.60 meters.& a minimum height of 1.40 Meters?
(Thai)
Yes
No
4. Can the signage be easily understood by people?
Yes
No
(Thai)
V.
FLOORING
1. Is the tread surface of the flooring a slip-resistant material? Is the stairs a slip resistant material?
(Thai)
Yes
No
2. Is the Ramp flooring non-skid?
Yes
No
(Thai)
3. Are the washroom and toilet floors made of non-skid materials?
(Thai)
4
Yes
No
SUMMARY ON THE FINDINGS:
(Thai)
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
ENGLISH TRANSLATION:
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
RECOMMENDATIONS:
(Thai)
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
ENGLISH TRANSLATION:
__________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
5
Note: This access audit tool is for monitoring the accessibility of the environment of the target areas based on the
Five (5) Minimum Requirements of the Batas Pambansa (BP) 344 or the “Accessibility Law” of the Philippines where
the NHE Project was pioneered.
6