One-Stop Assistive Technology Questionnaire

Please take a moment to review the following questions. The purpose of this survey is to determine the types of assistive devices that you have that can be used by individuals who have access to your information resources. Your answers will assist us in making recommendations that will make your shop more accessible to individuals with disabilities.

If you are not familiar with the terms or jargon used in the questions, please refer to the CD titled Assistive Technology for One-Stop Job Centers. This CD contains pictures of the items mentioned in the questions. Please indicate to us if you need training in the use of the equipment you identify. Once again, thanks very much for completing this survey.

QUESTION	ANSWER		IDENTIFY MAKE
1. Do you have a phone in your shop that is used by your clients?	YES	NO
2. Do you have a TTY phone?	YES	NO
If yes, does it have the ability to print out the phone conversation on paper?	YES	NO
If you answered yes, do you require training in the use of this equipment?	YES	NO
4. Do you have a phone that can be used “hands free” not requiring the use of hands to hold the handset or dial numbers?	YES	NO
If you answered yes, do you require training in the use of this equipment?	YES	NO
5. Do you have a phone that allows the user to increase the volume?	YES	NO
6. Do you have a large button phone in which the numbers are bigger than ½ inch?	YES	NO
7. Do you have any individual voice amplification systems (example: pocket talker, FM system)?	YES	NO
QUESTION	ANSWER		IDENTIFY MAKE
If you answered yes, do you require training in the use of this equipment?	YES	NO
8. Do you have televisions with closed captioning systems?	YES	NO
If you answered yes, do you require training in the use of this equipment?	YES	NO
9. Do you have any device that can magnify print from a book or pamphlet such as a hand held magnifier or CCTV? List:	YES	NO
If you answered yes, do you require training in the use of this equipment?	YES	NO
10. Do you have any software or hardware that would make the images on the computer screen larger for someone with a vision impairment? (Example: 20 inch monitor, Zoomtext, magnifier that attaches to the screen)	YES	NO
If you answered yes, do you require training in the use of this equipment?	YES	NO
11. Do you have any devices that can scan and read books an/or print material? (Example: WYNN, Openbook, Kurzwiel 1000, VERA)	YES	NO
If you answered yes, do you require training in the use of this equipment?	YES	NO
QUESTION	ANSWER		IDENTIFY MAKE
12. Do you have any screen reader software on your computer that can read the screen to someone with a vision impairment? (Example: JAWS, Window Eyes)	YES	NO
If you answered yes, do you require training in the use of this equipment?	YES	NO
15. Do you have height adjustable tables or desks? Do the desks have keyboard trays? If yes, can the tray tilt?	YES YES YES	NO NO NO
16. Do you have any computer that sits on an adjustable table that can move up or down?	YES	NO
If you answered yes, do you require training in the use of this equipment?	YES	NO
17. Do you have any hand held tape recorders that can be used by your clients?	YES	NO
18. Have you ever used the accessibility options, located in the control panel of the computer, with a client?	YES	NO
Has a client ever requested the need for a specific piece of adaptive equipment to access any of your information resources?	YES	NO
If yes, what type of equipment was requested? LIST: