| 1. Where is the toilet located? |
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| 2. Are there steps? |
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Yes |
No |
| 3. Is this toilet designated for? |
Male |
Female |
Unisex |
| 4. Is this toilet a shower toilet? |
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Yes |
No |
| 5. Is the doorway wide enough for a wheeled chair / a hoist? |
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Yes |
No |
| 6. Can the door be opened and shut easily? |
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Yes |
No |
| 7. Can the door be locked? |
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Yes |
No |
| 8. Is the toilet paper within easy reach? |
|
Yes |
No |
| 9. Is the flush system easy to activate? |
|
Yes |
No |
| 10. Is the wash basin in the same room? |
|
Yes |
No |
| 11. Is the soap dispenser within easy reach? |
|
Yes |
No |
| 12. Is the hand dryer or towels within easy reach? |
|
Yes |
No |
| 13. Are there any hazards? (List below) |
|
Yes |
No |
| 14. Does the cleanliness meet acceptable standards |
|
Yes |
No |
| 15. Is assistive equipment available e.g. rails? |
|
Yes |
No |
| 16. Is the height of toilet suitable? |
|
Yes |
No |
| 17. Are there unpleasant odours? |
|
Yes |
No |
| Additional comments: |
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