Which of the following describes you?

Person living with disability Parent or carer of a person with disability Elderly person Carer or family member of an elderly person Professional worker in related area (Healthcare worker, Disability sector worker, Aged care worker) Disaster affected person (includes bushfires, COVID-19, floods) Volunteering in any of the above areas As specified below

Please tick the ones that you have been affected by:

Bushfires COVID-19 economic downturn Discrimination for living with disability (unreported) Discrimination for living with disability (reported) Discrimination for being elderly (unreported) Discrimination for being elderly (reported) Discrimination for any other reason Other (Please specify)

We are going to offer an online directory that caters to the specific needs of those living with disability, elderly and disaster affected. Do you think this is a significant need and will be an asset for the community?

Yes I don't know No

How do you prefer to shop?

Online In person, locally In person, out side of my local community

Do you prefer to use the same shops or a different one each outing?

The same Different each time

Do you feel like businesses you shop at are catering to your specific needs and offering inclusion and accessibility?

Yes No

Which of the following services or business do you struggle to find? (this can include being able to locate but not being able to find a quality service or business that meets your needs.)

Health - including specialists, GP, mental health services, alternative therapies, Mobility specialists, home health services, pharmacy and medicine, health food shops, scans and radiologists. Food - dine in, take away, delivery, groceries and health food shops. Travel - accommodation/ places to sleep, transport services (not local), rail services, bus and coach travel, air travel. Fun - Water activities, land activities, cycling, culture, fun parks, extreme activities, day activities, night activities, group activities, social activities, computers and gaming activities, organised sports, sensory , museums, train-spotting, animal encounters, gardens. Self care - hair dressers, make up costumes, massage, day spa, sauna, gym, pools/spas, beauticians, hygiene, life coaches, home care services, free services to help. Help and Planning - ambulance, police, hospitals, advocacy, legal, service providers, phone services, emergency helplines, carers. Transport – taxi, uber, other, community transport, rail, bus and coach, air travel. Career/work/volunteering - work experience, specialised employment services, volunteer work, training services, private volunteering. Education - university, schools, tutoring, extra curricular activities and tafe. At home - tradesmen, real estate, group homes, cleaning services, food services mowing garden maintenance

If you were able to find services, facilities and businesses specific to your needs more than you currently can, would you:

Feel more included in your community Spend money locally more often Attend more sports activities Engage in more cultural activities Engage in more social activities None of the above

If you knew before you entered into a service, shop or facility that they had taken a pledge to be inclusive and kind to people, how would you feel?

More included in your community More likely to use the service, facility or business instead of others More likely to recommend them to others More likely to be a return customer More likely to attend cultural, social and sporting events None of the above

What kind of access or inclusion would you like to see more of from business, services and facilities?

Friendly and attentive staff Wheelchair/ mobile scooter access Easy to access disaster specific response Education on preventing Disaster impacts on people Mobile or "come to you" services (health professionals, hairdressers deliveries etc) Defibrillator/first aid qualified staff Flexible menu or adults able to order from kids menu Quiet atmosphere/quiet seating spaces Samples and/or Discounts for concession card holders Hearing loops or staff trained in AUSLAN Service animal / guide dog friendly (water bowl etc) Secure premises parks and areas Flexible refund policy for people who change their mind on activities or services Sensory friendly products Self check-in and assisted independence specialists Courtesy transport service Employment flexibility/volunteering Online learning with flexible completion dates Other (please specify)

How many times have you experienced discrimination in the last year?

None 1 to 5 times 6 to 10 times 11 to 20 times More than 20 times

Would you participate in more sport if you were able to find these services and clubs easily, and knew that they had taken a pledge to be actively inclusive?

Yes No

On a scale of 1 - 5 with 5 being the best it can possibly be, how do you rate your general quality of service when it comes to using your local businesses and services?

1 2 3 4 5

Are there any simple things that a business or service can do to make you feel more supported or included in community?

If you wish to tell us your email address, we can let you know when Awesism launches.

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