2) information in alternate formats on

• itinerary
• rates
• disability-related services (specify)
• other (specify)
• alternate format(s)
1. audio
2. electronic
3. braille
4. large print

3) provision of a seat that meets the person's needs (except in emergency EXIT rows)

• movable aisle arm rest
• near entrance
• additional leg room
• near washroom
• next to attendant
• other (specify):

4) attendant(s)

medical info required by carrier(s) (yes/no)

(specify)

5) carriage of a mobility aid *

• specify type of mobility aid

  1. manual wheelchair
  2. manual folding wheelchair
  3. scooter
  4. electric wheelchair
  5. other

• note dimensions

• type of batteries

  1. wet/acid
  2. gel
  3. dry
  
  

• special tool(s)/instructions needed to disassemble/ assemble wheelchair/battery (specify)

• tool(s)/instructions to be provided by

  1. carrier
  2. traveller

6) use of oxygen on board and/or in terminals *

• carrier provided
• passenger provided

7) verify with terminal operator(s) that accessible ground transportation is available to/from terminal

• taxi
• shuttle
• city bus
• other (specify)

8) "Unaccompanied-passenger" services - a higher level of assistance for individuals such as persons who have cognitive or intellectual disabilities

• (specify contact name/tel. no.)
• Dep.
• Arr.

• (specify services required in terminal(s) prior to departure, during connections, and/or upon arrival)

• (specify services required on board)

9) assistance with registration at check-in counter

10) on departure, assistance to transfer the person from a passenger mobility aid

• at registration counter
• at departure gate
• at aircraft door *

on arrival, assistance to transfer the person to a passenger mobility aid

• at aircraft door
• at arrival gate
• at baggage carrousel *

11) assistance to get to the boarding gate (specify)

12) assistance to board/deboard (specify)

13) assistance to transfer the person

• between a mobility aid and a passenger seat (on departure)
• between a passenger seat and a mobility aid (on arrival)

14) assistance to store and retrieve carry-on baggage

15) provide meal-related services onboard

• special meal (specify)
• opening packages
• identifying items
• cutting large portions

16) assistance to move to/from the onboard washroom (except by carrying)

17) assistance to get to a representative of another carrier in the same terminal (specify)

18) assistance to retrieve checked baggage

19) assistance to get

• to the general public area
• to a service animal relief area

20) carriage - free of charge - of a trained, certified and harnessed service animal (specify) at the person's seat

21) carrier issuing ticket to notify connecting carrier(s) of services requested to be provided

22) written confirmation of services to be provided by the carrier