Adult change facility email registration form
In order to maintain safety standards all facilities listed on the Changing Places website must meet our minimum safety requirements. If your facility passes the email registration process it will appear on the website as an Adult Change Facility.
Facilities which bear the Changing Places logo must be built according to the design specifications and guidelines set out on our website. Should you wish to apply for full accreditation as a Changing Places facility please tick the box below and you will be contacted by a Changing Places representative to facilitate an appointment with a Changing Places affiliated disability access consultant. An accreditation fee may apply.
Please nominate the type of registration you wish to apply for:
Email registration only……………………………………………………………………………………….
Full accreditation as a Changing Places facility…………………………………………………………..
Your name / contact details: ……………………………………………………………………………………………………..
Venue details
Name of venue: ……………………………………………………………………......
Correspondence Name: …………………………………………………………………………
Type of venue: ……………………………………………………………………………………
Location/address of venue: ……………
Postcode: ………………………………………………………………………………………….
Contact details of venue to appear on map (Telephone / Email / Website):
……..…………………………………………………………………………………………………
I hereby certify that the information provided below is correct.
Signature……………………………………………………………………………………………
(if send in by email, type name)
Please tick all the features that apply to your facility:
£ Changing bench –
£ adult sized
£ Height adjustable
£ Hoist
£ Peninsular Toilet (toilet at least 1 metre away from the nearest wall -from the mid point of the toilet - to allow for carers to assist on either/both sides)
£ A large bin for pads
£ A non-slip floor
£ A washbasin
£ Publicly accessible
£ Please specify the dimensions of your facility
……..…………………………………………………………………………………………………
Other facilities
£ Emergency alarm
£ Tear-off paper roll
£ Privacy screen/curtain
Helpful information for people visiting the toilet
Security/ Access
£ Toilet is locked with an MLAK key
£ Toilet is locked with
Please give details (i.e. Radar key, call ahead, key available from information desk etc):
………………
Hoist Characteristic
£ Loop system
£ Click system
£ Ceiling system
£ Mobile system (free standing)
Changing Bench characteristics
£ wall mounted
£ free standing
£ Changing bench has side safety rail
Is the toilet within a managed setting?
£ Yes
£ No
Signage
If it meets the criteria, would you like us to use our symbol at the entry? The sign does not get installed on the door
£ Yes
£ No
Location
Where is the toilet located (e.g. ground floor, part of a suite of toilets etc):
Opening Hours
Please tell us the opening hours of this venue:
Monday till Friday:
Saturday/ Sunday: ……………………………………………………………………
Public Holidays: ……………………………………………………………………….
Any further special additional features?
Please give any details you wish:
Photo
Please attach photos of the inside of the facility of all fittings and fixtures
Are you happy for us to put this picture on the website?
ÿ Yes
ÿ No
Please submit the completed form to or
Thank you.