Accessible Format and Communication Support Request Form (AODA) – Nursing & Homemakers Inc.

Upon request accessible formats and communication supports will be provided in a timely manner. Please fill out the form below.

Date of request:

Name:

Address:

Phone number:

E-mail:

Document or information requested:

Recorded audio
Online video (e.g., Zoom)
Large Print

Plain language
Sign language
Other

Is this information required by a specific date?

Yes

Required by date:

Additional comments:

NHI is committed to creating an inclusive workplace culture and will accommodate the needs of people with disabilities. Please inform us if you require any specific accommodation so that appropriate arrangements can be made to ensure continued compliance with Accessibility for Ontarians with Disabilities Act, 2005 (AODA) and its accessibility standards.

Monday - Friday	05:00am - Midnight
Saturday - Sunday	05:00am - Midnight
After Hours Answering Service	Midnight - 5am