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Reservation Checklist for Persons With Disabilities: A Step-by-step Guide for Planning Your Travel

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Name
___________________________________________________________________________

Date of travel
___________________________________________________________________________

File/Locator no.
___________________________________________________________________________

Phone/E-mail
___________________________________________________________________________

Service provider (carrier)
___________________________________________________________________________

Advise carrier of the nature of your disability
Obtain written confirmation of services to be provided

Accessible Services for Persons with Disabilities	Date Confirmed
1) Information in multiple formats on itinerary rates disability-related services: ____________________________________________________________ other: ____________________________________________________________ Multiple formats: e-mail braille text only
2) Seating that meets your needs (except in emergency exit rows) moveable aisle arm rest moveable arm rest between seats near entrance additional leg room near washroom next to attendant additional seating space other: ____________________________________________________________
3) Attendant(s)^* Is medical info required by carrier(s)? yesno If yes, specify: ____________________________________________________________
4) Carriage of a mobility aid^* Type: ____________________________________________________________ Dimensions: ____________________________________________________________ Type of batteries: ____________________________________________________________ Special tools/instructions needed to disassemble/assemble: ____________________________________________________________ Tools/instructions to be provided by: carrier traveller
5) Use of gaseous oxygen or portable oxygen concentrator on board and/or in terminals^* carrier-provided (fees may be applicable) passenger-provided assistance to/from washroom with oxygen Is oxygen needed between flights/travel segments? yesno
6) Accessible ground transportation to/from terminal taxi shuttle city bus between terminals other: ____________________________________________________________ Are advance reservations for accessible ground transportation required? yesno
7) "Unaccompanied-passenger" services (a higher level of assistance for individuals such as persons who have cognitive or intellectual disabilities) Contact name: ____________________________________________________________ Telephone number: ____________________________________________________________ Services required in terminal(s) prior to departure, during connections, and/or upon arrival: ____________________________________________________________ Services required on board: ____________________________________________________________
8) Assistance with registration at check-in counter? yesno
9) On departure, assistance to transfer from a passenger mobility aid^* at registration counter at departure gate between a mobility aid and a passenger seat at aircraft/vehicle door On arrival, assistance to transfer to a passenger mobility aid between a passenger seat and a mobility aid at aircraft/vehicle door at arrival gate at baggage carrousel^* Request electric cart or carrier-provided wheelchair? yesno
10) Assistance to get to the boarding gate/area? yesno If yes, specify: ____________________________________________________________ Assistance with short distances and stairs? yesno
11) Assistance to board/deboard? yesno If yes, specify: ____________________________________________________________
12) Assistance to store and retrieve carry-on baggage? yesno
13) Is an on-board wheelchair available? yesno
14) Is a tie-down available? yesno
15) Meal-related services provided on-board dietary requirements related to your disability opening packages identifying items cutting large portions
16) Assistance to move to/from the onboard washroom (except by carrying)? yesno
17) Assistance to get to a representative of another carrier in the same terminal? yesno If yes, specify: ____________________________________________________________
18) Assistance to retrieve checked baggage? yesno
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 at your seat Size (height, width, length in a standing position): ____________________________________________________________ Verify space for service animal at your seat
21) Carriage — free of charge — of your mobility aid (not counting towards checked baggage allowance)
22) Carrier to issue a ticket to notify connecting carrier(s) of services to be provided
23) Allergies Type of allergies: ____________________________________________________________ Accommodation required: ____________________________________________________________

^*There may be conditions or restrictions applicable to this service that should be discussed with your service provider.

For more information about the Agency, please contact:

Canadian Transportation Agency
Ottawa, ON K1A 0N9
Telephone: 1-888-222-2592
TTY: 1-800-669-5575
Facsimile: 819-997-6727
E-mail: info@otc-cta.gc.ca
Web site: www.cta.gc.ca

Available in multiple formats.

Last Modified: 2010-01-20

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