Sensory Scout Business AssessmentPlease enable JavaScript in your browser to complete this form.1Business Details2Business Logistics3Business Structural4Exhibits5Restrooms6Food/Drinks7Sounds & Smells8Sensory Accomodations9Visit Details10Visit Summary11Photos12Pilot Form FeedbackYour NameFirstLastBusiness DetailsBusiness NameBusiness AddressAddress Line 1Address Line 2CitySelect a StateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeBusiness PhoneWebsite / URLDo not include https://Establishment TypeSelect an Establishment TypeCircusEquestrianFitness / Community CenterInteractive EntertainmentLibraryMovie TheaterMuseumParkPlay PlaceRailwayRestarauntRetail CompanySummer CampTheaterTheme ParkZooOtherDefine Other Establishment TypeNextParkingPrivate LotPublic or Shared LotParking GarageStreet ParkingLocationStandalone BuildingIndoor MallOutdoor Mall or Strip PlazaOutdoor LotSelect if business has multipleFloorsExhibits/Rooms/SectionsRestroomsRestrictionsAge LimitationsSize LimitationsNo DrinkNo FoodNo GumNo JeweleryNo ShoesOtherDescribe Other RestrictionsRequirementsSign WaiverStamp on hand/wrist/footWear specified clothingWear a stickerWear a wristbandOtherDescribe Other RequirementsCOVID RequirementsMasks RequiredMasks RecommendedNo Mask Requirements SpecifiedReservations Needed in AdvanceOtherDescribe Other COVID RequirementsFront Entrance Image Click or drag a file to this area to upload. All images need to respect a person’s privacy. Images should not include an individual’s face. All images should be of empty exhibits or be taken from behind patrons.PreviousNextFloor & WallNumber of floorsFloor/Ground types present (select all that apply)CarpetHard Flooring (linoleum, hardwood, tile, etc)Rubberized floorsGlass floorGrass or turfMulchFoam MatsStairsElevatorEscalatorMoving SidewalkRampIs the flooring surface even and consistent?Select a ValueYesNoDescribe where the flooring is not evenAre there any large gaps in the floor or doorways?Select a ValueNoYesDescribe where the large gaps are locatedAre handrails available at all changes in floor surfaces?Select a ValueYesNoWall Coverings presentBrick WallsArtworkGlass walls or large windowsDrywallConcreteFoam MatsCeiling & LightingCeiling types present (select all that apply)SkylightsHigh CeilingsLow CeilingsDrop CeilingsExposed HVACLighting types (select all that apply)General LightingTask LightingAccent LightingGeneral lighting replaces sunlight and is fundamental to a lighting plan.Task lighting should be free of distracting glare/shadows and should be bright enough to prevent eyestrain.Accent lighting focuses on an object or area and requires at least three times as much light on the focal point as the general lighting around it.Variable lighting sourcesMoving, blinking or flashing lightsBlacklight or colored lightsVery bright, harsh lightsSoftened or filtered lightSeatingAvailable Seating OptionsBenchesCouchesChairsStoolsTablesHigh CountersBench MaterialsMetalPlasticMoldedWoodenCushionedChair MaterialsMetalPlasticMoldedWoodenCushionedChair Movement OptionsAttached to tableIndependent from tableNormal HeightHigh Bar heightShorter Kids HeightSpinsRockingStool MaterialsMetalPlasticMoldedWoodenCushionedStool Movement OptionsAttached to tableIndependent from tableNormal HeightHigh Bar heightShorter Kids HeightSpinsRockingGeneral Structural CommentsPreviousNextLayoutApproximate number or exhibits/rooms/sectionsGeneral Exhibit floor plan layoutWide Open SpacingCompartmentalized AreasPercentage of Business that is open space layout<10%10% – 25%25% – 50%50% – 75%75% – 90%>90%Percentage of Business that is compartmentalized layout<10%10% – 25%25% – 50%50% – 75%75% – 90%>90%Entrance/Exit paths for exhibitsA single pathway into/out of exhibitsMultiple pathways into/out of exhibitsActivitiesLearning Types UsedReadingListeningWatchingHands On PlayHands On CreatingFull Body MovementSelect all that are presentBright art workCrowds of PeopleDisplaysFlashing LightsLoose Toys or BooksMoving ExhibitsPeople Moving (ie-running & jumping)Playground EquipmentSensory Table or Wall PanelsTelevisions or ScreensVideo GamesPlayground Equipment expandedBall/Foam PitBalls or Sporting EquipmentCrawl Tunnels or CubesJungle gym or climbing structureLadder, rope ladder or climbing netMerry-go-roundMonkey barsPlayhouse or enclosed structureSlideSuspension BridgeSwingsTrampolineZiplineDo any of the hands on activities includeWaterSandBeadsFoamPaintPlaydoughOtherDefine Other materials presents on hands in activity areaNearby options available for clean upBathroomSinkPaper TowelsSanitizerOtherDefine Other Clean Up OptionPreviousNextRestroom AccessibilityMore than 1 restroom availableMultiple Stalls in each restroomFamily or Unisex bathroom availableRestroom AmenitiesAutomatic Hand DryersChild’s height toiletHooks to hang jacket/bagAutomatic ToiletsChild’s height sinkDiaper changing stationPaper TowelsStool to reach SinkSharps containerWater fountainRestroom ConditionsHas an OdorSound level different than main areaTemperature different than main areaLighting different than main areaBathroom OdorAir freshnerCleaning productsFood or cooking smellsMusty or moldy odorRubber, plastic or vinyl smellSweaty or ‘gym’ odorUrine/Feces smellOtherDescribe Other Bathroom OdorSound Level DetailsSelect a ValueLouderQuieterTemperature DetailsSelect a ValueWarmerCoolerLighting DetailsSelect a ValueBrighterDimmerLighting Measurement (in Lux)Any comments about the restroomPreviousNextIs food or drinks allowed on premise?Select a ValueYes – EverywhereYes – In designated areas onlyNoArea where food can be consumedNoticable odors in the food areaFood or cooking smellsCleaning products or air freshnersOtherDefine Other OdorIs food or drink available for purchase onsite?Select a ValueYesNoSelect all that are available:Prepackaged SnacksCold BeveragesFresh SnacksHot BeveragesMeal OptionsWater FountainsDiary, Nut or Gluten AlternativesPreviousNextSoundsSounds heard (select all that apply)Music, radio or televisionMachine or equipment noisesEchoes from other areasPA announcementsExternal noises (ie – traffic)High Pitched soundsPeople or CrowdsOtherDescribe Other Sound heardNoise FrequencyConsistent (ie – background music)Repetitive (ie – HVAC system kicks on)Random (ie – announcements)Average Decible ReadingDownload the free decible reader app ‘Decibel X’ on your smart phone to record sound levels.Minimum Decible ReadingDownload the free decible reader app ‘Decibel X’ on your smart phone to record sound levels.Maximum Decible ReadingDownload the free decible reader app ‘Decibel X’ on your smart phone to record sound levels.Smells/OdorDo any of the areas have a noticable odor?Select a ValueNoYesOdorAir freshnerCleaning productsFood or cooking smellsMusty or moldy odorRubber, plastic or vinyl smellSweaty or ‘gym’ odorOtherDescribe the location of the odorDescribe the 'other' odorWhat is the intensity of the odor Selected Value: 11= no odor detected 5= intense, overwhelming odorPreviousNextAccommodationsSensory Accomodations Available From BusinessHeadsetsFidgetsCalm SpaceSocial StoriesSensory MapSensory AppReduced LightingReduced SoundsReduced CapacityOtherLocation to Obtain Sensory Accomodation MaterialsSelect LocationFront DeskAt the ExhibitRequest from ManagerSensory App Name & LocationLocation of Calm SpaceDescribe the Calm SpaceIf no calm space is available, what is the best alternate location that could be used?Describe what other accomodations are availableProgrammingDoes this business offerSensory Friendly HoursAdaptive ProgrammingLocation for additional details on Sensory-Friendly hoursIf no public posting, please include details below for Sensory-Friendly hoursLocation for additional details on Adaptive ProgrammingIf no public posting, please include details below for Adaptive ProgrammingPreviousNextDate / Time of Your VisitDateTimeNumber of hours present at business during visitYour visit was representative of Select a ValueAverage VisitSlow VisitBusy VisitBusiness Specified Peak TimesBusiness Specified Slow TimesName of staff spoke withManager's NameManager's EmailPreviousNextWhy did you leave and how did you feel when you left?What did this business do well?What could this place do better?How would you describe this place to another parent?PreviousNextImage #1 Click or drag a file to this area to upload. All images need to respect a person’s privacy. Images should not include an individual’s face. All images should be of empty exhibits or be taken from behind patrons.Image #2 Click or drag a file to this area to upload. All images need to respect a person’s privacy. Images should not include an individual’s face. All images should be of empty exhibits or be taken from behind patrons.Image #3 Click or drag a file to this area to upload. All images need to respect a person’s privacy. Images should not include an individual’s face. All images should be of empty exhibits or be taken from behind patrons.Image #4 Click or drag a file to this area to upload. All images need to respect a person’s privacy. Images should not include an individual’s face. All images should be of empty exhibits or be taken from behind patrons.Image #5 Click or drag a file to this area to upload. All images need to respect a person’s privacy. Images should not include an individual’s face. All images should be of empty exhibits or be taken from behind patrons.Image #6 Click or drag a file to this area to upload. All images need to respect a person’s privacy. Images should not include an individual’s face. All images should be of empty exhibits or be taken from behind patrons.Image #7 Click or drag a file to this area to upload. All images need to respect a person’s privacy. Images should not include an individual’s face. All images should be of empty exhibits or be taken from behind patrons.Image #8 Click or drag a file to this area to upload. All images need to respect a person’s privacy. Images should not include an individual’s face. All images should be of empty exhibits or be taken from behind patrons.Image #9 Click or drag a file to this area to upload. All images need to respect a person’s privacy. Images should not include an individual’s face. All images should be of empty exhibits or be taken from behind patrons.Image #10 Click or drag a file to this area to upload. All images need to respect a person’s privacy. Images should not include an individual’s face. All images should be of empty exhibits or be taken from behind patrons.PreviousNextForm LengthSelect a ValueJust RightToo LongToo ShortWere the appropriate data points on the form?Select a ValueYesNoWhat data points were missing?Is the form organization relevent?Select a ValueYesNoHow could the form organization be better? General Form & Process FeedbackPreviousSubmit
