Disability The Equality Act 2010 defines a as anyone with a physical or mental ‘disabled person’ impairment which has a substantial and long term adverse effect upon his/her ability to carry out normal day-to-day activities Do you consider yourself to have an impairment?    Yes No Prefer not to say If yes, how would you describe your impairment(s)? Please mark all the boxes that apply to you Blind or Partially Sighted Deaf or Hard or Hearing Physical    impairment (do not use a wheelchair) Physical impairment Physical impairment Learning    (permanent wheelchair (use a wheelchair on disability (e.g. user) occassions) Downs Syndrome, etc) Learning difficulty Mental Health Long-term    Condition illness (e.g. Movement (e.g. Difficulty (e.g. depression, stress, cancer, multiple (Dyspraxia), Dyslexia, etc) etc) sclerosis, HIV+, etc) Other (please specify):   Prefer not to say ………………………………………………………………. Is there anything, as your potential employer, we might need to know or put in place to ensure that you are appropriately supported within the workplace?   Yes No If yes, please give further information:
Disability The Equality Act 2010 defines a ‘disabled person’ as anyone with a physical or mental impairment which has a substantial and long term adverse effect upon his/her ability to carry out normal day-to-day activities Do you consider yourself to have an impairment?  Yes  No  Prefer not to say If yes, how would you describe your impairment(s)? Please mark all the boxes that apply to you  Blind or Partially Sighted  Deaf or Hard or Hearing  Physical impairment (do not use a wheelchair)  Physical impairment (permanent wheelchair user)  Physical impairment (use a wheelchair on occassions)  Learning disability (e.g. Downs Syndrome, etc)  Learning difficulty (e.g. Movement Difficulty (Dyspraxia), Dyslexia, etc)  Mental Health Condition (e.g. depression, stress, etc)  Long-term illness (e.g. cancer, multiple sclerosis, HIV+, etc)  Other (please specify): ……………………………………………………………….  Prefer not to say Is there anything, as your potential employer, we might need to know or put in place to ensure that you are appropriately supported within the workplace?  Yes  No If yes, please give further information:
Equal_Opps_form.docx