BuildLACCD: Accessibility feedback and assistance
Blank template: complete after the activity or decision

Record ID
Use the ID from your approved tracker.
Response: ____________________

Activity date
Record the date the activity actually happened.
Response: ____________________

Prepared by
Name and role of the person creating this record.
Response: ____________________

Scope and version
Identify the site, page, asset, process or staff group and the version covered.
Response: ____________________

Supporting evidence
Add approved storage links, filenames, dates and versions. Keep personal or sensitive information in the approved system.
Response: ____________________

Received date and channel
Use a case reference instead of personal contact details.
Response: ____________________

Page, file and difficulty
Ask only for the information needed to understand and resolve the barrier.
Response: ____________________

Acknowledgment and assigned owner
Record actual acknowledgment time, owner and agreed next update.
Response: ____________________

Assistance provided
Describe the accessible alternative and whether it enabled the requested task.
Response: ____________________

Linked issue and escalation
Connect the request to technical/content remediation and any escalation.
Response: ____________________

Outcome and closure
Record follow-up, user confirmation if available and any unresolved limitation.
Response: ____________________