1. Use heading styles
Text that is merely bold and larger is just a paragraph to a screen reader. Apply Word's built-in Heading 1, Heading 2 and so on from the Home tab's Styles gallery. Change how they look by modifying the style, not by formatting each heading by hand.
- Use one Heading 1 for the document's main title, or the Title style followed by Heading 1 sections, and nest from there without skipping levels.
- Open View → Navigation Pane. If your outline appears there as you expect, a screen-reader user will see the same outline.
- Numbered headings such as "Appendix A" or "3.2 Scope" still need heading styles. The number alone doesn't make them headings.
2. Add alt text to images
Right-click an image and choose View Alt Text (or Edit Alt Text). Describe what the image conveys in context, or tick Mark as decorative if it carries no information. Review any auto-generated description Word offers; they are often vague or wrong. Charts, SmartArt and shapes need alt text too. See writing alt text.
3. Keep images and objects in line with text
Floating images, text boxes and shapes with "Square" or "In front of text" wrapping are positioned on the page, not in the flow of the document, and they often end up out of order or missing from the tagged PDF. Where you can, set images to In Line with Text (Layout Options) and put sidebar content in the body instead of a text box.
4. Build tables for screen readers
- Use Insert → Table. Never draw tables or line columns up with tabs and spaces.
- Select the first row, open Table Properties → Row, and tick
Repeat as header row at the top of each page. This marks
it as the header row and is what becomes
THcells in the PDF. - Avoid merged and split cells, and empty rows or columns used for spacing.
- Don't use tables for page layout.
- Give each table a caption or a heading just above it that says what it shows.
5. Use real lists
Use the Bullets and Numbering buttons rather than typing hyphens, asterisks or "1." by hand. Built-in lists become list tags in the PDF, so a screen reader can say how many items there are.
6. Write meaningful link text
Instead of pasting a raw URL or writing "click here", put the link on descriptive words, such as "2026 program guidance". Edit an existing link with right-click → Edit Hyperlink and change the "Text to display".
7. Colour, contrast and fonts
- Body text needs at least 4.5:1 contrast with its background, and large text 3:1. Avoid light grey text, and text over images or coloured shading.
- Don't use colour as the only way to convey meaning, such as "required fields are in red" or chart series told apart only by colour.
- Prefer common, readable fonts. Unusual decorative fonts are a frequent cause of PDFs whose text reads aloud as gibberish.
8. Title and language
- Set a descriptive Title in File → Info → Properties. This becomes the PDF's title and is what a screen reader announces when the file opens.
- Check the proofing language under Review → Language, and set passages in another language separately.
9. Run the Accessibility Checker
Review → Check Accessibility opens Word's checker. It reliably finds missing alt text, tables without header rows, and some reading-order and contrast problems. It won't tell you whether your alt text is any good or whether your heading levels match the real outline, so treat a clean result as a floor, not a finish line.
10. Export to PDF the right way
This step undoes all the work above if you get it wrong.
- Use File → Save As (or Export) and choose PDF. Do not use Print → Microsoft Print to PDF; printing discards every tag.
- Click Options and make sure Document structure tags for accessibility is ticked.
- Tick Create bookmarks using: Headings so the PDF gets an outline.
On a Mac, use Save As → PDF and choose "Best for electronic distribution and accessibility". Avoid the print dialog's PDF button for the same reason as on Windows.
Even a careful export usually leaves things to fix: artifacts not marked, table headers without scope, figures without bounding boxes. Check the PDF afterwards with the accessible PDF checklist.