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  • Wheelchair Home Risk Assessment Form

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Convacare Manual Wheelchair Home Assessment Patient Name: Date of Assessment: Patient Address: Describe outside Accessibility (i.e. paved, gravel, dirt): Describe Patients Residential Environment.

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3. Risk assessment template and examples who might be harmed and how. what you're already doing to control the risks. what further action you need to take to control the risks. who needs to carry out the action. when the action is needed by.

Typically the clinician is an Occupational Therapist (OT) or Physical Therapist (PT), so the prescription from your doctor will read, "OT or PT Wheelchair Evaluation." Getting a prescription from your doctor is essential, because it allows a therapist (OT or PT) to conduct an evaluation.

Tipping and falling are the most common accidents of wheelchair users. For example, you can fall from making your wheelchair go to fast, unlocked brakes, slippery surfaces, the sitting stability of the user and hitting a large bump with one wheel causing the wheelchair to become unbalanced.

Spinal Cord Injuries. Cerebral Palsy. Muscular Dystrophy. CVA (AKA stroke-related paralysis)

What happens at the assessment? The clinician will introduce themselves and explain what will happen. They will need to ask you many questions and take your measurements. They may need to assess your range of movements and physical constraints, and may ask you to demonstrate your abilities.

However, there are five steps that can guide you while carrying out home assessment. Step 1: Identify Hazards At Home. ... Step 2: Determine Who May Be Harmed By The Hazard And How. ... Step 3: Introduce Safety Measures. ... Step 4: Have A Record On Your Findings. ... Step 5: Review Home Assessment And Makes Changes Where Necessary.

BASIC WHEELCHAIR CHECKS AND MAINTENANCE Rough, loose or slippery ground, and other unsuitable surfaces. Imbalanced sitting positions. Overreaching for items. Incorrect or ignored use of parking brakes, tipping levers and balance casters.

What happens after I've been assessed? If, after your assessment, it has been determined that you need a wheelchair, we will supply and set up the mobility equipment, including any cushions or accessories that you may require.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
Content Takedown Policy
Bug Bounty Program
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
+1 833 426 79 33
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232