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Wheelchair Risk Assessment Form
"I need a Wheelchair Risk Assessment Form for a new rehabilitation facility opening in March 2025, which must comply with both federal ADA requirements and California state regulations, with particular emphasis on bariatric patient accommodations."
1. Patient Information: Basic demographic and medical information about the wheelchair user, including medical history, diagnosis, and current mobility status
2. Environmental Assessment: Evaluation of the spaces where the wheelchair will be used, including home, work, or other frequent locations, with attention to accessibility and potential hazards
3. Physical Assessment: Evaluation of user's physical capabilities and limitations, including posture, balance, strength, and range of motion
4. Equipment Specifications: Details of the wheelchair and any modifications or accessories required to meet the user's needs
5. Risk Identification: Specific risks identified during assessment, including environmental hazards, physical limitations, and equipment-related risks
6. Control Measures: Actions and recommendations to mitigate identified risks, including modifications, training requirements, and safety protocols
1. Caregiver Assessment: Evaluation of caregiver capabilities, training needs, and ability to assist with wheelchair use and transfers
2. Transportation Requirements: Assessment of vehicle transport needs, including securing methods and transfer procedures
3. Specialized Activity Assessment: Evaluation of specific work, educational, or recreational activities that require special consideration
1. Maintenance Schedule: Detailed timeline and checklist for regular wheelchair maintenance and safety checks
2. Training Record: Documentation of completed training for user, caregivers, and staff members
3. Equipment Specifications Sheet: Technical specifications, measurements, and adjustments of the wheelchair and accessories
4. Floor Plan Assessment: Detailed diagrams and measurements of relevant spaces showing accessibility considerations
Authors
Assessor
Risk Assessment
Control Measures
Environmental Hazards
Manual Wheelchair
Powered Wheelchair
Transfer
Mobility Aid
Postural Support
Seating System
Weight Capacity
Turning Radius
Access Route
Safety Features
Authorized Personnel
Maintenance Schedule
Functional Assessment
Caregiver
Training Requirements
Environmental Assessment
Physical Assessment
Risk Identification
Health and Safety
Equipment Specifications
Maintenance Requirements
Training Requirements
Emergency Procedures
Confidentiality
Documentation Requirements
Liability
Review and Reassessment
Incident Reporting
Equipment Modification
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