Table of Contents
Advertisement
Service checks
Manual wheelchairs will require periodic service checks, at least every twelve months, or more
frequently when the usage criteria is more complex.
Service review periods should be determined by the Clinical Assessment and Technical Service
Team, as proposed for example, by using the recommended scoring procedures, or a similar
objective method.
component replacement schedule a sensible service schedule can be achieved.
Client Name ..................................................................................................................
Address.........................................................................................................................
.........................................................................................................................................................
Batch Code
Wheelchair Serial Number
SCORES BELOW ARE GUIDELINES PATIENT NEEDS TAKE PRECEDENCE OVER THIS.
OCCUPANT WEIGHT
OCCUPANT/ USER ACTIVITY
AND ENVIRONMENT
OCCUPANT LEVEL OF
WHEELCHAIR DEPENDENCY
OCCUPANT / USER
SAFETY AWARENESS
GRADING RESULT
SCORES
SCORES
SCORES
SCORE
SCORE
R HEALTHCARE
00 08 73 00. MAR 2003. Rev B
R Healthcare Technical Information Manual - Dash
By using this Wheelchair Service Guideline in conjunction with the critical
WHEELCHAIR SERVICE GUIDELINES
Service Ref No.
This assessment to be completed by Rehabilitation Specialist prior
to issue of wheelchair to end user.
This form to be retained at distribution point for service reference.
A review of this information is recommended at least every two years
Issue Date
ASSESSMENT CRITERIA
V.HEAVY
(OVER 100Kg)
HEAVY
MEDIUM
LIGHT
(UNDER 50Kg)
ROUGH
MEDIUM
LIGHT
HIGH
MEDIUM
LOW
LOW
HIGH
TOTAL SCORE
RECOMMENDED SERVICE INTERVAL
12 TO17
3 MONTHS
9 TO 11
6 MONTHS
7 TO 8
12 MONTHS
5 TO 6
18 MONTHS
3 TO 4
24 MONTHS
A controlled service programme will improve
safety and performance of wheelchairs.
Lack of maintenance may affect warranty.
Signed......................................................
Rehabilitation Specialist.
Review Date
SCORE
4
(75-100Kg)
3
(50 - 75Kg)
2
1
4
2
1
6
2
NIL
3
1
9
November 2013 Revision B
Advertisement
Table of Contents
