Mobility Aids Checks
Please check all mobility aids, bed rails and hoists
Room 1
Is room currently occupied?
*
Yes
No
Are there any equipment in the room? e.g. hoist, wheelchair, air mattress or bed frames?
*
Yes
No
Hoist Check
Is there a hoist in place?
*
Yes
No
Is the hoist functioning correctly? going up and down without issue?
*
Yes
No
Wheels present, rotate freely, no flat spots
*
Yes
No
Are the brakes working correctly?
*
Yes
No
Power cable/charger intact
*
Yes
No
Are the correct slings in place?
*
Yes
No
Are there any rips or damage on the slings?
*
Yes
No
Has the hoist been serviced? And do we have more than 30 days before service is required?
*
Yes
No
When did/does the hoist service expire?
*
/
Day
/
Month
Year
Date
Please expand on any actions required?
if you have selected "No" to any item above, please expand
Bed Railings
Are bed railings in place?
*
Yes
No
Are rails securely attached to bed frame, no looseness
*
Yes
No
Locking mechanisms intact and working
*
Yes
No
Rails raise and lower smoothly
*
Yes
No
Mattress fits bed frame snugly (no sliding into gaps
*
Yes
No
Please expand on any actions required?
if you have selected "No" to any item above, please expand
Wheelchair
Is a wheelchair in place?
*
Yes
No
Seat frame stable, no wobbling
*
Yes
No
Armrests secure, padding intact
*
Yes
No
Wheels rotate freely, no wobble
*
Yes
No
Tyres inflated and not worn/cracked
*
Yes
No
Wheel locks engage and hold securely
*
Yes
No
Seat fabric intact, no tears or sagging
*
Yes
No
Please expand on any actions required?
if you have selected "No" to any item above, please expand
Sara Stand
Is a Sara Stand in place?
*
Yes
No
Handgrips secure, not worn or slippery
*
Yes
No
Wheels roll freely and swivel correctly
*
Yes
No
Brakes engage securely
*
Yes
No
Please expand on any actions required?
if you have selected "No" to any item above, please expand
Back
Next
Room 2
Is room currently occupied?
*
Yes
No
Are there any equipment in the room? e.g. hoist, wheelchair, air mattress or bed frames?
*
Yes
No
Hoist Check
Is there a hoist in place?
*
Yes
No
Is the hoist functioning correctly? going up and down without issue?
*
Yes
No
Wheels present, rotate freely, no flat spots
*
Yes
No
Are the brakes working correctly?
*
Yes
No
Power cable/charger intact
*
Yes
No
Are the correct slings in place?
*
Yes
No
Are there any rips or damage on the slings?
*
Yes
No
Has the hoist been serviced? And do we have more than 30 days before service is required?
*
Yes
No
When did/does the hoist service expire?
*
/
Day
/
Month
Year
Date
Please expand on any actions required?
if you have selected "No" to any item above, please expand
Bed Railings
Are bed railings in place?
*
Yes
No
Are rails securely attached to bed frame, no looseness
*
Yes
No
Locking mechanisms intact and working
*
Yes
No
Rails raise and lower smoothly
*
Yes
No
Mattress fits bed frame snugly (no sliding into gaps
*
Yes
No
Please expand on any actions required?
if you have selected "No" to any item above, please expand
Wheelchair
Is a wheelchair in place?
*
Yes
No
Seat frame stable, no wobbling
*
Yes
No
Armrests secure, padding intact
*
Yes
No
Wheels rotate freely, no wobble
*
Yes
No
Tyres inflated and not worn/cracked
*
Yes
No
Wheel locks engage and hold securely
*
Yes
No
Seat fabric intact, no tears or sagging
*
Yes
No
Please expand on any actions required?
if you have selected "No" to any item above, please expand
Sara Stand
Is a Sara Stand in place?
*
Yes
No
Handgrips secure, not worn or slippery
*
Yes
No
Wheels roll freely and swivel correctly
*
Yes
No
Brakes engage securely
*
Yes
No
Please expand on any actions required?
if you have selected "No" to any item above, please expand
Back
Next
Room 3
Is room currently occupied?
*
Yes
No
Are there any equipment in the room? e.g. hoist, wheelchair, air mattress or bed frames?
*
Yes
No
Hoist Check
Is there a hoist in place?
*
Yes
No
Is the hoist functioning correctly? going up and down without issue?
*
Yes
No
Wheels present, rotate freely, no flat spots
*
Yes
No
Are the brakes working correctly?
*
Yes
No
Power cable/charger intact
*
Yes
No
Are the correct slings in place?
*
Yes
No
Are there any rips or damage on the slings?
*
Yes
No
Has the hoist been serviced? And do we have more than 30 days before service is required?
*
Yes
No
When did/does the hoist service expire?
*
/
Day
/
Month
Year
Date
Please expand on any actions required?
if you have selected "No" to any item above, please expand
Bed Railings
Are bed railings in place?
*
Yes
No
Are rails securely attached to bed frame, no looseness
*
Yes
No
Locking mechanisms intact and working
*
Yes
No
Rails raise and lower smoothly
*
Yes
No
Mattress fits bed frame snugly (no sliding into gaps
*
Yes
No
Please expand on any actions required?
if you have selected "No" to any item above, please expand
Wheelchair
Is a wheelchair in place?
*
Yes
No
Seat frame stable, no wobbling
*
Yes
No
Armrests secure, padding intact
*
Yes
No
Wheels rotate freely, no wobble
*
Yes
No
Tyres inflated and not worn/cracked
*
Yes
No
Wheel locks engage and hold securely
*
Yes
No
Seat fabric intact, no tears or sagging
*
Yes
No
Please expand on any actions required?
if you have selected "No" to any item above, please expand
Sara Stand
Is a Sara Stand in place?
*
Yes
No
Handgrips secure, not worn or slippery
*
Yes
No
Wheels roll freely and swivel correctly
*
Yes
No
Brakes engage securely
*
Yes
No
Please expand on any actions required?
if you have selected "No" to any item above, please expand
Back
Next
Room 4
Is room currently occupied?
*
Yes
No
Are there any equipment in the room? e.g. hoist, wheelchair, air mattress or bed frames?
*
Yes
No
Hoist Check
Is there a hoist in place?
*
Yes
No
Is the hoist functioning correctly? going up and down without issue?
*
Yes
No
Wheels present, rotate freely, no flat spots
*
Yes
No
Are the brakes working correctly?
*
Yes
No
Power cable/charger intact
*
Yes
No
Are the correct slings in place?
*
Yes
No
Are there any rips or damage on the slings?
*
Yes
No
Has the hoist been serviced? And do we have more than 30 days before service is required?
*
Yes
No
When did/does the hoist service expire?
*
/
Day
/
Month
Year
Date
Please expand on any actions required?
if you have selected "No" to any item above, please expand
Bed Railings
Are bed railings in place?
*
Yes
No
Are rails securely attached to bed frame, no looseness
*
Yes
No
Locking mechanisms intact and working
*
Yes
No
Rails raise and lower smoothly
*
Yes
No
Mattress fits bed frame snugly (no sliding into gaps
*
Yes
No
Please expand on any actions required?
if you have selected "No" to any item above, please expand
Wheelchair
Is a wheelchair in place?
*
Yes
No
Seat frame stable, no wobbling
*
Yes
No
Armrests secure, padding intact
*
Yes
No
Wheels rotate freely, no wobble
*
Yes
No
Tyres inflated and not worn/cracked
*
Yes
No
Wheel locks engage and hold securely
*
Yes
No
Seat fabric intact, no tears or sagging
*
Yes
No
Please expand on any actions required?
if you have selected "No" to any item above, please expand
Sara Stand
Is a Sara Stand in place?
*
Yes
No
Handgrips secure, not worn or slippery
*
Yes
No
Wheels roll freely and swivel correctly
*
Yes
No
Brakes engage securely
*
Yes
No
Please expand on any actions required?
if you have selected "No" to any item above, please expand
Back
Next
Room 5
Is room currently occupied?
*
Yes
No
Are there any equipment in the room? e.g. hoist, wheelchair, air mattress or bed frames?
*
Yes
No
Hoist Check
Is there a hoist in place?
*
Yes
No
Is the hoist functioning correctly? going up and down without issue?
*
Yes
No
Wheels present, rotate freely, no flat spots
*
Yes
No
Are the brakes working correctly?
*
Yes
No
Power cable/charger intact
*
Yes
No
Are the correct slings in place?
*
Yes
No
Are there any rips or damage on the slings?
*
Yes
No
Has the hoist been serviced? And do we have more than 30 days before service is required?
*
Yes
No
When did/does the hoist service expire?
*
/
Day
/
Month
Year
Date
Please expand on any actions required?
if you have selected "No" to any item above, please expand
Bed Railings
Are bed railings in place?
*
Yes
No
Are rails securely attached to bed frame, no looseness
*
Yes
No
Locking mechanisms intact and working
*
Yes
No
Rails raise and lower smoothly
*
Yes
No
Mattress fits bed frame snugly (no sliding into gaps
*
Yes
No
Please expand on any actions required?
if you have selected "No" to any item above, please expand
Wheelchair
Is a wheelchair in place?
*
Yes
No
Seat frame stable, no wobbling
*
Yes
No
Armrests secure, padding intact
*
Yes
No
Wheels rotate freely, no wobble
*
Yes
No
Tyres inflated and not worn/cracked
*
Yes
No
Wheel locks engage and hold securely
*
Yes
No
Seat fabric intact, no tears or sagging
*
Yes
No
Please expand on any actions required?
if you have selected "No" to any item above, please expand
Sara Stand
Is a Sara Stand in place?
*
Yes
No
Handgrips secure, not worn or slippery
*
Yes
No
Wheels roll freely and swivel correctly
*
Yes
No
Brakes engage securely
*
Yes
No
Please expand on any actions required?
if you have selected "No" to any item above, please expand
Back
Next
Room 6
Is room currently occupied?
*
Yes
No
Are there any equipment in the room? e.g. hoist, wheelchair, air mattress or bed frames?
*
Yes
No
Hoist Check
Is there a hoist in place?
*
Yes
No
Is the hoist functioning correctly? going up and down without issue?
*
Yes
No
Wheels present, rotate freely, no flat spots
*
Yes
No
Are the brakes working correctly?
*
Yes
No
Power cable/charger intact
*
Yes
No
Are the correct slings in place?
*
Yes
No
Are there any rips or damage on the slings?
*
Yes
No
Has the hoist been serviced? And do we have more than 30 days before service is required?
*
Yes
No
When did/does the hoist service expire?
*
/
Day
/
Month
Year
Date
Please expand on any actions required?
if you have selected "No" to any item above, please expand
Bed Railings
Are bed railings in place?
*
Yes
No
Are rails securely attached to bed frame, no looseness
*
Yes
No
Locking mechanisms intact and working
*
Yes
No
Rails raise and lower smoothly
*
Yes
No
Mattress fits bed frame snugly (no sliding into gaps
*
Yes
No
Please expand on any actions required?
if you have selected "No" to any item above, please expand
Wheelchair
Is a wheelchair in place?
*
Yes
No
Seat frame stable, no wobbling
*
Yes
No
Armrests secure, padding intact
*
Yes
No
Wheels rotate freely, no wobble
*
Yes
No
Tyres inflated and not worn/cracked
*
Yes
No
Wheel locks engage and hold securely
*
Yes
No
Seat fabric intact, no tears or sagging
*
Yes
No
Please expand on any actions required?
if you have selected "No" to any item above, please expand
Sara Stand
Is a Sara Stand in place?
*
Yes
No
Handgrips secure, not worn or slippery
*
Yes
No
Wheels roll freely and swivel correctly
*
Yes
No
Brakes engage securely
*
Yes
No
Please expand on any actions required?
if you have selected "No" to any item above, please expand
Back
Next
Name of person completing the form
*
First Name
Last Name
Date
*
/
Day
/
Month
Year
Date
Hour Minutes
Signature
*
Submit
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