Risk Assessment Checklist for Wheelchair Transportation in Vehicles

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Cordelia French
6 years ago
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1 Person s Name: Date of Birth: Address: Diagnosis: Sex: M/F/O It is recommended this be read in conjunc on with and in reference to the following documents: Australian/New Zealand Standard, Wheelchairs Part 19: Wheeled mobility devices for use as seats in motor vehicles (AS/NZS :2009) Australian/New Zealand Standard, Technical systems and aids for disabled or handicapped persons - Wheelchair edown and occupant-restraint systems, Part 1: Requirements and test methods for all systems (AS/NZS :2015) Interna onal Best Prac ce Guidelines, 4th Interna onal Interdisciplinary Conference on Posture and Wheeled Mobility, 2013 Decision Making Tree, Western Australian Travel-Safe Interagency Group, Transporta on is only one of many daily ac vi es that introduce unique circumstances and requirements that wheelchairs and wheelchair occupants may experience. Wheelchair products that comply with this part of ISO 7176 will have addi onal features that provide increased levels of occupant security and safety whilst their occupants are riding in motor vehicles. However, a wheelchair's failure to comply with this part of ISO 7176 cannot be used to limit access to, and availability of, motor vehicle transporta on of wheelchair users." (ISO :2008/ANZS :2009) In the first instance when travelling in a motor vehicle, it is considered safest for wheelchair occupants to transfer out of their wheelchair to a vehicle seat and to use the vehicle seatbelt system or child safety seat that complies with local legisla on. Is this a suitable op on? (If no con nue to complete form) Wheelchair Suitability To be considered when transfer to a seat in a motor vehicle is not possible. Please circle and indicate appropriate response below: Wheelchair: Model/Type: PWC / MWC / MWC with power assist What is the weight of the occupied wheelchair? kg + kg = kg (weight of wheelchair, plus components essen al (weight of person) (total occupied weight) for life and any body support system*) * If unsure of weight of body support system, add 15kg for standard or 20kg for complex. Please circle and indicate appropriate response below. All "" responses below indicate a transport risk. Person/NOK need to be advised. Risks need to be addressed where prac cable and documented in notes. Does the person s body weight fall with the SWL of wheelchair? Has the wheelchair passed crash tes ng to AS/NZ ? Does the wheelchair have transport lugs? OR Are there designated points on the frame for e downs? Refer to manufacturer s manual/website for specifica ons. If refer to manufacturer s manual/website for recommended edown points. tes Reviewed 11/2016 Page 1 of 6

If this wheelchair has been involved in a motor vehicle accident has it been checked by a qualified technician or engineer for frame integrity? Is the upholstery in good condi on/undamaged?

2 Please circle and indicate appropriate response below. te: Any "" responses indicate a transport risk and do not meet standards. Wheelchair Frame/Accessories Is the frame free of visible damage or rust? If this wheelchair has been involved in a motor vehicle accident has it been checked by a qualified technician or engineer for frame integrity? Is the upholstery in good condi on/undamaged? Are the tyres inflated correctly? Do the brakes engage and prevent the wheelchair from rolling? Is there a head support in place? Is the backrest at or above persons shoulder height? Can wheelchair accessories that are non essen al for life be removed from wheelchair? Can wheelchair accessories that are non essen al for life be stored safely during transport? Has the body support system been manufactured by a TGA registered agency? tes Is the body support system secured to the wheelchair frame as per manufacturer s instruc ons? In the regular posi on, is the backrest within 30 of the ver cal as per diagrams A and B below? te: If, document reason why as it is recognised that there maybe instances where this is NOT prac cal. Vehicle Considera ons Will the person be in a forward facing posi on in the modified motor vehicle? tes Vehicle Name/Type: What is the safe work load (SWL) of the exis ng or proposed loader (hoist/li /ramp) on the vehicle: kg Does occupied wheelchair weight fit within this SWL? Reviewed 11/2016 Refer to manufacturer s manual/website for specifica- ons. Page 2 of 6

3 Wheelchair Tiedown System Please circle and indicate appropriate response below. te: Any "" responses indicate a transport risk and do not meet standards. Is the e down system in the vehicle clearly labelled with the manufacturer's name, month and year of manufacture and does the label state conformance to Australian Standard AS/NZS :2009 (Specify type of system and details in notes). Is the combined weight of the wheelchair and body support system within the SWL of the wheelchair edown system? Are the wheelchair edown straps free from damage including nicks, tear, fraying,breaks etc. Refer to manufacturers manual/website for SWL. The wheelchair edown system should also comply with the following: te: If edown systems and tracking do not allow these angles to be achieved please indicate in notes what angles can be achieved as close as possible to the standard. Rear edowns should a ach to the floor at an angle of 30 0 to 45 0 (rela ve to horizontal) tes tes Front edowns should a ach to the floor at an angle of 40 0 to 60 0 (rela ve to horizontal) E.g.: if no what is the closest angle that can be achieved? Reviewed 11/2016 Page 3 of 6

Wheelchair Occupant Restraint Systems Please circle and indicate appropriate response below.

Please circle relevant occupant restraint op on and state reasons for choice.

Lap Sash Seatbelt 2 Point Sta c Harness Lapbelt only Occupant Restraint System Wheelchair Restraint System Reason/s: The wheelchair

1:2015 as per diagram: Rear clearance zone 450mm (or items in this zone covered with padding that conforms with the impact

4 Wheelchair Occupant Restraint Systems Please circle and indicate appropriate response below. te: Any "" responses indicate a transport risk and do not meet standards. Please circle relevant occupant restraint op on and state reasons for choice. te lap belt is not recommended in the current standard AS/NZS :2009 but may be only suitable op on. Lap Sash Seatbelt 2 Point Sta c Harness Lapbelt only Occupant Restraint System Wheelchair Restraint System Reason/s: The wheelchair restraints system should comply with the clear space requirements, stated in the relevant sec on/s of AS/NZS :2015 as per diagram: Rear clearance zone 450mm (or items in this zone covered with padding that conforms with the impact performance requirements). Minimum above head clearance zone 100mm. Front clear zone is 650mm with upper torso restraint and 950 mm with only pelvic restraint. 220mm clearance zone on either side from midline of head. Can this be achieved? N/A Above head clearance zone 100mm If no, please explain: Reviewed 11/2016 Page 4 of 6

5 Wheelchair Occupant Restraint Systems (con nued) Please circle and indicate appropriate response below. te: Any "" responses indicate a transport risk and do not meet standards. As per diagrams below from standard AS/NZS :2015, when a person is secured in the wheelchair as a seat in a vehicle the occupant restraint should: Fit low over the hips, touch the top of the thighs and ideally be angled at to the horizontal when viewed from the side. As per standards The angle of the pelvic belt should be within the preferred zone of to the horizontal, or the op onal zone of to the horizontal, as shown below For lapsash: First cross the collarbone, the chest and then connect to the lapbelt near the opposite hip The upper anchor point should a ach to a structural point on the sidewall of the vehicle and behind the occupants shoulder NB To ensure effec ve fit feed the lap belt between the arm support and wheelchair occupant (not over or around the armrests). Any postural supports a ached to the wheelchair are not considered a vehicle restraint but can be le in place to provide postural support to the occupant. te: If postural support/sea ng system is used with a wheelchair there may be componentry that interferes with this line of pull. Please remediate as prac cable and document reasons below: Reviewed 11/2016 Page 5 of 6

6 Assessor Recommenda ons: Assessor Name: Profession: Organisa on: Person/NOK Declara on (Please circle appropriate response) I (person / NOK ) have been informed of the details contained and risks iden fied in this assessment. I (person / NOK ) have been advised of my op ons/recommenda ons and have selected the following: 1. I choose not to travel in the wheelchair, as advised in this assessment. 2. I choose to a end an appointment at a sea ng agency to undergo assessment for a transport approved wheelchair, as advised in this assessment. 3. I choose to use an alterna ve wheelchair deemed suitable for use as a seat in a vehicle, as advised in this assessment. 4. I choose to travel in my exis ng wheelchair with the acknowledgement of the above informa on and risks as a result of this assessment. 5. Other: Person Name: Signature: Date: If applicable NOK Name : Signature: Date: Reviewed 11/2016 Page 6 of 6

MODEL CS-41. instructions IMPORTANT: KEEP THIS INSTRUCTION BOOKLET IN THE PLACE PROVIDED ON THE CHILD RESTRAINT

MODEL CS-41. instructions IMPORTANT: KEEP THIS INSTRUCTION BOOKLET IN THE PLACE PROVIDED ON THE CHILD RESTRAINT MODEL CS-41 instructions IMPORTANT: KEEP THIS INSTRUCTION BOOKLET IN THE PLACE PROVIDED ON THE CHILD RESTRAINT Smart Design Please keep this Instruction Booklet in the storage area under the seat for future