49 / 80
SKILL 2 – CLOSING AND OPENING THE WHEELCHAIR
SKILL 3 – DEMONSTRATING WHEELCHAIR PROFICIENCY
SKILL 4 – PLACING A SEATBELT ON WHEELCHAIR
SKILL 5 – SECURING THE WHEELCHAIR AND PATIENT
Skills Sheet – Closing and Opening the Wheelchair
Completes Successfully?
Step
Yes
No
1. Positions him/herself at the side of chair
2. Lifts up on the seat of the chair to close the frame
3. Places hands on metal bars on each side of seat
4. Pushes down on each side evenly so as to open the frame of the chair
5. Continues until the crossbar is fully open and the chair is completely
deployed
Instructor Signature: _________________________________________ Date: _____________
Skills Sheet – Securing the Wheelchair and Patient
Completes Successfully?
Step
Yes
No
1. Removes and replaces both arms rests
2. Removes and replaces both leg rests and extenders
3. Locks and unlocks both brakes
4. Verbalizes 2 other inspection items on the wheelchair
Instructor Signature: _________________________________________ Date: _____________
Skills Sheet – Securing the Wheelchair and Patient
Completes Successfully?
Step
Yes
No
1. Opens wheelchair fully, applies brakes
2. Wraps seatbelt around rear vertical posts of chair
3. Threads seatbelt through arms of wheelchair and buckles seatbelt
snugly over pateint’s lap
Instructor Signature: _________________________________________ Date: _____________
Skills Sheet – Securing the Wheelchair and Patient
Completes Successfully?
Step
Yes
No
1. Informs the patient of the procedure
2. Positions the wheelchair for tie down
3. Secures two straps to the front frame of wheelchair at no more than 45
degree angles
4. Secures two straps to the rear frame of wheelchair at not more than 45
degree angles.
5. Secures patient to chair using ADA 3-point restraint or equivalent.
6. Alternates straps so that ratchet, pull-through, and folding tie downs are
all utilized
Instructor Signature: _________________________________________ Date: _____________