R Healthcare Technical Information Manual - Dash November 2013 Revision B
9
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. By using this Wheelchair Service Guideline in conjunction with the critical
component replacement schedule a sensible service schedule can be achieved.
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
Client Name ..................................................................................................................
Address.........................................................................................................................
.........................................................................................................................................................
Batch Code
Wheelchair Serial Number
Issue Date
Review Date
SCORES BELOW ARE GUIDELINES PATIENT NEEDS TAKE PRECEDENCE OVER THIS.
ASSESSMENT CRITERIA
SCORE
OCCUPANT WEIGHT
V.HEAVY
(OVER 100Kg)
4
HEAVY
(75-100Kg)
3
MEDIUM
(50 - 75Kg)
2
LIGHT
(UNDER 50Kg)
1
OCCUPANT/ USER ACTIVITY
ROUGH
4
AND ENVIRONMENT
MEDIUM
2
LIGHT
1
OCCUPANT LEVEL OF
HIGH
6
WHEELCHAIR DEPENDENCY
MEDIUM
2
LOW
NIL
OCCUPANT / USER
LOW
3
SAFETY AWARENESS
HIGH
1
TOTAL SCORE
GRADING RESULT
RECOMMENDED SERVICE INTERVAL
SCORES
12 TO17
3 MONTHS
SCORES
9 TO 11
6 MONTHS
SCORES
7 TO 8
12 MONTHS
SCORE
5 TO 6
18 MONTHS
SCORE
3 TO 4
24 MONTHS
R HEALTHCARE
A controlled service programme will improve
safety and performance of wheelchairs.
Lack of maintenance may affect warranty.
Signed......................................................
00 08 73 00. MAR 2003. Rev B
Rehabilitation Specialist.