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1
CATEGORY FOR CONSULTATION/TRAININGDISCUSSION/DEMODATEPERSONNEL TRAINED
INITIALS
DATE
2
3
DISABILTY/MEDICAL CONCERN/ALLERGIES
4
5
BACK UP STAFF DESIGNATED
6
7
BACK INJURY PREVENTION TRAINING
8
9
TRANSFER TRAINING
10
 -PROPER LIFTING TECHNIQUES
11
 -WHEELCHAIR ↔ CHANGING TABLE
12
 -WHEELCHAIR ↔ POTTY CHAIR
13
 -WHEELCHAIR ↔FLOOR
14
 -SLIDING BOARD
15
 -ONE PERSON LIFT
16
 -TWO PERSON LIFT
17
 -STAND PIVOT TRANSFER
18
19
EQUIPMENT SAFETY CHECK
20
 -WHEELCHAIR
21
 PELVIC POSITIONING STRAPS
22
 LATERAL TRUNK SUPPORTS
23
 CHEST & SHOULDER STRAPS
24
 WHEEL LOCKS
25
 FOOT RESTS
26
 HEAD REST
27
 ANTI TIPPERS
28
 JOY STICK/HEAD ARRAY
29
 DISENGAGING MOTOR
30
 -AFO'S-APPLICATION AND REMOVAL
31
 -STANDER
32
 -ADAPTIVE SEATING DEVICE(S)
33
 -ASSISTIVE WALKING DEVICE
34
 -POTTY CHAIR
35
 -HOYER/BARRIER FREE LIFT & SLING
36
 -DESK
37
CATEGORY FOR CONSULTATION/TRAININGDISCUSSION/DEMODATEPERSONNEL TRAINED
INITIALS
DATE
38
39
MOBILITY
40
 -CLASSROOM
41
 -DOORS
42
 -HALLWAYS
43
 -LEVEL SURFACES
44
 -OUTDOORS (UNEVEN SURFACES)
45
 -STAIRS
46
 -RAMPS
47
 -FIRE DRILLS/EVACUATIONS
48
49
DOC FOR USE OF PROTECTIVE DEVICE
50
51
MECHANICAL RESTRAINT AWARENESS
52
53
COMPLIANCE METHOD FOR POSITIONING PROGRAM
54
55
GUARDING METHOD FOR AMBULATION
56
57
PLAYGROUND ACCESS
58
59
TRANSPORTATION
60
 -ASSISTIVE DEVICE MANAGEMENT
61
 -LOADING/UNLOADING-LIFT/STEPS
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98
99
100