SVPHM - Manual Handling (Patient) Competency Assessment - Individual

• This assessment form is to be used to assess manual handling competency of SVPHM employees. Once completed it is to be emailed to: manualhandling@svpm.org.au

• Employee

• Conducted on

  Date

Staff attendance

• Name

• Site

• Fitzroy

• Department

• Competency

• Inserting slide sheets - patient unable to assist

  C

  NC

  NA

• Comments / actions

• Inserting slide sheets - patient able to assist

  C

  NC

  NA

• Comments / actions

• Removing slide sheets

  C

  NC

  NA

• Comments / actions

• MovIng patient up & down bed - patient unable to assist

  C

  NC

  NA

• Comments / actions

• MovIng patient up & down bed - patient able to assist

  C

  NC

  NA

• Comments / actions

• Turning dependent patient - slide sheet method

  C

  NC

  NA

• Comments / actions

• Lateral transfer of patient

  C

  NC

  NA

• Comments / actions

• Sitting a patient forward in bed

  C

  NC

  NA

• Comments / actions

• Assisting a patient out of bed

  C

  NC

  NA

• Comments / actions

• Legs on bed

  C

  NC

  NA

• Comments / actions

• Stedy

  C

  NC

  NA

• Comments / actions

• Hoist - floor or ceiling

  C

  NC

  NA

• Comments / actions

• Sit to stand machine

  C

  NC

  NA

• Comments / actions

• Hovermatt

  C

  NC

  NA

• Comments / actions

• Hover jack

  C

  NC

  NA

• Comments / actions

• Application of TED stockings

  C

  NC

  NA

• Comments / actions

• Supine to prone with Hovermatt

  C

  NC

  NA

• Comments / actions

• East Melbourne

• Department

• Competency

• Inserting slide sheets - patient unable to assist

  C

  NC

  NA

• Comments / actions

• Inserting slide sheets - patient able to assist

  C

  NC

  NA

• Comments / actions

• Removing slide sheets

  C

  NC

  NA

• Comments / actions

• MovIng patient up & down bed - patient unable to assist

  C

  NC

  NA

• Comments / actions

• MovIng patient up & down bed - patient able to assist

  C

  NC

  NA

• Comments / actions

• Turning dependent patient - slide sheet method

  C

  NC

  NA

• Comments / actions

• Lateral transfer of patient

  C

  NC

  NA

• Comments / actions

• Sitting a patient forward in bed

  C

  NC

  NA

• Comments / actions

• Assisting a patient out of bed

  C

  NC

  NA

• Comments / actions

• Legs on bed

  C

  NC

  NA

• Comments / actions

• Stedy

  C

  NC

  NA

• Comments / actions

• Hoist - floor or ceiling

  C

  NC

  NA

• Comments / actions

• Sit to stand machine

  C

  NC

  NA

• Comments / actions

• Hovermatt

  C

  NC

  NA

• Comments / actions

• Hover jack

  C

  NC

  NA

• Comments / actions

• Application of TED stockings

  C

  NC

  NA

• Comments / actions

• Kew

• Department

• Competency

• Inserting slide sheets - patient unable to assist

  C

  NC

  NA

• Comments / actions

• Inserting slide sheets - patient able to assist

  C

  NC

  NA

• Comments / actions

• Removing slide sheets

  C

  NC

  NA

• Comments / actions

• MovIng patient up & down bed - patient unable to assist

  C

  NC

  NA

• Comments / actions

• MovIng patient up & down bed - patient able to assist

  C

  NC

  NA

• Comments / actions

• Turning dependent patient - slide sheet method

  C

  NC

  NA

• Comments / actions

• Lateral transfer of patient

  C

  NC

  NA

• Comments / actions

• Sitting a patient forward in bed

  C

  NC

  NA

• Comments / actions

• Assisting a patient out of bed

  C

  NC

  NA

• Comments / actions

• Legs on bed

  C

  NC

  NA

• Comments / actions

• Stedy

  C

  NC

  NA

• Comments / actions

• Hoist - floor or ceiling

  C

  NC

  NA

• Comments / actions

• Sit to stand machine

  C

  NC

  NA

• Comments / actions

• Hovermatt

  C

  NC

  NA

• Comments / actions

• Hover jack

  C

  NC

  NA

• Comments / actions

• Application of TED stockings

  C

  NC

  NA

• Comments / actions

Comments

• Additional Comments

• Assessors Name & Signature

  Sign