Information

  • ASSESSMENT CONDUCTED BY

  • CONDUCTED ON

  • TYPE OF CALL

  • CITY

  • LOCATION OF CALL (Kitchen eg)

  • STATION

  • Document No.

PLEASE OBSERVE THE WORK ACTIVITIES AND USE THE CHECKLIST BELOW TO DETERMINE/ASSESS IF MEASURES OF CONTROL WERE TAKEN TO ENSURE THE ACTIVITY WAS CONDUCTED SAFELY.

PRIOR TO THE CALL

  • Was the call at the beginning, middle or end of the shift?

  • Footwear in good condition and safely tied?

ON THE WAY TO THE CALL (if observed)

  • Gathered information from dispatch and started their risk assessment?

AT THE SCENE

  • Positioned the ambulance to ensure their safe exit and egress?

  • Positioned Ambulance to ensure safe unload and load of equipment?

  • Assessment of patient

PREPARING FOR THE LIFT OR TRANSFER

  • Selected the appropriate equipment taking into consideration the work environment and weight/height of the patient.

  • Called for additional help, when dictated by weight/height of patient and circumstances that increase risk.

  • Early recognition of need for additional help.

  • Call for additional help did not affect patient outcome

  • Checked for and removed any hazards on patient or self.

  • Discussed and agreed on a plan with persons involved in lift or transfer.

PREPARING FOR THE LIFT OR TRANSFER

  • Communicated plan to patient (if conscious)

  • Established feedback mechanism with patient.

  • Positioned equipment properly (if needed)

  • Positioned body properly

  • Established firm footing.

  • Positioned feet shoulder width apart.

  • Established firm power grip on equipment or patient

  • Communicated sequence of lift with partner and other agency personnel.

POSITIONING PATIENT ON EQUIPMENT OR MOVING WITH PATIENT

  • Turned body with feet and avoided unnecessary twisting when positioning the patient on the equipment.

  • Properly secured patient to equipment.

LIFTING OR TRANSFERRING USING WHICH FERNO PRODUCT?

  • Which lifting device was used?

  • Bent knees?

  • Used a pelvic tilt?

  • Lifted with legs?

  • Exhaled when lifting/pulling?

  • Kept load close to body?

  • Maintained balance?

  • Maintained contact and communication with partner(s)?

  • Maintained control of the lift/transfer throughout?

  • Lift/transfer was gradual, smooth motion with no jerking?

  • Lift/transfer plan was implemented as planned?

  • Clear route of access/egress?

LIFTING OR TRANSFERRING USING OTHER THAN PREVIOUS PRODUCT

  • Was there a second piece of equipment used to lift or transfer?

  • Which lifting device was used?

  • Bent knees?

  • Used a pelvic tilt?

  • Lifted with legs?

  • Exhaled when lifting/pulling?

  • Kept load close to body?

  • Maintained balance?

  • Maintained contact and communication with partner(s)?

  • Maintained control of the lift/transfer throughout?

  • Lift/transfer was gradual, smooth motion with no jerking?

  • Lift/transfer plan was implemented as planned?

  • Clear route of access/egress?

TRANSFERRING PATIENT TO AMBULANCE

  • Patient not wheeled with stretcher in top two positions

  • Lift/transfer plan was implemented as planned?

  • Patient always attended while on equipment

  • Stretcher pushed not pulled

  • Ensuring that all belts are securely fastened

PREPARING TO LOAD PATIENT INTO AMBULANCE

  • Ensured no tripping hazards.

  • Discussed and agreed on a plan with persons involved in lift or transfer.

  • Communicated plan to patient (if conscious).

  • Established communication mechanism with patient.

  • Correctly positioned the equipment the patient was on (if needed).

  • Positioned personnel properly.

  • Established firm footing.

  • Positioned feet shoulder-width apart.

  • Established firm power grip on equipment.

  • Maintained control of the "Gatch" throughout the lift.

  • Ensure safety hook engaged.

UNLOADING PATIENT FROM AMBULANCE

  • Ensure sufficient space to unload patient safely.

  • Bent knees when lifting/lowering.

  • Used a pelvic tilt.

  • Kept back straight.

  • Lowered/lifted with legs.

  • Exhaled when lifting/pulling.

  • Kept load close to body.

  • Maintained balance.

  • Maintained contact and communication with partner(s)?

  • Maintained control of the "Gatch" throughout the lift.

  • Used all available assists on the equipment and in the ambulance.

  • Lift/transfer was gradual, smooth motion with no jerking?

  • Turned body with feet and avoided unnecessary twisting when positioning the patient on the equipment.

  • Lift/transfer plan was implemented as planned?

AT HOSPITAL/TRIAGE

  • Stretcher correct height

  • All restraints secure

  • Patient advised not to move

  • Patient was not left unattended

TRANSFERRING FROM STRETCHER TO HOSPITAL BED

  • Communicated sequence of transfer with patient, partner and other agency personnel

  • Stretcher correct height

  • Slider board used

  • Correct lifting techniques

  • Sufficient personnel

  • Communication with all personnel involved

DEBRIEF WITH CREW

  • Input from crew

  • Feedback to crew

  • Evaluation form to crew

ADDITIONAL COMMENTS OF INSPECTOR(S):

  • Any other comments, especially related to any increased risk of MSI, when conducting the lift or transfer?

  • OBSERVED BY DOSH MEMBER (Print & sign first/last name)

  • Select date

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