Client Transport Vehicle Specific OHS Needs Assessment

Client Transport Vehicle Specific OHS Needs Assessment

How to Use this Form:

This form has been designed to be used when a client transport vehicle is to be replaced or a new vehicle is required. It covers only specific OHS requirements and does not address all OHS vehicle requirements such as star rating of the vehicle, ABS etc
This form could be completed at a team meeting to ensure all staff are involved.
Referral/ involvement of relevant staff, such as occupational therapist etc should occur during the completion of this form as required.
Client Reports can be attached to this form; including client’s mobility plans, client transport plan, and client manual handling plan. Photos of the environment, current vehicle etc can also be attached.
The form can be used when purchasing from dealer or with vehicle modifier.

Site Location
Manager: / Name:
Endorsement Signature: / Contact Number:
Date:
1. Current Vehicle – If your location has a current vehicle please complete this section. If not please go to Section 2.
Model/Make:
Registration Number:
Current Odometer reading, Modifications:
Are there any concerns with the current vehicle?
If there are not any concerns with your current vehicle , tick this box:  / Access for driver:  Details ______Size of vehicle:  Details ______
Access for clients:  Details ______Ease of driving/parking: Details ______
Access for staff to attend clients:  Details ______Loading/Unloading Equipment  Details ______
Ease of attaching wheelchair restraints:  Details ______
Maintenance / Servicing Details ______Other:  Details ______
Physical aspects of the current vehicle that meet your need. / Access for driver:  Details ______Size of vehicle:  Details ______
Access for clients: Details ______Ease of driving/parking Details ______
Access for staff to attend clients:  Details ______Current modifications:  Details ______
Maintenance / Servicing  Details ______Other: eg: Tinting/  Details ______
Air conditioning
2. Proposed Vehicle Use – Provide information on what, how and where the vehicle is to be used.
What purpose/s will the vehicle be used for? Tick where applicable. / Transport Clients to day programs:  Details ______
Clients day outings:  Details ______
Single Client appointments:  Details ______
Other eg: shopping  Details ______
Is the vehicle used for:

Short distance driving (less 50km)

/ If yes how often:
How many trips a day would be completed?
In one trip how many times does the driver get in/out of the vehicle? / Frequently
(Min 5 days a week) / Often
(2-3 times a week) / Occasionally
(1 time or less a week)

Long distance driving

/ If yes how often: / Frequently
(Min 5 days a week) / Often
(2-3 times a week) / Occasionally
(1 time or less a week)
Is the vehicle to be used in an urban or rural location or both?
3. Clients Requirements –If required consider client’s functional requirements and needs. Including client mobility/manual handling plans and client transport plans (as required).
How many clients of the unit use this vehicle?
Are the client’s who use the vehicle children or adults?
What is the maximum number of clients and staff (to support the clients) transported at one time? / Client number ______Staff number ______Total Number ______
How often is the maximum number of clients/staff transported? / Frequently
(Min 5 days a week) / Often
(2-3 times a week) / Occasionally
(1 time or less a week)
Combined weight/ load of clients and staff to ensure within vehicle recommend load limits.
Name of Client: / Client 1 / Client 2 / Client 3 / Client 4 / Client 5 / Provide details as required
Tick box if relevant to the client
Does the client use a wheelchair (including to access the van and/or to travel in).
Does the client use the wheelchair only to get to/from the vehicle?
Is the wheelchair required to be folded and stored in the vehicle?
If the client uses a wheelchair do they transfer into a car seat?

Independently

With verbal prompting only

With physical assistance

How many of the wheelchair clients are transported while seated in their wheelchair?
Does the client (other than those who use a wheelchair) require assistance for enter/exiting the bus or sit to stand transfer?

Independently

With verbal prompting only

With physical assistance

Does the client have any special requirements due to their physical characteristics eg: height, size, condition etc such as head rests. / Type of equipment:
Size/Weight:
Clearance required:
Features:
Special Considerations:
Does the client have aids etc that need to be stored in the vehicle? If yes provide detail including name of equipment, dimensions and any special considerations. / Type of equipment:
Size/Weight:
Features:
Special Considerations:
Does the client have special physical medical needs while being transported? For example epilepsy, requiring Oxygen. Provide details.
Does the vehicle require any modifications to assist the client using the vehicle? (i.e. rails, step heights) Provide Details, Develop seating plan / Rails:
Additional Steps:  Details ______
Number of journeys planned each week by client.
Does the client have behaviours while being transported (i.e. do they interfere or can distract the driver) Develop transport plan. / Single Seat Details ______
Harness:  Details ______
Seat belt cover:  Details ______
Crutch Strap:  Details ______
Other:  Details ______
Are there any restricted practise protocols? (i.e. restraints, seat belt locks) Attach transport plan.
4. Vehicle Requirements/Modifications
Are there any other non client specific vehicle modifications required? / Additional handrails for the driver seat:  Details ______
Window Tinting:  Details ______
Additional Reversing mirrors:  Details ______
Dual Air conditioning:  Details ______
Reversing Camera or sensor:  Details ______
Other:  Details ______
Are the internal vehicle fittings such as seats/flooring etc required to be easy to clean?
For example vinyl seats, not carpeted flooring.
5. Environment
Describe access and parking for the vehicle at the site. (Include access for client/staff entering/exiting the vehicle, how the driveway is accessed, presence of carport/garage) / Include photos
Describe access and parking for the vehicle at common day trip destinations:
Terrain/driving conditions the vehicle is to be driven /

Heat Details ______
Rural roads: Details ______
Heavy traffic:  Details ______

Ice/Fog  Details ______
Animal/livestock  Details ______
Other Details ______

Who drives the vehicle? (Number of staff in category) /

Support staff:

Agency staff:
Casual:

Other comments

______

Staff Consulted:

Name: ______Signature: ______Position: ______Date: __/__/__

Version 1, September 2009