RERC_WTS: Transportation Review Checklist

1. Once on the bus, is it feasible for the student (with or without assistance), to move from a wheelchair to a regular seat? Yes _______ No ______ . If yes, please continue to answer the questions below. If no, please proceed to question #5.

2. Briefly describe the safest way for the child to board and leave the bus and the most appropriate techniques used by the student to transfer into the vehicle seat including the level of assistance/supervision necessary by transportation staff.

What type of occupant restraint will be used?
________ None – reliance on compartmentalization
________ Harness/Vest Crotch strap Yes ___ No ___
Waist Size with clothing only ___
Waist Size with coat _____

Please Note: When at all possible, vests will be put on and taken off by school staff with the assistance of transportation staff at the school and parents when at home.
Is training necessary? _____No _____Yes (if yes, date of training ________)

Portable seat mounts will be installed and checked daily by transportation staff that will be responsible for assisting the child onto the bus and into the seat and for securing the vest to the seat mount. In addition, they will responsible for being certain that the seat behind the vested child will be empty or is occupied by a child who is also in a vest or car seat. Is training necessary? No _____ Yes _____ (if yes, date of training _________)

Car seat:
___ Infant (rear facing – up to 20 lbs. and 26 inches or max. allowed by manufacturer)
___ Integrated child safety seat/occupant restraint
___ Standard child safety seat (up to 40 lbs. and 40 inches or max. allowed by manufacturer)
___ High backed, booster seat used only with harness straps
___ Special purpose car seat/occupant restraint

Please confirm that the following required conditions are provided for in this proposed transportation plan.

____ This student is not seated in an emergency exit or adjacent to a push out window.

____ If this student is seated in the aisle seat, the wall position seat is empty or seats a child also using a safety vest or car seat.

4. Check any additional securement or add-on devices necessary.

______ Tether Location of anchor point ______
______ Buckle Cover
______ Neck Collar
______ Other

5. What type of wheelchair does the student currently use?
What is the approximate weight of this wheelchair including all of its attachments?____
If electric powered, is the battery gel electrolyte, sealed lead acid, or regular lead acid ____
If electric powered, is the child safely able to independently drive onto the lift?
If not, describe the process to disengage the chair’s motor.__________________________
When positioned on lift platform, motor should be _______disengaged ________ engaged.

6. Has the wheelchair manufacturer indicated to the owner of this wheelchair that it is not designed for use in a motor vehicle? Yes _______ No _______ Unknown _______

7. What type of securement device (i.e., tie-down system) will be utilized (including the proper angles and points on the chair, need for additional belts, etc.)?

8. What type of extra supportive equipment must be transported and secured (e.g., ambulation equipment, communication aides, trays, monitors, oxygen tanks, suction machines, etc.)?

9. Describe any necessary environmental specifications including modifications or adaptations needed for increased postural security, comfort, or safety (i.e., physical placement in vehicles, padding, wheel well, or other leg support, etc.).

10. What is the height and weight of this student? Height ______ Weight _______

11. What is the approximate point-to-point travel time from the student’s residence to their school/placement?

12. Does this student have increased sensitivity to any of the following:

___ Temperature changes
___ Smells (i.e., fumes, etc.)
___ Movement
___ Sounds
___ Sunlight

Please describe the above sensitivities in detail as well as recommended methods of dealing with these concerns on the vehicle.

13. Please describe any special medical conditions which may present a problem on the bus i.e., feeding tube or significant swallowing problems, allergies i.e., latex, bee stings, shunts (especially a concern for vested children), spinal rods, respiratory difficulties, etc.:

14. Specify emergency evacuation precautions to be considered:
Child safe belt cutter on bus ______Yes _____ No

15. Is there any head/neck support or restraint, which needs to be removed and/or added for transportation? Yes ______ No ____ If yes, specify:

Note: Any restraint which secures the child’s head or neck to the back of the wheelchair needs to be removed for transportation.

16. Are there any trunk or extremity supports, which need to be removed or loosened during transportation? Yes _______ No _______ If yes, specify:

17. If the wheelchair has a tilt’n’ space mechanism, does the student require the chair to be reclined during transportation? Yes _______ No _____
If so, degree of tilt _______
Need for mountaineering strap? _______
All tie down points on one frame__________

18. Are there concerns regarding the school board’s belief that all students should ride in a forward facing position? Yes _______ No _______ If yes, describe:

19. A shoulder lap belt will be utilized for securement of this student. Are there any concerns regarding this type of occupant restraint? (Clear path for placement of lap belt, etc.)
Yes _______ No _______ If yes, describe: _________________________

20. Has every viable alternate option to transport this student while in a motor vehicle been explored? Yes _______ No _______

If utilizing this wheelchair is the only viable method available to transport this student in a motor vehicle, is the present wheelchair as reasonably safe as currently possible?
Yes _______ No _______ Unknown _______

21. Do representatives of the school district or you as parents/guardians have any other concerns or suggestions, which would make transportation safer for this student? _________

22. Is a test run or staff in-service/training necessary before proceeding with the above planned transportation? Yes _______ (Expected Date of Completion ___________) No _________

Please note: Information from the checklist above will be used by occupational and physical therapy staffs to design a securement plan for use on the vehicle.

ACKNOWLEDGMENT OF RECEIPT OF NOTICE OF RISK OF TRANSPORTING STUDENTS IN WHEELCHAIRS

As the parent/guardian of ______________________________________, I have been advised by the Trumbull County Educational Service Center, my school district of residence, and Community Bus Service, Inc. of the safety factors involved in transporting students in wheelchairs. I have been provided with information concerning this matter, had the opportunity to participate in a meeting where the transportation checklist and individual transportation plan for my child was completed, and had the opportunity to raise questions and concerns.

__________________________________ _____________________________

Parent/Guardian Signature Date

Individual transportation plan committee participants:

______________________________ _____________________ ________

Name Title Date

_____________________________ ____________________ ________

Name Title Date

______________________________ ____________________ ________

Name Title Date

This report has been reviewed with me.

_____________________________________ ______________

Parent/Guardian Date

You can download this document "Transportation Review Checklist" in a PDF format. This will make it easy to print and give to others or use as part of an educational program.

You will need a free copy of Adobe Reader installed on your computer in order to do this.

Last updated: December 9, 2005

		An information fact sheet brought to you by… A project of the Rehabilitation Engineering Research Center on Wheelchair Transportation Safety Consumers \| Prescribers \| Manufacturers \| Transporters The following is a document used in the Trumbull County School District and is used with permission. It was adapted from a Transportation Review Checklist written by Lynwood Beekman, Esq., rec. 3/3/93. It has been included on this website as a model for reviewing the safety issues that affect children who ride in wheelchairs on school buses. The same precautions apply to adults travelling in fixed route and door-to-door transporation. Transportation Review Checklist The purpose of this checklist is for representatives of school districts of residence, the Trumbull County Educational Service Center, Community Bus Service, Inc., (where appropriate), and parents to review the special transportation needs of students who use wheelchairs (3 wheeled scooters are included). The following areas are noted as possible matters of concern, but the participants should raise any other items of concern as well in order that they might be discussed and addressed. Student’s Name: ___________________________________ Date: ___________________ 1. Once on the bus, is it feasible for the student (with or without assistance), to move from a wheelchair to a regular seat? Yes _______ No ______ . If yes, please continue to answer the questions below. If no, please proceed to question #5. 2. Briefly describe the safest way for the child to board and leave the bus and the most appropriate techniques used by the student to transfer into the vehicle seat including the level of assistance/supervision necessary by transportation staff. What type of occupant restraint will be used? ________ None – reliance on compartmentalization ________ Harness/Vest Crotch strap Yes ___ No ___ Waist Size with clothing only ___ Waist Size with coat _____ Please Note: When at all possible, vests will be put on and taken off by school staff with the assistance of transportation staff at the school and parents when at home. Is training necessary? _____No _____Yes (if yes, date of training ________) Portable seat mounts will be installed and checked daily by transportation staff that will be responsible for assisting the child onto the bus and into the seat and for securing the vest to the seat mount. In addition, they will responsible for being certain that the seat behind the vested child will be empty or is occupied by a child who is also in a vest or car seat. Is training necessary? No _____ Yes _____ (if yes, date of training _________) Car seat: ___ Infant (rear facing – up to 20 lbs. and 26 inches or max. allowed by manufacturer) ___ Integrated child safety seat/occupant restraint ___ Standard child safety seat (up to 40 lbs. and 40 inches or max. allowed by manufacturer) ___ High backed, booster seat used only with harness straps ___ Special purpose car seat/occupant restraint Please confirm that the following required conditions are provided for in this proposed transportation plan. ____ This student is not seated in an emergency exit or adjacent to a push out window. ____ If this student is seated in the aisle seat, the wall position seat is empty or seats a child also using a safety vest or car seat. 4. Check any additional securement or add-on devices necessary. ______ Tether Location of anchor point ______ ______ Buckle Cover ______ Neck Collar ______ Other 5. What type of wheelchair does the student currently use? What is the approximate weight of this wheelchair including all of its attachments?____ If electric powered, is the battery gel electrolyte, sealed lead acid, or regular lead acid ____ If electric powered, is the child safely able to independently drive onto the lift? If not, describe the process to disengage the chair’s motor.__________________________ When positioned on lift platform, motor should be _______disengaged ________ engaged. 6. Has the wheelchair manufacturer indicated to the owner of this wheelchair that it is not designed for use in a motor vehicle? Yes _______ No _______ Unknown _______ 7. What type of securement device (i.e., tie-down system) will be utilized (including the proper angles and points on the chair, need for additional belts, etc.)? 8. What type of extra supportive equipment must be transported and secured (e.g., ambulation equipment, communication aides, trays, monitors, oxygen tanks, suction machines, etc.)? 9. Describe any necessary environmental specifications including modifications or adaptations needed for increased postural security, comfort, or safety (i.e., physical placement in vehicles, padding, wheel well, or other leg support, etc.). 10. What is the height and weight of this student? Height ______ Weight _______ 11. What is the approximate point-to-point travel time from the student’s residence to their school/placement? 12. Does this student have increased sensitivity to any of the following: ___ Temperature changes ___ Smells (i.e., fumes, etc.) ___ Movement ___ Sounds ___ Sunlight Please describe the above sensitivities in detail as well as recommended methods of dealing with these concerns on the vehicle. 13. Please describe any special medical conditions which may present a problem on the bus i.e., feeding tube or significant swallowing problems, allergies i.e., latex, bee stings, shunts (especially a concern for vested children), spinal rods, respiratory difficulties, etc.: 14. Specify emergency evacuation precautions to be considered: Child safe belt cutter on bus ______Yes _____ No 15. Is there any head/neck support or restraint, which needs to be removed and/or added for transportation? Yes ______ No ____ If yes, specify: Note: Any restraint which secures the child’s head or neck to the back of the wheelchair needs to be removed for transportation. 16. Are there any trunk or extremity supports, which need to be removed or loosened during transportation? Yes _______ No _______ If yes, specify: 17. If the wheelchair has a tilt’n’ space mechanism, does the student require the chair to be reclined during transportation? Yes _______ No _____ If so, degree of tilt _______ Need for mountaineering strap? _______ All tie down points on one frame__________ 18. Are there concerns regarding the school board’s belief that all students should ride in a forward facing position? Yes _______ No _______ If yes, describe: 19. A shoulder lap belt will be utilized for securement of this student. Are there any concerns regarding this type of occupant restraint? (Clear path for placement of lap belt, etc.) Yes _______ No _______ If yes, describe: _________________________ 20. Has every viable alternate option to transport this student while in a motor vehicle been explored? Yes _______ No _______ If utilizing this wheelchair is the only viable method available to transport this student in a motor vehicle, is the present wheelchair as reasonably safe as currently possible? Yes _______ No _______ Unknown _______ 21. Do representatives of the school district or you as parents/guardians have any other concerns or suggestions, which would make transportation safer for this student? _________ 22. Is a test run or staff in-service/training necessary before proceeding with the above planned transportation? Yes _______ (Expected Date of Completion ___________) No _________ Please note: Information from the checklist above will be used by occupational and physical therapy staffs to design a securement plan for use on the vehicle. ACKNOWLEDGMENT OF RECEIPT OF NOTICE OF RISK OF TRANSPORTING STUDENTS IN WHEELCHAIRS As the parent/guardian of ______________________________________, I have been advised by the Trumbull County Educational Service Center, my school district of residence, and Community Bus Service, Inc. of the safety factors involved in transporting students in wheelchairs. I have been provided with information concerning this matter, had the opportunity to participate in a meeting where the transportation checklist and individual transportation plan for my child was completed, and had the opportunity to raise questions and concerns. __________________________________ _____________________________ Parent/Guardian Signature Date Individual transportation plan committee participants: ______________________________ _____________________ ________ Name Title Date _____________________________ ____________________ ________ Name Title Date ______________________________ ____________________ ________ Name Title Date This report has been reviewed with me. _____________________________________ ______________ Parent/Guardian Date You can download this document "Transportation Review Checklist" in a PDF format. This will make it easy to print and give to others or use as part of an educational program. You will need a free copy of Adobe Reader installed on your computer in order to do this. Last updated: December 9, 2005
Acknowledgement: Department of Education, Washington DC This Rehabilitation Engineering Research Center (RERC) on Wheelchair Transportation Safety is funded by NIDRR grant #H133E060064 Contact webmaster