An information fact sheet brought to you by…
A project of the Rehabilitation Engineering Research Center on Wheelchair Transportation Safety
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 (rev. 02/07)
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.
_____________________________________________________________________________________
_____________________________________________________________________________________
3. 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 be 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
______ STAR/STAR Plus
______ 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 ___________
______ 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 the wheelchair is 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- in-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 staff 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 (23K). This will make it easy to print and share with others or to use as part of an educational program. You will need to have Adobe Acrobat in order to read this document.
Last updated: June 21, 2009
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