Engineer Cane Inspection
Resident Name: ______________________ Room: ____________ Date: _____
Ask the resident and staff to give you the cane at a time when it is not in use. Follow the instructions and answer each question. If the answer to the question is Yes, follow the arrow down to the next question. If the answer is No, follow the arrow across to the list of tasks. Check the box beside each task that needs to be done. When you have done the task, write your initials beside it.
| Instructions: If the cane is made of wood, inspect the shaft and handle for cracks or weak spots. If the cane is metal, check if all the bolts and screws are present. Check if the rubber tip(s) is present and inspect the shape. | ||
| Question: 1. Is the cane stable with all the hardware present and secure? | ||
| Yes/NA ___ ↓ |
No ___ → | ___ Tighten the loose bolts and screws. ___ Replace the missing hardware. ___ Ask the Fall Prevention Therapist to replace a wooden cane if it is cracked or weak. |
| Question: 2. Is the rubber tip present, even and clean? If it is a quad cane, are all four of the tips present, even, and clean? | ||
| Yes/NA ___ |
No ___ → | ___ Clean the dirty rubber tips. ___ Replace the missing or worn tips. |
Signature: ________________________________________
Engineer Walker Inspection
Ask the resident and staff to give you the walker at a time when it is not in use. Follow the instructions and answer each question. If the answer to the question is Yes, follow the arrow down to the next question. If the answer is No, follow the arrow across to the list of tasks. Check the box beside each task that needs to be done. When you have done the task, write your initials beside it.
| Instructions: Look at the bolts and screws. Check for all four of the rubber tips and inspect their shape. If the walker has caster wheels, check for cracks, shape, and movement while rolling. | ||
| Question: 1. Is the walker stable with all the hardware present and secure? | ||
| Yes/NA ___ ↓ |
No ___ → | ___ Tighten the loose bolts and screws. ___ Replace the missing hardware. |
| Question: 2. Are all four rubber tips present, even, and clean? | ||
| Yes/NA ___ ↓ |
No ___ → | ___ Clean the dirty rubber tips. ___ Replace the missing or worn tips. |
| Question: 3. If the walker has caster wheels, are they firm, in good shape, and do they roll smoothly? | ||
| YES/NA ___ |
NO ___ → | ___ Replace the worn or cracked caster wheels. ___ Clean and oil the caster wheels. |
Signature: ________________________________________
