Mechanical Lift: Transfer Observation

Staff Observed ______Date ______Time ______

Variable Findings Comments

Correct mechanical lift was used for transfer [per care plan or order] Correct size sling was used for transfer [per care plan or order] Procedure was explained to the resident Resident was positioned appropriately in the sling prior to being lifted Sling clips were positioned appropriately and secured prior to lifting the resident Lift was appropriately positioned prior to lifting resident Resident’s head and extremities were protected during the transfer Resident was appropriately positioned in chair and/or commode The chair or other device to which the resident was being transferred was positioned appropriately and in a manner to minimize amount of time resident was suspended. Sling was removed from under resident unless using commode or resident had other instructions If sling was left under the resident, it was checked to minimize pressure from wrinkles For mechanical lift transfers in which the resident does not bear weight or does not hold on to a support bar while standing, the transfer was completed using 2 staff members If sling was soiled, it was removed after use and replaced with clean sling Equipment and sling were clean and appeared to be in good repair COMMENTS

“Confidential – Privileged Under Virginia Code §8.01-581.16 and 17 – For Quality Assurance Use Only” AUDIT Page 2