PERFORMANCE CHECKLIST

6 POINT SEATER

NOT
PROCEDURE DONE SCORE
DONE
1. Gather all the necessary materials needed. 3

2. Do hand washing. 3

3. Introduce yourself & inform the patient about the activity 3

to be done. (transfer from Bed to Wheel Chair).
4. Lower down the head of the bed. 2

5. Remove the pillow. 2

6. Move the patient towards the edge of the bed in 3 2

segmental manners.
7. I’ll be moving the upper part and _________(caregiver 2)
will move the lower part.
8. “At the count of 3, I will move the patient in sitting position
and _______(caregiver 2) will be supporting the lower  2
extremities. 1,2,3 up”
9. Caregiver 2 put the guard belt at the thigh of the patient as
I put the other guard belt at the patient’s waist.(arms of 3
the patient around your shoulder).
10. At the count of 3 we’ll do practice lifting, 1,2,3 lift.” 3

11. At the count of 3 we’ll transfer the patient from bed to

wheelchair. 1,2,3 up (I’ll pivot to my right-moving in front 3
of the wheelchair)
12. Remove guard belt 2

13. Check body alignment 3

14. Ask the patient:

“Are you okay? Are you comfortable?” “Do you feel dizzy?” “Do 3
you need anything?”
15. Check Vital signs. 3

16. Do hand washing. 3

17. Do after care 2

18. Do documentation. 2

19. Inform your superior that you are done with the activity. 2

50
TOTAL

Name: ____________________ Score: _______________

Section: ___________________ Date: _______________
Instructor:__________________