Multi-Point Inspection
Serial #
Technician
Today’s Date
S = Satisfactory
Frame
A = Requires Attention
Original Purchase Date
P = Priority Item
S
A
P
Axles, Wheels & Tires
S
A
P
Cushion & Back Upholstery
S
A
P
Nuts & bolts are secure
Legrests can be released
Footrests can be released
Armrests can be released
Back canes adjust easily (if applicable)
Wheelchair opens and folds easily
Frame inspected for cracks
Test quick-release wheels
Wheel locks embed 1/8 inch in tire
Tires checked for extreme wear or flat spots
Axles clean of debris
Wheels inspected
Front casters inspected
Drum brake and cables inspected
Cushion checked for excessive wear
Sling upholstery checked for sagging or excessive wear
Back upholstery checked for excessive wear
Comments / Recommendation