Professional drivers · PD-29

Wheelchair Passenger Securing Check

A free printable wheelchair securing record: tie-downs, belts and anchor points checked before use, then each journey's chair, belt and second-person check logged.

Download Free · no sign-up

2 pages. Choose your paper size — both versions are laid out identically, so neither one gets shrunk to fit.

Print it and write on it

A4 60 kB US Letter 60 kB

Fill it in type and save

A4 265 kB US Letter 265 kB

The fillable versions have real form fields — open them in any PDF reader, type into them and save. Printing help.

What this sheet is for

Show the restraints were checked and each wheelchair passenger secured and double-checked. Withdrawn equipment, and anything in use during a collision, is logged as well.

Who it is for

Drivers, passenger assistants and transport coordinators in community transport, schools, care services and accessible taxis.

How to use it

Write the date at the top of a column and check each item before the vehicle is first used that day.
If anything fails, mark it X, withdraw and label it, and log it in the defects table.
For each journey, record the chair, its facing, the tie-downs and the belt, and have a second person check each one.
Withdraw every restraint that was in use in any collision and record it in the box provided.

What is on the sheet

2 pages, in this order:

Page 1

Printed under the title: The check of every tie-down, belt and anchor point before the vehicle is used, then a line per journey showing the chair and the passenger were each secured and that a second person checked both.

Follow the makers' instructions. Fit and tension each strap the way the restraint maker and the wheelchair maker say: this sheet records that it was done and checked, not how to do it. A chair its maker does not approve for travel with someone sitting in it is a reason to stop and ask, not to improvise.

Write-on lines: Vehicle reg · Restraint system (make, model) · Wheelchair spaces · Organisation

Equipment check before use — one column per day — tick if sound; if not, write X, withdraw it and log it below

Also printed: Check · Date · Front tie-downs: webbing, hooks, retractors · Rear tie-downs: webbing, hooks, retractors · Buckles and tensioners lock and release · Floor track and anchor points clean, sound · Occupant lap belt · Occupant diagonal belt · Head and back restraint, if fitted · Ramp or lift, its controls and roll stop · Spare restraints stowed, nothing loose · Checked by (initials)

After any collision — every restraint in use is withdrawn until the maker's instructions have been followed

Write-on lines: Date of collision · Items withdrawn · Inspected or replaced by · Back in use · Journey or passenger affected · Reported to · Notes

Page 2

Defects found and items withdrawn — label withdrawn items so nobody uses them

Table, 3 rows: Date · Item · Defect · Withdrawn · Reported to · Back in use

Journey log — one line per wheelchair passenger per journey

Also printed: Chair · Tie-downs and belt fitted

Table, 14 rows: Date · Time · Passenger / chair · Approved · Facing · Front · Rear · Belt · Checked · Unloaded · Driver

Write-on lines: Log checked by · Date · Notes

Questions

Does this sheet explain how to secure a wheelchair?

No. How each strap and belt is fitted and tensioned depends on the restraint system and the wheelchair, and their makers' instructions are the ones to follow. This sheet records that the check and the securing were done and confirmed by a second person.

Why does the journey log ask whether the chair is approved for travel?

Not every wheelchair is designed to be travelled in with someone sitting in it. Checking the maker's instructions or the chair's labelling first, and writing it down, stops the question being skipped on a busy morning.