Two-Person Lift Transfer Checklist
Ensure all steps of the two-person lift transfer are completed safely and correctly.
Staff Member 1 Full Name
*
First Name
Last Name
Staff Member 2 Full Name
*
First Name
Last Name
Patient Full Name
*
First Name
Last Name
Date and Time of Transfer
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Location of Transfer
*
Have both staff members received proper lift transfer training?
*
Yes
No
Pre-Lift Safety Checklist
*
Rows
Checked
Wheelchair/bed brakes applied
1
Floor is clear of obstacles
2
Patient is wearing appropriate footwear
3
Equipment is in good condition
4
Transfer path is clear
5
Was the transfer plan communicated and agreed upon by both staff and the patient?
*
Yes
No
Did the transfer proceed smoothly without incident?
*
Yes
No
Post-Transfer Assessment
*
Rows
Yes
No
Patient is comfortable and safe
6
7
No injuries or discomfort reported
8
9
Equipment returned to proper place
10
11
Additional Comments or Observations
Signature of Staff Member Completing Checklist
*
Submit Checklist
Submit Checklist
Should be Empty: