- Date of Assessment/Session*
- Arm Assessed*
- Stance Position*
- Was the Non-Working Hand or Knee Supported on a Stable Surface?*
- Back Position*
- Head and Neck Alignment*
- Shoulder Position*
- Pulling Path*
- Elbow Track*
- Control at Top and Bottom of Lift*
- Strengths observed
- Correction cues needed
- Overall evaluation*
- Should be Empty: