Bed Transfer Training Assessment Form
Use this form to assess competency in bed transfer training. Please complete all relevant sections based on your observation.
Trainee Name
*
First Name
Last Name
Date of Assessment
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Training Context
*
Please Select
Initial Training
Refresher Training
Annual Competency Check
Other
Observed Transfer Method
*
Independent
Assisted with Device
Assisted by Staff
Other
Bed Transfer Competency Assessment
*
Rows
Not Demonstrated
Partially Demonstrated
Fully Demonstrated
Not Applicable
Positions bed and equipment correctly
1
2
3
4
Explains procedure to patient
5
6
7
8
Uses proper body mechanics
9
10
11
12
Ensures patient safety throughout transfer
13
14
15
16
Completes transfer efficiently
17
18
19
20
Safety Awareness Demonstrated
*
Yes
No
Partially
Level of Assistance Required
*
None
Minimal Assistance
Moderate Assistance
Maximum Assistance
Total Assistance
Overall Performance
*
1
2
3
4
5
Assessor Notes
Submit Assessment
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