Occupational Therapy

Home Modification Report

Client Details

Name

Date of Birth

Phone Number

Email Address

Address

Street address

Suburb

State

Postcode

Occupational Therapist Details

Name

Position

Phone Number

Email Address

Assessment Details

Date of Assessment

Referral Source

Reason for Referral

Name of Referrer

Referrer's Email Address

Consent Obtained

Yes - VerbalYes - WrittenNo - VerbalNo - Written

Persons Present for Assessment

Home Recommendations

Sensible Care Pty Ltd. recommends that all home modifications be completed in accordance with the Australian Building Standards and the Design for Access and Mobility Standards (AS 1428.1). Recommendations are provided based on the clinical assessment and professional judgement of the Occupational Therapist and may not account for structural factors unknown at the time of assessment. It is recommended that all grab rails and handrails be securely fixed to wall studs or appropriately reinforced surfaces to ensure they can safely support the required weight and force. Measurement ranges may be provided to guide suitable placement within these requirements. All proposed modifications should be reviewed by a registered builder or qualified tradesperson prior to commencement to confirm compliance with relevant standards. Any adjustments to the design or positioning of modifications should be discussed with the Occupational Therapist prior to completion of works.

Recommendation

Description

Recommendation 1

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Recommendation 2

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Recommendation 3

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Recommendation 4

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Occupational Therapist Signature

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Occupational Therapist Name

Date of Occupational Therapist Signing

This is the final copy of the assessment and will be sent to the referrer email address

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