Service providers can use this form to request wheelchairs, pressure cushions, powered conversion kits, hoists, scooters, beds, mattresses, standing frames, tilt tables, large exercise equipment, lounge chairs and customised chairs.
The form should also be used to request repairs or modifications to this equipment.
Details to be completed in the form include:
the injured employee's details
equipment details, including if it’s to be reissued, replaced, modified or purchased
the employee's work-related injuries and medical history
what type of equipment is recommended and how it will benefit the employee
It is expected that prescribing therapists conduct trial of items from the Equipment List (if available) with WorkSafe equipment contracted suppliers before recomending any non-contracted items from an alternative supplier in line with the WorkSafe Equipment and related services policy
anticipated maintenance and repair, training requirements and the treating therapist's details