Home modifications assessment form

A form for occupational therapists providing home modifications assessment services to Transport Accident Commission (TAC) and WorkSafe clients.

Shape
 
Published: 01 Mar 2017
 
File type: PDF
 
File size: 713.21 kB
 
Length: 9 pages
 
Reading level: Difficult

What it contains

Blank form with supplementary notes and information.

This form is for use by Occupational Therapists providing home modifications assessment services to TAC and WorkSafe Victoria (WorkSafe).

  • Approval from the TAC/WorkSafe Agent must be obtained prior to completing a home modifi cations assessment
  • Please type or use block letters and ensure that all sections are complete
  • All incomplete forms will be returned. Please provide reasons if you are unable to complete a section.