Ride-on-mower equipment prescription form

What it contains

This form must be completed for all requests for ride-on-mowers and like vehicles (e.g. side-by-side and farm utility vehicles, and related equipment e.g. tow-behind weed sprayers and trailers).

Note: any vehicle used on the Victorian road system that travels for more than two kilometers at a time in one direction is considered to be a motor vehicle. The Transport and Car Needs Assessment Form should be used for the prescription of any motor vehicle.

Supporting evidence must be provided along with the completed form including:

• measurement recordings
• detailed site photos showing identified hazards
• photo and/or video footage of the worker trialing the equipment
• supporting ADL/home help services assessment
• all related notes

An equipment trial and site assessment must occur at the injured worker's property. The prescribing therapist, worker and supplier representative must sign the separate 'Ride-on-mower Trial and Training Acknowledgement Form'.