Mental Health Transport Risk Assessment Form (Page 2 of 4) in pdf

Mental Health Transport Risk Assessment Form Page 2

RISK ASSESSMENT NOTES

This section has been provided to record notes relevant to the risk assessment. Details such as next of kin/trusted friend, location of

crisis, patient’s behaviour and/or demeanour, current or history of mental illness/treatment, severity of situation and agency response

can be recorded here.

MEDICAL OR AUTHORISED PRACTITIONERS REQUESTING THE TRANSPORT ARE REQUIRED TO RECORD A COMPREHENSIVE RISK ASSESSMENT

(INCLUDING APPROPRIATE DETAIL). ALL STAFF INVOLVED IN TRANSPORTATION ARE REQUIRED TO UTILISE UNIVERSAL PRECAUTIONS TO MITIGATE

THE RISK OF INFECTIOUS DISEASES.

Risk Rating Rationale:

Delusional systems that may impact on safe escort

(e.g. fear of authority figures)

Access to weapons, concealed or otherwise:

Sensory impairment

(e.g. sight, hearing, intoxication)

Medical considerations that may impact on safe escort

(e.g. heart condition, epilepsy)

Has the patient’s Family/Carer been notified regarding the transfer? Yes ⃝ No ⃝

Family/Carer Contact Name: ___________________________ Number:________________________

Does the patient have children that need care? Yes ⃝ No ⃝

(please specify arrangements made)

Notes:

Name: ____________________ Signature: _________________ Designation: ___________________

Date: _______/_______/_______ Time: _____________________

Page 2 of 4

Mental Health Transport Risk Assessment Form Page 2