CheckUp Form Training

1
Check-Up Form Training

• A guide to documenting a car seat check using the
  WA State form.
• Prepared by Denise Donaldson
  July 26, 2007

2
Document, Document, Document!

• Memory Aid Provides structure, flow, and
  reminders for a thorough seat check.
• Teaching Tool WA State form is in triplicate.
  Caregiver keeps pink copy.
• Liability Limiter Shows how seat was brought in
  by parent, and changes made during check, so it
  documents improvements.

3
Guidelines to Remember for WA State Form

• Form should tell the story of the seat check
  experience.
• Check the boxes to show how seat was used on
  arrival. (NOT how seat was improved by end of
  check.)
• Use comment lines to describe changes/improvements
  .
• Additional details in margins are fine.

4
Explain Form to Parents

• Sometimes the form intimidates seen as grading
  tool.
• Tell parents the basics
• This form makes sure we are thorough.
• It will show how you used the seat before the
  check, and how we worked together to make
  improvements.
• Yes answers are fine, and nos show us where
  we found room for improvement.
• You will be given a copy.

5
Upper Boxes of Form
6
Caregiver Info
7
Vehicle Location Info

• Pictures indicate unacceptable side/rear-facing
  VEHICLE seats.
• Diagram shows child location in vehicle

8
Child Arrives In Boxes
9
Positive Orientation

• Moving down the form from this point, you will be
  marking yes, no and n/a.
• Wording has been made so that
• Yes Good
• No Needs some work (dont say bad)
• Use these nos to document changes in comment
  box later.

10
Rear-Facing Box
11
Rear-Facing Info
12
Forward-Facing Box
13
Forward-Facing Info
14
BPB Box
15
BPB Info
16
Shield Booster Box
17
Shield Booster Info
18
Seat Belt Box
19
Lower Boxes of Form
20
Car Seat and Harness Info
21
Info on New Seat Provided

• Use when giveaway or by donation
• seat is provided to family. Otherwise leave
  blank.

22
Installation/Seat Belt Info
23
Lower Anchors/Tethers
24
Upper Boxes-Note Comments
25
Your Changes - Detailed
26
Note sign off box
27
Demonstration Seat Checks

• Some seat checks are for demonstrating proper
  use, such as when the child is not born or not
  present, or when the seat comes uninstalled.
• This info is marked at the top of the form.
• You will find some of the lines hard/impossible
  to answer under these demonstration
  circumstances.

28
Child Not Born

• Make sure this is noted at the spot on the top of
  the form.
• Use a doll to show proper harness use and to
  allow the caregivers to practice.
• Fill in the lines in the shaded box with yeses
  as you teach about each concept, or else leave
  the lines blank.
• Dont forget to fill in the upper weight limit.

29
Child Not Present

• Make sure this is noted at the spot on the top of
  the form.
• Fill in the shaded boxes, noting parent reports
  next to lines that cant be assessed without the
  child present.

30
Car Seat Uninstalled

• Make sure this is noted at the spot on the top of
  the form.
• Mark the various lines to describe how the car
  seat was installed that day. (Hopefully all
  yes responses.)
• If you want, you can additionally note that it is
  a First-time Installation.

31
Conclusion

• Always use a check-up form anytime you are
  checking a car seat.
• Fill in the form to tell the story of how the
  seat came in (the check marks), and how it was
  improved (the comments).
• Use the form for as a teaching tool.
• Form should be saved in case it is needed in the
  future.