A. General
     1. Open with ease __________
     2. Closes with ease __________
     3. Rolls straight __________
B. Back
     1. Upholstery/Firm back
          a. Check for tears/cracks __________
          b. Excessive slack __________
          c. Hardware secure __________
          d. All components secure __________
          e. Clean
     2. Back canes
          a. Push handles secure __________
          b. Hardware secure __________
          c. Welded joints intact __________
          d. Recline mechanism
               1.Operates properly __________
               2.Secures easily __________
C. Seat
     1. Upholstery/solid seat
          a. Check for tears/cracks __________
          b. Excessive slack __________
          c. Hardware secure __________
          d. Clean __________
     2. Positioning belt
          a. Webbing intact __________
          b. Fastener intact __________
          c. Hardware secure __________
          d. Properly fitting __________
D. Frame/Cross brace
     1. Side Frame
          a. Right side straight __________
          b. Left side straight __________
     2. Seat rail guides
          a. Present and secure __________
           b. Seat rail fits snugly __________
     3. Cross brace
          a. Center pin present __________
          b. Center pin free moving __________
     4. Anti-tip devices present __________
     5. All welded joint interact __________
     6. Clean__________
E. Arms
     1. Armrest pad
          a. Check for tears/cracks __________
          b. Securely attached __________
     2. Armrest
          a. Right
               1. Straight __________
               2. Release mechanism intact __________
               3. Remove/replace easily __________
          b. Left
               1. Straight __________
               2. Release mechanism intact __________
               3. Remove/replace easily __________
     3. Side panel/cloth guard
          a. Right
               1. Check for tears/cracks __________
               2. Securely attached __________
          a. Left
               3. Check for tears/cracks __________
               4. Securely attached __________
F. Front Rigging
     1. Swing away foot rest/elevating leg rest
          a. Right
               1. Straight __________
               2. Release mechanism intact __________
               3. Remove easily __________
               4. Locks securely __________
               5. Legrest panel intact __________
               6. Elevates easily/securely __________
               7. Adjusted to the correct length __________
          b. Left
               1. Straight __________
               2. Release mechanism intact __________
               3. Remove easily __________
               4. Locks securely __________
               5. Legrest panel intact __________
               6. Elevates easily/securely __________
               7. Adjusted to the correct length __________
     2. Foot plate
          a. Right
               1. Intact __________
               2. Stays up __________
          b. Left
               1. Intact __________
               2. Stays up __________
               3. Heel loops/calf strap __________
          a. Right
               1. Anchor bolt tight __________
               2. Webbing intact __________
          b. Left
               1. Anchor bolt tight __________
                2. Webbing intact __________

G. Rear Wheels
      1. Right
          a. Axle bolt secure __________
          b. Spins freely __________
          c. Proper alignment __________
          d. Mag/spokes intact __________
          e. Tires inflated properly __________
          f. Tred worn __________
          g. Handrims intact __________
          h. Handrims secure __________
     2. Left
           a. Axle bolt secure __________
           b. Spins freely __________
           c. Proper alignment __________
           d. Mag/spokes intact __________
           e. Tires inflated properly __________
           f. Tred worn __________
           g. Handrims intact __________
           h. Handrims secure
H. Front casters
     1. Right
           a. Caster bolt secure __________
           b. Spins freely __________
           c. Swivels freely without flutter __________
           d. Top of fork parallel to floor __________
           e. Wheel intact __________
           f. Tire inflated properly __________
           g. Tred worn __________
     2. Left
           a. Caster bolt secure __________
           b. Spins freely __________
           c. Swivels freely without flutter __________
           d. Top of fork parallel to floor __________
           e. Wheel intact __________
           f. Tire inflated properly __________
           g. Tred worn __________
           I. Wheel locks __________
      1. Right
           a. Disengaged: Free motion of wheel __________
           b. Engaged: No motion of wheel __________
           c. Mounting bracket secure __________
           d. Tension appropriate __________
     2. Left
           a. Disengaged: Free motion of wheel __________
           b. Engaged: No motion of wheel __________
           c. Mounting bracket secure __________
           e. Tension appropriate __________
J. Maintenance Schedule
     1. Weekly (or at least biweekly)
           a. General operation __________
           b. Tightness of axle bolts __________
           c. Tire pressure __________
      2. Monthly
           a. Back and seats __________
           b. Arms __________
           c. Front riggings __________
           d. Rear wheels __________
           e. Front casters __________
           f. Wheel locks __________
           g. Cushions __________
           h. Basic cleaning __________
      3. 6 Months
           a. Frame/cross brace __________
           b. All welded joints __________
           c. Lube bearings __________
           d. Lube center pin __________
           e. Lube rear axle __________
     4. Yearly
          The entire wheelchair should be checked, serviced and           cleaned by the dealer.

**Before performing any maintenance on the wheelchair, please consult your owners manual.