Mobility & Transfer Skills Assessment

Client Name: Date of Assessment: Assessor:

Mobility Skills

Skill	Independent	With Assistance	Unable	Notes
Bed Mobility
Sit to Stand
Standing Balance
Walking
Stair Climbing

Transfer Skills

Transfer Type	Independent	With Assistance	Unable	Notes
Bed to Chair
Chair to Toilet
Chair to Car
Chair to Wheelchair

Assistive Devices Used

Additional Notes / Recommendations