Sample Applicant Assessment for RDA activities RDA person Qualification Date Print name Name of County Region Time and place Names of of assessment people at assessment Applicant’s DOB: 5ft 2 Weight 10 st 3 kg name lbs Maximum weight carrying limit of available equines 14 st 7 lbs Action: Complete assessment √ kg Refer on to: Have you seen a completed Application form for this person, understood Y / N the medical information and sought help if required from county / regional officials listed in the current handbook? Are any contraindications/ precautions? (found on the RDA website - ) Y / N If Yes then list here: Is there anything that you need help with? If Yes then please seek help from your county and regional officials listed in the current handbook Y / N Has the person had any previous riding/equine contact (not only RDA)? Y / N If Yes then list here: Was a riding helmet worn? Y / N Did you see the person arrive? Y / N What did you notice? Car driven by his wife. Had to have left leg lifted out and needed to hold onto door for support. Can walk with just a stick Please tick all of the following that apply: Does the person use A self propelled A powered wheelchair Any equipment such as leg / hand splints: wheelchair For No Leg Splint on left leg distances Walk independently With a wheeled With crutches With a With physical support from another Can the person No walking aid No No No person Yes Walk on an uneven surface with help / without still and balance Stand and balance on Sit independently on a stool / chair without arms help without any support their left leg for a few and without leaning on the back of the chair No seconds No Yes but leans to right
Sample Applicant Assessment for RDA activities RDA person Print name Qualification Date Name of County Region Time and place of assessment Names of people at assessment Applicant’s name DOB: 5ft 2 Weight 10 st 3 lbs kg Maximum weight carrying limit of available equines 14 st 7 lbs kg Action: Complete assessment √ Refer on to: Have you seen a completed Application form for this person, understood the medical information and sought help if required from county / regional officials listed in the current handbook? Y / N Are any contraindications/ precautions? (found on the RDA website - ) Is there anything that you need help with? If Yes then please seek help from your county and regional officials listed in the current handbook Y / N Y / N If Yes then list here: Has the person had any previous riding/equine contact (not only RDA)? Y / N If Yes then list here: Was a riding helmet worn? Y / N Did you see the person arrive? Y / N What did you notice? Car driven by his wife. Had to have left leg lifted out and needed to hold onto door for support. Can walk with just a stick Please tick all of the following that apply: Does the person use A self propelled wheelchair For distances A powered wheelchair No Any equipment such as leg / hand splints: Leg Splint on left leg Can the person Walk independently No With a wheeled walking aid No With crutches No With a No With physical support from another person Yes Walk on an uneven surface with help / without help still and balance without any support No Stand and balance on their left leg for a few seconds No Sit independently on a stool / chair without arms and without leaning on the back of the chair Yes but leans to right
Completed-Applicant-assessment-for-RDA-activities.docx