FACILITIES OFFICE
Room Prep Questionnaire for Residents
with Physical Disabilities |
| General Information |
| Name (Last) |
|
| Name (First) |
|
| Assignment |
|
| Phone |
(
)
-
|
Have
you requested a "Medical Buyout"?
A buyout is a double occupancy room as
a single occupancy room. All
buyouts must be requested in writing to
ORS and must be approved by the Associate
Director, Wray VanVoorhis,
937-775-4172.
|
| |
Yes
No
Please Check those that apply to you:
Desk (Buyout, how many?
)
Desk Chair (Buyout, how many?
)
Bed frame and mattress (Buyout, how many?
)
Dresser/3-drawer unit (Buyout, how many?
)
Wardrobe (Buyout, how many?
)
* Standard setup
for buyout is 2 sets of furniture minus
1 bed frame and mattress * |
- Mark entry door marked with an emergency
evacuation sticker
|
Yes
No
|
- Install a pull string on the entry
door (easier to close door)
|
Yes
No |
- Install an electronic deadbolt on
front door of room/apt. (Locks/unlocks
standard deadbolt without using a key.
Provided free of charge by WSU.
|
Yes
No |
- I will have an electronic door opener.
(Resident's responsibility to pay for
and contract Modern Entrance 937-431-8141
|
Yes
No |
|
|
Yes
No |
- Supply automatic hallway door clickers
(remotes to open your buildings' main
entry door and hallway doors
|
Yes
No |
|
|
| HON,
HAH, MAH, PIH, HIH, UP settings:
- High bed - bottom
of bed to floor is 33"
- Low bed - bottom
of bed to floor is 23
BOH,
CEH, JAH, OAH settings:
- High bed - bottom
of bed to floor is 27.5"
- Low bed - bottom
of bed to floor is 20
|
Hamilton
Hall and Forest Lane
offers 10 choices of mattress positions
- Top of mattress
to floor
11" - 38"
|
|
- WOODS AND HONORS
lower microwave & put it on counter
|
Yes
No |
- WOODS AND HONORS
remove cabinet fronts so student can
roll under sink
|
Yes
No |
- Do you need Braille Labeling
|
Yes
No
Please Check those that apply to you:
Microwave
Stove
Washer and Dryer
|
|
|
|
|
|
