Build Instruction Form by 3RDIA21k


									                                                Build Instruction Form                                                                                  DB1
Help Line:              01642353492              Fax 01642223313                           Greencare Mobility Limited,             Riverside Park Road, TS2 1UU

Person Specifying                                                                                               Your Order reference

Wheelchair service                                                                                              Order Date

Contact telephone                                                                                               Date chair required
                                                                                                                Delivery address
Contact Fax

Contact Email

                   This form combines price and build specification with informative notes. Prices and Specifications are subject to change without notice
                                Please contact Greencare Mobility for help on any aspect of this form including current price or build information                                           1st October 2011

Occupant Weight                                 Tick one        a                                                          Occupant height (optional)
up to 100 KG               "Light"      up to 135 KG "Standard" up to 150 KG "Heavy Duty"                               up to 175KG "Extra Heavy Duty"                  up to 200KG               "Bariatric"
Single brace chair                      Double brace chair                Reinforced double braced chair                Triple brace chair. With Tension                Triple brace chair. As per extra heavy duty
Lightweight configuration and           Standard DB1 wheelchair for most with Tension Adjustable Back, HD               Adjustable Back, HD castors & reinforced        but with footbar, impact suppression and
accepts all DB1 accessories             needs and accepts all accessories castors & reinforced arm rests                arm rests                                       reinforced frame
                a                                       a                                       a                                                a                                                a
Seat Width and Depth for all chairs
Seat Width              Seat Depth Single Brace                         Seat Depth Double Brace                         Seat Depth Double Brace                         Seat Depth           Triple Brace

 (please choose)        'Light' version occupants to 100kg              Double brace occupants to 135kg                 Double brace occupants to 150kg                 Triple brace occupants to 175kg

                a                       a                       a                        a                      a
13" (330mm)             13" (330mm)             15" (380mm)             15" (380mm)             17" (430mm)                             a                        a
14" (360mm)             13" (330mm)             15" (380mm)             15" (380mm)             17" (430mm)             17" (430mm)             19" (480mm)

15" (380mm)             15" (380mm)             17" (430mm)             15" (380mm)             17" (430mm)             17" (430mm)             19" (480mm)

16" (405mm)             15" (380mm)             17" (430mm)             15" (380mm)             17" (430mm)             17" (430mm)             19" (480mm)

17" (430mm)             15" (380mm)             17" (430mm)             15" (380mm)             17" (430mm)             17" (430mm)             19" (480mm)

18" (455mm)             15" (380mm)             17" (430mm)             15" (380mm)             17" (430mm)             17" (430mm)             19" (480mm)

19" (480mm)                                                             15" (380mm)             17" (430mm)             17" (430mm)             19" (480mm)                              a
20" (510mm)                                                                                                             17" (430mm)             19" (480mm)             19" (480mm)               21" (530mm)

22" (560mm)                                                                                                             17" (430mm)             19" (480mm)             19" (480mm)               21" (530mm)

24" (610mm)                You may choose any seat depth outside of the above matrix. Give details of requirement to obtain quotation.                                  19" (480mm)               21" (530mm)

Bucket Seat Upholstery                                                                                                                                                                   a
In a range of seat widths 15" to 20" bucket seat are available to increase rearward tilt of seat canvas 10º to horizontal
Narrow Build Option Build chair narrow (seat + 6¼" so a 20" wide chairs will fit through 27" doors)                                                                                      a
Narrow build is achieved by reduced hub connectors and reduced wheel push rim spacing. Reinforced armrest sides (no flex aluminium panels) may be used on self
propelling wheel builds to facilitate minimum chair widths being selected. Narrow build option is not available on hub brake wheels.

Outrig armrests                                  to increase arm sides increasing seat width by 3" (75mm)          Normally only available on Attendant chairs

Plain seat rails for special seating without seat canvas                        (enter width of seat required in table above) Available in seat widths 15",17",19", 20"

PLEASE NOTE: Heavy Duty occupant weight demands assessment of many factors including the ability of the carer to push the load safely. A chair should be used on level surfaces to ensure safe operation. Consider
24" or 26" wheels as an option for attendant builds as bigger wheels are easier to push. Hub brakes help carers. 20" hub braked wheels can be used without pushrims to reduce overall chair widths. A full technical
assessment for the wheelchair specification and the use environment should be made.

                                                                                                                             '8BL' type
Special Chairs                                                   Front Propelling                                                                                                            One Arm Drive
A selection of special                                                                                                  Available seat                                          One arm drive configuration
                                                                Available in a
builds are shown here.                                                                                                  sizes 15" 16" 17"                                       available on all chair sizes in wheel
                                                                range of sizes.                                                                                                 size 24" and 26". Price shown
Quotations should be                                            Price shown indicative
                                                                                                                        18". Price shown
                                                                                                                        indicative                                              indicative
obtained for all special

Seat to Ground Height                                                   a                                       Note : High and low seat settings are achieved through wheel and castor sizes and
                                                                                                                reconfiguring the frame. The larger 200mm (8") diameter castor wheels can be used
Extra Low               395mm         (15½")
                                                                                                                with the low height castor connectors on builds where seat to ground height is less
Low                     420mm           (16½")                                                                  than 495mm (19 ½") Please note that low seat to ground heights can reduce push
                                                                                                                handle height which can be adjusted at build. Extra high is achieved with extended
Low Standard            450mm           (18")
                                                                                                                spigot on front castor mount. Seat to ground angle of chair is nominally built 5
Standard                495mm           (19½")                                                                  degrees.                                              SEAT TO GROUND
                                                                                                                MEASUREMENT is to ISO 7071 part 7 and is measured to seat canvas under load
High Standard           530mm           (20½")                                                                  and not seat rail. For seat rail heights add approx 3/4" or 20mm from ground.
Extra High              560mm           (22")
Specify height seat to ground                                                                                                                                                                               gcqa009revN
Wheel Selection                                                                                             WHEEL BUILD NOTES : Wheel size and position of wheel in frame determines seat to
                                                                                                            ground height. Small 315 wheels are for very low seat to ground builds. For heavier occupant
Attendant wheels                                                         a                                  weights larger wheels facilitate easier roll. Hub brakes should be considered for heavier
                                                                                                            occupant weights and 20" hub brake wheels (even without pushrims) are an easier roll and
12½" (315mm)        Low build option                                                                        are an option where space and chair width is an issue. Note: Narrow build configurations
                                                                                                            minimise overall width of chair usually seat width plus160mm (6 ¼"). Rigid aluminium full side
12½" (315mm)        QD Low build option                                                                     panels should be considered for these. Hub braked wheels which add 25mm to the width
16" (405mm)                                                                                                 cannot be set 'narrow'. .
                    Fixed Axle

16" (405mm)         Quick Release                                                                                            The unique easier
                                                                                                                             roll Greencare 16"
16" (405mm)         with Hub Brakes                                                                                          wheel for attendant
                                                                                                                             builds                             All tyres fitted as standard are non marking
20" (510mm)         with Hub Brakes                                                                                                                                      latex free & puncture proof.

Self Propelling wheels                                                   a                                  Rear Wheel Set                             a       Wheel Setting. ISO 7176 rearward static stability
                                                                                                                                                               as follows: Active 6º; Mid Stability 14º and Max
20" (510mm)             Fixed axle                                                                          Active                                             8º. The 24" Composite wheels have plastic push
                                                                                                                                                               rims in colour black. Hub brakes need extended
20" (510mm)             Quick Release                                                                       Mid Stability                                      handles to position brake levers. Stability testing
                                                                                                                                                               recommended to determine use of anti tippers
22" (560mm)             Fixed axle                                                                          Maximum stability
22" (560mm)             Quick Release                                                                       Anti Tippers Built for chair                        £15 No anti tippers Stability testing rec
24" (610mm)             Quick Release
24" (610mm)             Composite (Black)                                                                   Speciality tyres                                                             a
24" (610mm)             QD with hub brakes                                                                  Plain Tread Tyres for indoor use
26" (660mm)             Quick Release                                                                       Pneumatic Tyres
26" (660mm)           QD with Hub Brakes                                                                    Coloured        Tyres      black/red/yellow/blue/green

Handrim                                                                  a                                                           Greencare polyurethane                                      Coloured tyres can
                                                                                                                                                                                                 change a chairs
                                                                                                                                     handrims 24" only are
Greencare Polyurethane                24" wheels only                                                                                                                                            appearance and are
                                                                                                                                     ergonomically designed,                                     liked by children. Black
Aluminium Handrims                 Standard Build                                                                                    never scuff, warm to touch                                  tyres are non marking
                                                                                                                                     and gentle on door frames.                                  and hide dirt.
Set push rim                     Close in         a                 Full grip          a
Front Castor                                                             a                                  Front Castor Position                       Build Notes
5"   (125mm)             wide profile                                                                       Small castors are most compact and large most manoeuvrable. Ground to seat height, footrest position
                                                                                                            and forward stability will determine position of castor wheel in the fork. 5" castor occupant weight limit
6"   (150mm)             wide profile                                                                       125KG, 6" and 8" narrow profile 150KG and 8" wide profile is 175kg. Heavy occupant rated castors
                                                                                                            normally have an M16 threaded fitting.                                          NOTE: Castor choice may
8"   (190mm)             narrow profile                                                                     have to be selected by Greencare to accommodate other build considerations that may have been
                                                                                                            selected such as footrest specification and seat height.
8"   (200mm)            wide profile Heavy Duty

Armrest Height           from seat rail                                  a                                                   Side Panel Colour/Type                                      a
220mm                   Angled                                                                                               Standard Black flex

250mm                   Angled                                                                                               Translucent Green flex

280mm                   Angled
                                                                                                                             Reinforced (aluminium) Non Flex
280mm                   Forward supportive

310mm                   Angled
Make Armrest Completely Removable

Armpad Type                                                       a                                                                  Armpad Specials                                     a
Slimline pad for self propel builds                                                                                                  Extra Length Slimline Armpads
Shaped support pad attendant builds                                                                                                  Armalite Safety armpad lighting system

Foam Tube cover for active users                                                                                                     Armrest reinforcing for heavy users
No armpad Side panel provided only                                                                                                   Therapy Tray (Bexhill Armrest)

Back Post Angle                                           a                                                                          Back Post Type                                      a
                                                                                       Standard backs available in
Upright Setting 3º         ( 7º to vertical)                                           angle settings 3º, 10º, 15º                   Folding
                                                                                       and 20º Reinforced back
Standard setting 10º          0̊
                            (15º to vertical)                                          posts will need back                          Non folding
                                                                                       cushion if rearward back
Reclined setting 15º       ( 2 º to vertical)                                          post set selected.                            Reinforced Non Fold Back Post
                                                                                       Reinforced back posts
Reclined setting 20º       ( 25º to vertical)                                                                                        Reinforced Folding Back Post
                                                                                       only available in 10º
Back Rest Recliner

Seat Back Height                                                                              a                                      Backrest Fabric                                     a
480mm (Push handle height 950mm)                                                                                                     Integral Cushion Back Not 22" 24" seats

530mm (Push handle height apprx 1000mm)                                                                                              Tension Adjustable Back

580mm (Push handle height apprx 1050mm)                  Note: Requires Tension Back                                                 No backrest fabric

Set seat back height to                                 specify                        mm                                                                      Integral cushioned backs not available on 22" and
Set Push Handle height from ground to                 specify
                                                                                                                                                               24" seat widths. Tension adjustable backs
                                                                                                                                                               available on folding back posts and standard
Upper Back Support               (additional 160mm ( 6") back height)                                                                                          on seat widths 20"+. No backrest for special
                                                                                                                                                               seating such as V-Care systems
Head support                      (additional 250mm (10") back height)
Foot Bracket Angle                                             a                                                                   Footrest                                    a
Compact 105º                                                                                                                       Small footplates    13" to 18" chairs

Mid Position 110º                                                                                                                  Large footplates    16" to 24" chairs

Forward 115º                                                                                                                       Foot bar            Fits all chairs

Swing away footrests 110º only                                                                                                     Dynamic footboard (Carcassonne)

Steel Reinforcing for heavy users                                                                                                  Angle adjustable footplates

Short Adjustable height 105º                                                                                                       High Lift catch release
Short Adjustable height 90º                                                                                                        CAPS type adjustable footrests
Out Rig Footrests (increase width of foothangers by 3")                                                                            Footrest Length Seat to Heel            Specify

Accessories                                                                                                     a              a
Elevating Leg Support                     (specify if footplate not to be fitted)                      Left            Right

Residual Limb Support (Stump pad)                                                                      Left            Right

Lap Strap                      Airline type buckle for outdoor security only

Wheelchair User Gloves                                Small                    Medium                  Large
Calf Strap - Padded
Oxygen Bottle Carrier

Signwriting of Chair Back
Brake Lever Extensions

Crutch holder                                                  Fitted to       Both sides              Left            Right

Spoke Guards          for 22" and 24"                                                                  Black           Clear

Therapy Armrest (For CVA arm support)                 inc tray fitting bracket                         Left            Right

Tray    soft wrap around version                      inc tray fitting brackets
Tray Fitting Brackets                                     16mm socket to arm frame
Bag (fitted under arm rest)                                                                            Left            Right

Extendable upper back and push handles ( used with lever operated hub brakes )

Adductor pad Adjustable soft pad mounted onto foot hanger for knee positioning                         Left            Right

Thoracic side pads                                                                                     Left            Right

Thoracic supports are available only with non folding backs. They adjust for height, width, length. Details of required height of pads from seat
and distance between pads should be given with this order in the space below. They will need adjusting at handover.

Cushions supplied to fit chairs                                                                                                a
Cushion 2" Viscoe elastic memory & high resilience foam - see matrix for availability: depth = seat +1"

Cushion 3" Viscoe elastic memory & high resilience foam - see matrix for availability: depth = seat +1"

Cushion 3" Viscoe elastic memory & high resilience foam - see matrix for availability: depth = seat +1"

PVC liner to protect cushion foam         (available for some cushion sizes only as shown in matrix as outlined box)

Special Build Instructions                                     Write here any instructions for build or special features not otherwise optioned on this form.
Please Note: Specialised build instructions could involve additional cost and usually sign-off for any increased cost will be sought before commencement of build

Assessments - Handover - Delivery                                     Greencare staff are available for assessment and handovers at chargeable cost.
For more complicated builds or client needs it is recommended that Greencare staff attend to ensure client needs are met fully utilising the flexibility                              of the
Greencare build system. Mileage and hourly charges may apply. For 'next day' shipments a carriage charge of £10 is added to all orders.

  Order checked by                 Chair Builder                     T Unit Code                          Date made                Quality Checked              Chair Serial number

Road, TS2 1UU

 t October 2011

As per extra heavy duty
pact suppression and


afe operation. Consider
. A full technical

ne Arm Drive

 ve configuration
  all chair sizes in wheel
d 26". Price shown

nd castor sizes and
 wheels can be used
ound height is less
s can reduce push
 ved with extended
minally built 5
   canvas under load
 from ground.

  termines seat to
 . For heavier occupant
 dered for heavier
are an easier roll and
w build configurations
 igid aluminium full side
  25mm to the width

ard are non marking
ncture proof.

rearward static stability
Stability 14º and Max
eels have plastic push
rakes need extended
evers. Stability testing
e use of anti tippers

    Coloured tyres can
    change a chairs
    appearance and are
    liked by children. Black
    tyres are non marking
    and hide dirt.

 height, footrest position
 occupant weight limit
upant rated castors
TE: Castor choice may
hat may have been

 ot available on 22" and
 djustable backs
k posts and standard
ackrest for special
of the

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