NSW Home Modifications and Maintenance Services State Council
OCCUPATIONAL THERAPY WRITTEN SPECIFICATIONS
MAJOR BATHROOM MODIFICATIONS
A joint site visit with the builder nominated by the HMMS must be undertaken before finalising the OT diagrammatical and
written specifications.
This form is a template for the OT written specifications.
How to complete this form:
1. Retain headings and delete points, as appropriate
2. Client identification (i.e. client name and date of birth) to be included on top right hand
corner of page 2 and on all subsequent pages
3. Complete Appendix A- Bath and/or Appendix B-Bidet only if applicable
4. Refer to the NSW HMMS State Council Fact Sheet 17 “Major Home Modifications: Minimum
requirements for Occupational Therapy referrals to HMMS”
Date:
Occupational Therapist
Client
Name:
Full Name:
Organisation:
Address:
OT Address:
Phone:
Phone:
Email:
DOB:
Days Available:
Contact Person:
General description of modification required (eg wheelchair accessible bathroom):
WEIGHT OF CLIENT: Please specify if over 100kg .....................................kg
NSW Home Modifications and Maintenance Services State Council
1. Approach and Entry to Bathroom
1.1. Retain existing doorway/Widen existing doorway/Reposition doorway to Wall ................. with
distance from corner of Wall ............. to be ................mm (as per diagram....................)
1.2. Specify for widening existing doorway/repositioning doorway
Clear door opening to be ...................mm
Install inward opening hinged door/ cavity sliding door/surface mounted sliding door/
Smart Door/Bi-fold door/Other (specify)
Latch side on left/right when entering bathroom
Type of door handle (if applicable)
Height of door handle above finished floor surface..................mm
1.3. Re-hinge existing door. Specify
1.4. Provide level access at doorway.
If not possible, install a wedge within the door jambs (maximum lip of 25mm) or threshold ramp
(as appropriate).
Length ....................mm x Width ....................mm
Wedge or threshold ramp must be clearly visible against adjacent floor surfaces (colour contrast)
1.5. Other
2. Floor Surface
2.1. Floor surface of bathroom and shower recess to be continuous
2.2. Tile bathroom floor with slip resistant tiles - R10 rating (size 100mm x 100mm maximum)
OR
Alternatively specify (eg slip resistant vinyl)
2.3 Other
3. Window
3.1. Retain existing window/ Remove existing window/Install new window/ Other (specify)
3.2. Install new window on Wall
Dimensions. Height .................. mm x Width .................mm
Distance from corner of Wall .................. to be ...................mm (as per Elevation............... )
Height of window sill above finished floor surface of bathroom ....................mm
Type of window (eg sliding, wind-out style)
Specify window operating control (if applicable e.g. extended lever)
3.3. Other (eg safety glass)
NSW Home Modifications and Maintenance Services State Council
4. Shower Recess
4.1. Install a level access shower recess (as per position on diagram ...................)
No lip or nosing tile at entry
Length .................. mm x Width .................mm
Grade to a single floor waste in the shower recess
OR
Grated drainage system
OR
Other (Specify)
4.2 Walls of shower recess to be tiled
OR
Other specify (eg slip resistant vinyl)
4.3 Taps to be Capstan/Lever/Flick mixer mounted on wall
Specify Type (if applicable)
Standard turn (both taps turn on/off in the same direction) .................. Yes/ No
If not standard turn, specify
Length of lever handle (if applicable) ................ mm
Indicator on taps (if applicable):
Specify colour: Red/Blue
Yes/No OR Hot /Cold
Yes/ No
Position of taps to be either:
Horizontally aligned with height above finished floor surface ................mm
Centre line of taps/flick mixer to be .....................mm from corner of Walls ..............and ............
OR
Vertically aligned with height of taps ...........mm and .............mm from the finished floor surface of
the shower recess.
Centre line of taps to be ..................mm from corner of Walls..................and ........................
4.4. Shower Head
Retain/ Install a fixed shower head on wall ................... at a height of .............mm above finished
floor surface and .................mm from the corner of walls ................... and .......................
Install a ........... mm length hand held shower hose (HHSH) mounted on Wall ............... as either:
Shower head support grabrail (weight bearing grabrail).
Length of grabrail ................mm
Lowest fixing point above finished floor surface ....................mm.
Distance from corner of walls ................... and ................ to be ...................mm
NSW Home Modifications and Maintenance Services State Council
OR
Hook/peg to be located …...............mm above finished floor surface.
Distance from corner of walls …............…and ............... to be...............mm
OR
2nd hook/peg to be located ……...........mm above finished floor surface
Distance from corner of walls …….......... and .............. to be................mm.
OR
Diverter switch
Yes / No
4.5. Install a soap holder wall mounted/recessed on Wall …..............
Height of base of soap holder to be …….........mm above the finished floor surface
Distance from corner of walls ……........... and................to be ….......….....mm
Specify type (if applicable)
OR
Supply and install soap holder on shower head support grabrail
4.6. Grab rail requirements- See Point 10
4.7. Install a straight /continuous L-shaped/continuous U shaped shower curtain rail at a height to
facilitate weighted shower curtain meeting finished floor surface.
Shower curtain to extend across Wall ……............ to cover window (if required)
Yes / No
Height of top of shower curtain rail to be ………….........mm above finished floor surface
4.8. Other (e.g. shelf for shampoo container)
5. Bath- See appendix A (if applicable)
6. Toilet:
6.1. Retain existing toilet position/Install new toilet/Install combined toilet bidet (see Appendix B)
6.2. Install a new standard/ disabled toilet pan:
Locate toilet cistern on Wall ..................
Distance from Wall .................. to centre line of toilet to be 450 mm
Other specify (e.g. bariatric requirements)
Distance from back wall to front of toilet pan ................mm
Seat height above finished floor surface ................mm
Flush control location (specify if not standard).
Flush control operation (specify if not standard)
NSW Home Modifications and Maintenance Services State Council
6.3. Grab rail requirements- See Point 10
6.4. Install toilet paper dispenser on Wall….......... /other location (specify)
Height above finished floor surface….............mm
Distance from corner of back wall......….........mm
6.5. Other
7. Basin/Vanity:
7.1. Retain existing basin or vanity position /Install new basin/Install new vanity
7.2. Install a new wall mounted/pedestal/corner hand basin on Wall ….......
Width of basin to be...................mm and length to be.................mm
Height of rim of basin above finished floor surface to be.............mm
Centreline of basin to be ……................mm from corner of Walls…….................. and….…................
Specify type (if applicable)
Additional specifications (eg depth of basin)
OR
Install a new vanity on Wall ……..
Side of vanity to be ….......mm from corner of Walls…........ and ...…….
Dimensions Height …........mm x Width ….........mm x Depth ….........mm
Specify type (if applicable eg vanity bench)
Self-rimming/semi-recessed/under counter style basin with rim ….......mm above finished
floor surface
Position of drawers (if applicable)
Left side/ Right side
Handles type (specify)
7.3. Leg and knee clearance under basin/vanity bench (specify in mm)
7.4. Taps: Capstan/Lever/Flick mixer/Sensor
Specify Type (if applicable)
Standard turn (both taps turn on and off in the same direction)
If not standard turn, specify
Length of lever handle (if applicable)……..mm
Hot and cold water to be delivered through a central mixing spout
Indicators on taps (if applicable):
Specify colour: Red/Blue
Yes/No
OR
Hot /Cold
Yes/ No
Yes/ No
7.5. Other
8. Storage
8.1. Provide a storage cupboard/mirrored shaving cabinet located on Wall …….
Dimensions of cupboard Height ……mm x Width ……...mm x Depth ……...mm
Height of base above finished floor surface to be............mm
Distance of centreline from corner of walls……. and...........to be …...….mm
Wall mounted/Recessed
Handle type (specify)
NSW Home Modifications and Maintenance Services State Council
8.2. Other (eg shelving, robe hook, wall buddy towel storage)
9. Mirror
9.1. Install mirror on wall ………
Dimensions of mirror Height ..........mm x Width ...........mm
Height of base above finished floor surface to be............mm
Distance of centreline from corner of walls……. and ..........to be …...….mm
Additional specifications (eg centred above basin)
9.2. Other (eg shelf/ angled/ mirror cabinet)
10. Grab rails:
10.1 Grab rails in Shower recess
Install a grabrail(s). Horizontal/Vertical/Other (specify)...................................on wall.............
Diameter……....mm
Length of straight grab rail….........mm
Length of components for combined grab rail(s) – Horizontal…......mm
Vertical…..........mm
Height / Lowest fixing point above finished floor surface to be.......... mm
To commence............mm from corner of walls......... and............
10.2 Grabrails outside shower recess
Install a …….mm horizontal grab rail, outside the shower recess on wall..................
eg for towel/support
Diameter ..........mm
Height of top of grabrail above finished bathroom floor surface …...............….mm
To commence.................mm from corner of walls.......... and............
10.3 Grab rails next to toilet
Install a grabrail(s), on the left/right hand side when seated on toilet
Horizontal/Vertical/Angled/other (specify)............................................on wall...........
Diameter…..…..mm
Length of straight grabrail…........mm
Length of components for combined grab rail(s) – Horizontal….......mm
Vertical…...........mm
Angled…............mm
Height/Lowest fixing point above finished floor surface to be....................mm
Height of highest fixing point above finished floor surface (if applicable) to be.............mm
Distance from back wall to be..........mm
10.4 Other grab rails. (Specify as per requirements in 10.3)
11. Water Temperature:
Discuss with builder nominated by the HMMS
11.1 Install a thermostatic mixing valve/tempering valve
11.2 Other
12. Lighting/General Power Outlet (GPO)/Fans/Heating:
Discuss with Builder nominated by the HMMS, prior to prescribing electrical items.
NSW Home Modifications and Maintenance Services State Council
12.1 Retain existing light switch/ Install new light switch
12.2 New light switch to be located on wall ……../hallway/other (specify)
Height above finished bathroom floor surface ……......mm.
Distance from corner of walls ……...and ......... to be..........mm
Type of switch Standard/Rocker action/Toggle switch/ push-pad switch
Additional specifications
12.3 Retain existing GPO/ Remove existing GPO/ Install new GPO
12.4 New GPO to be located (eg within mirrored cabinet, inside vanity)
Height above finished floor surface...........mm
Distance from corner of walls...........and ............to be...........mm
Other specify (eg shaving outlet)
12.5 Install three-in-one light, heating and exhaust fan
Yes / No
Additional specifications
12.6 Task lighting (if applicable)
12.7 Other
13.
Additional Information:
NSW Home Modifications and Maintenance Services State Council
Appendix A BATH (if applicable):
A.1
Retain existing bath/ Install new bath
A.2
Install new bath long side on Wall........... (as per diagram............)
Length ….mm x Width…..mm
Height of rim of bath above finished floor surface ….....mm
Specify type (if applicable)
A.3
Install taps on Wall..............
Capstan/Lever/Flick mixer
Specify type (if applicable)
Standard turn (both taps turn on and off in the same direction)
If not standard turn, specify
Yes/No
Length of lever (if applicable)……...............mm
Indicators on taps:
Specify colour: Red/Blue
Yes/No
OR Hot /Cold
Yes/ No
Position of taps:
Distance from corner of walls …….. and ..........to be...........mm
Height above rim of bath ….....….mm
Hot and cold water to be delivered through a central mixing spout.
A.4
Install grabrails. Horizontal/Vertical/Other (specify)...................................on wall..........
(as per elevation............)
Diameter……....mm
Length of straight grab rail….........mm
Length of components for combined grab rail(s) - Horizontal…..........mm
Vertical…..............mm
Angled…...............mm
Height /Lowest fixing point above finished floor surface to be..............mm
Highest fixing point above finished floor surface to be......................mm (if applicable)
Grab rail to commence.................mm from corner of walls............ and ............
A.5
Install a hand held shower hose (HHSH) ..............mm in length, mounted on Wall.……
and to be either:
Shower head support grab rail
Length ..……..mm
Lowest fixing point above finished floor surface …..........mm
Distance from corner of walls……. and ......... to be............mm
OR
Hook/peg to be located …….mm above finished floor surface. Distance from corner of
walls .......... and.......... to be…….mm.
OR
2nd hook/peg to be located …….mm above finished floor surface.
NSW Home Modifications and Maintenance Services State Council
Distance from corner of wall...........and wall............to be.....…….mm.
A.6
Install a soap holder. Wall mounted/recessed on Wall ….......
Height of base of soap holder to be ……...mm above the rim of the bath.
Distance from corner of walls …….... and...........to be …….....mm.
Specify type (if applicable)
OR
Supply and install soap holder on shower head support grab rail
A.7
Other (e.g. additional grabrails, shower curtain rail)
NSW Home Modifications and Maintenance Services State Council
Appendix B BIDET (if applicable)
Discuss requirements with Builder nominated by HMMS
B.1
Install bidet seat on toilet / or install combined toilet bidet
B.2
Specify for bidet seat on toilet
Specify location
Type..................................... (Compatible with toilet)
Supplier (if applicable)
Weight capacity.............................kg
Shape of bidet seat - round/elongated/large/other (specify)
Height of top of Bidet seat above finished floor surface................mm
Controls:
Right/ Left on seat
Or
Wall mounted remote control
Yes/No
Locate on wall.............Height above finished floor surface ........mm
Distance from back wall.......mm
Other (specify)
General Power Outlet (GPO)
Utilise existing GPO (within 1500mm of toilet)
OR
Install new GPO on right/ left side of seated client (opposite to water tap preferred, within 1500
mm of toilet)
Locate on Wall.............commencing.................mm from corner of walls................and......................
Height above finished floor surface to be...........mm
Distance from walls........... and...........to be ..........mm
Filter anti bacterial/ standard/ mesh
Specify additional aides for mountings eg.support arms (standard/ splayed, fold down); raised
toilet seat
B.3
Specify for separate bidet
Specify Type
Weight capacity...............................kg
Locate on wall........... (as per diagram.........)
Set out from side wall..............to be.............mm
Set out from back wall to be.............mm
Wall/ floor mounted
Height of top of pan above finished floor surface.................mm.
NSW Home Modifications and Maintenance Services State Council
Tap system- mixer/ extended lever tap/ flexible hose/other (specify)
Flush control location. Specify (if applicable)
B.4.
Specify for combined toilet bidet
Locate on wall.............. (as per diagram.........)
Specify Type
Weight capacity.............................kg
Specify location
Distance from Wall …........to centre line of toilet to be 450 mm/for bariatric client …….....mm (if
applicable)
Distance from back wall to front of toilet pan..............mm (consider bariatric needs)
Height of bidet seat above finished floor surface............mm
Flush control location. Specify (if applicable)
B.5
Install toilet paper dispenser on Wall….......
Height above finished floor surface….........mm
Distance from corner of walls..............and.............to be .............mm
B.6
Install a grab rail (s) Horizontal/Vertical/Other (specify).............................on wall..........................
(as per elevation.................)
Diameter….....mm
Length of straight grab rail…........mm
Length of components for combined grab rail(s) - Horizontal…...................mm
Vertical…......................mm
Angled….......................mm
Height / Lowest fixing point to be..............mm above finished floor surface
Highest fixing point to be............mm above finished floor surface (if applicable)
To commence.................mm from corner of walls.............. and ..............
NOTE: If prescribing a bidet seat on toilet, include specifications for grab rails in point 10.
B.7
Other
Disclaimer: The recommendations contained in this form are made after consultation with the client and an investigation of the client’s
circumstances and needs. Their purpose is to outline steps required to be taken for the benefit of the client, having regard for his or her
disabilities. They do not purport to reflect other than limited knowledge on the part of the Occupational Therapist of structural considerations
and building codes. Any queries, concerns or alterations considered necessary for compliance with current building regulations must be
discussed with the Occupational Therapist before quoting for the cost of the work and before the work proceeds. The Occupational Therapist
accepts no responsibility for supervision of the work or for the quality of the workmanship.
NSW Home Modifications and Maintenance Services State Council
NOTE: Attached to these written specifications are:
1. The following diagrammatical specifications (please tick):
NB: All diagrams must be to scale
□ Existing bathroom floor plan (Mandatory)
□ Proposed bathroom floor plan (Mandatory)
□ Changes to spaces adjacent to bathroom eg hallway, bedroom, doorways (Mandatory)
Also elevations (full or partial) of any wall that requires modification, as appropriate
(please tick)
□ Elevation Wall A
□ Elevation Wall B
□ Elevation Wall C
□ Elevation Wall D
2. Photographs of existing bathroom and other areas relevant to the modification
requested, (eg hallway adjacent to bathroom doorway), if available (please tick)
□ Photographs
Forward these completed written specifications to your Level 1 HMMS with the
following:
1) CIARR or equivalent information
2) OT Report and Checklist for Major Home Modifications and
3) Diagrammatical specifications
The level 1 HMMS will forward all documentation to the level 2 HMS.
The OT Report and Checklist for Major Home Modifications is available for download as a word
document from State Councils website www.nswhmms.org