Veterans Affairs



Attachment 2SPH EQUIPMENT PM CHECKLISTEquipment Name/Location: ARJO STEDYDate: FORMTEXT ????? EE/Serial #: FORMTEXT ?????ACTION/CHECKEVERY 12 MONTHSEVERY 2 YEARSEVERY 3 YEARSCarry out a visual inspection of all external parts. All functions must be tested for correct operation, to ensure no adverse damage has occurred during previous use. FORMCHECKBOX FORMCHECKBOX FORMTEXT ?????Make sure all casters rotate freely and the two rear brakes lock. FORMCHECKBOX FORMCHECKBOX FORMTEXT ?????Examine all exposed parts, especially where there is personal contact with the patient's body. Make sure no cracks or sharp edges have developed that could cause patient or user injury or have become unhygienic. Replace where necessary and decontaminate. FORMCHECKBOX FORMCHECKBOX FORMTEXT ?????Make sure all external fittings are secure and that all screws and nuts are tight. FORMCHECKBOX FORMCHECKBOX FORMTEXT ?????Make sure the casters are firmly secured to the chassis. FORMCHECKBOX FORMCHECKBOX FORMTEXT ?????Make sure all instruction labels are firmly attached and in good readable condition. Replace when necessary. FORMCHECKBOX FORMCHECKBOX FORMTEXT ?????Inspect the two sling attachment points. If worn or damaged, replace with new. FORMCHECKBOX FORMCHECKBOX FORMTEXT ?????SPH EQUIPMENT PM CHECKLISTEquipment Name/Location: SARA PLUS FLOOR LIFTDate: FORMTEXT ????? EE/Serial #: FORMTEXT ?????ACTION/CHECKEVERY 12 MONTHSEVERY 2 YEARSEVERY 3 YEARSTest the Automatic Stop Function as follows. With the Arc-Rest raised well above its lowest position, using the cable remote control handset lower the Arc-Rest, at the same time with your other hand, hold the Arc-Rest up for about five seconds. The motor will continue to run while the Arc-rest is held up and does not move. Release the button, the Arc- Rest must remain in its previously restrained position. Repeat the test this time using the Dual Control Panel lower buttons. FORMCHECKBOX FORMCHECKBOX FORMTEXT ?????Test the emergency stop facility by operating the cable remote control handset to lift or lower the Arc-Rest, whilst operating press the emergency stop button. Powered movement must stop immediately. Reset by pressing the green reset button. Repeat the test this time operating the chassis legs to open or close. FORMCHECKBOX FORMCHECKBOX FORMTEXT ?????Examine the two sling attachment points in the Lower Lift Arm. If found loose torque tighten to 20 Nm (15lb ft), or if damaged replace with new. See Fig. 2, item Cx2. FORMCHECKBOX FORMCHECKBOX FORMTEXT ?????Examine the manoeuvring handle for security, if loose torque tighten the two retaining screws to 20 Nm (15lb ft). See Fig. 3, item Dx2. FORMCHECKBOX FORMCHECKBOX FORMTEXT ?????Examine the Foot Bracket assembly for operation and for fitment to the mast. FORMCHECKBOX FORMCHECKBOX FORMTEXT ?????Make sure the chassis legs are square to the chassis member, also the commode frame will locate freely into its location holes in the chassis legs. Adjust if required. FORMCHECKBOX FORMCHECKBOX FORMTEXT ?????Where scales are installed, check the accuracy of the unit and recalibrate if required. FORMCHECKBOX FORMCHECKBOX FORMTEXT ?????Do a torque tightening check of the following:Castors to the chassis and legs 4 off - 25Nm (18lb ft). Fig. 5, item Ex4.Chassis leg pivot bolts 2 off - 47Nm (35lb ft). Fig. 5, item Fx2.Scale or block attachment bolts 2 off to Chassis - 70Nm (51lb ft). Fig 5, item Gx2.Note:To carry out check c) above,will require the removal of the legs and leg actuator.Centering/Stop unit for leg actuator, to chassis countersunk screws, 2 off, - 10Nm (7lb ft). Fig 6, item Ax2Upper lift arm to trailing arm plates attachment Hex head & countersunk screws - 20Nm (15lb ft). Fig. 1, item Hx4.Lower arm lift to pivot arm assembly attachment Hex head & countersunk screws - 20Nm (15lb ft). Fig. 2, item Ix4. FORMCHECKBOX FORMCHECKBOX FORMTEXT ?????Lubricate the attachment points for the footboard and the mounting shaft for the kneepad with silicone grease. See Fig. 4. FORMCHECKBOX FORMCHECKBOX FORMTEXT ?????Replace the 4 off nylon slide blocks attached to the PLA housing assembly (see Fig. 1) with new unused slide blocks. Make sure the 4 off attachment screws are torque tightened to 20Nm (1 5lb ft). See Fig. 1, item Bx4. FORMCHECKBOX FORMCHECKBOX FORMTEXT ?????Replace the Rear Pivot bearing assembly attached to the pivot arm assembly. Make sure the Nyloc nut is torque tightened to 20 Nm (15lb ft). See Fig. 2, item A FORMCHECKBOX FORMCHECKBOX FORMTEXT ?????Lubricate the rear pivot bearing and actuator slide blocks and tracks with LM grease. See Fig. 2. FORMCHECKBOX FORMCHECKBOX FORMTEXT ?????Examine the hydraulic actuator for an oil leak. A small amount of discharge onto the felt pad is acceptable but recommend the felt pad be replaced. If a large oil leak is found the actuator must be replaced.Note:The specified maintenanceinstructions are in addition to the daily and weekly maintenance instructions that are specified in the lift operating manual. FORMCHECKBOX FORMCHECKBOX FORMTEXT ?????SPH EQUIPMENT PM CHECKLISTEquipment Name/Location: MIRANTI FLOOR LIFT/Date: FORMTEXT ????? EE/Serial #: FORMTEXT ?????ACTION/CHECKEVERY 12 MONTHSEVERY 2 YEARSEVERY 3 YEARSReplace brake pads FORMCHECKBOX FORMCHECKBOX FORMTEXT ?????Perform a safe working load test (local requirements) FORMCHECKBOX FORMCHECKBOX FORMTEXT ?????Lubricate inner profile FORMCHECKBOX FORMCHECKBOX FORMTEXT ?????Check battery and battery charger FORMCHECKBOX FORMCHECKBOX FORMTEXT ?????Check scale calibration (if attached and not verified) FORMCHECKBOX FORMCHECKBOX FORMTEXT ?????Check all vital parts for corrosion/damage FORMCHECKBOX FORMCHECKBOX FORMTEXT ?????Perform full feature functionality test FORMCHECKBOX FORMCHECKBOX FORMTEXT ?????Check mechanical attachments FORMCHECKBOX FORMCHECKBOX FORMTEXT ?????Check that the latest upgrades have been implemented FORMCHECKBOX FORMCHECKBOX FORMTEXT ?????Check the safety stop function FORMCHECKBOX FORMCHECKBOX FORMTEXT ?????Check the emergency High/Low function FORMCHECKBOX FORMCHECKBOX FORMTEXT ?????Replace winch hook and rope FORMCHECKBOX FORMCHECKBOX FORMTEXT ?????Replace wheel parts* FORMCHECKBOX FORMCHECKBOX FORMTEXT ?????Replace guide pieces, lower bushing and outer profile seal FORMCHECKBOX FORMCHECKBOX FORMTEXT ?????Replace the plastic cross on the actuator FORMCHECKBOX FORMCHECKBOX FORMTEXT ?????Check the power drive wheel FORMCHECKBOX FORMCHECKBOX FORMTEXT ?????Lubricate the cog wheels on the winch FORMCHECKBOX FORMCHECKBOX FORMTEXT ?????Lubricate the spiral cables FORMCHECKBOX FORMCHECKBOX FORMTEXT ?????* NOTE! Wheels may require more or less frequent service/replacement, due to heavy use of the product and exposure to aggressive environmentSPH EQUIPMENT PM CHECKLISTEquipment Name/Location: MAXI SKY 600/1000 CEILING LIFTDate: FORMTEXT ????? EE/Serial #: FORMTEXT ?????ACTION/CHECKEVERY 12 MONTHSEVERY 2 YEARSEVERY 3 YEARSINSPECTIONS FOR LIFT CASSETTE AND TRACK SYSTEM: FORMCHECKBOX FORMCHECKBOX INSPECT FOR EVIDENCE OF EXTERNAL DAMAGE, MISSING PARTS OR BROCKEN PANELS. FORMCHECKBOX FORMCHECKBOX FORMTEXT ?????MAKE SURE THAT END STOPPERS AND RAIL CAPS ARE IN PLACE AND TIGHTENED. FORMCHECKBOX FORMCHECKBOX FORMTEXT ?????INSPECT WHEELS IN RAIL FOR DAMAGE, RUST OR CRACKS. REPLACE IN DAMAGED. FORMCHECKBOX FORMCHECKBOX FORMTEXT ?????CLEAN THE RAIL AND THE CLIP-ON CHARGING STATION CONTACTS. FORMCHECKBOX FORMCHECKBOX FORMTEXT ?????INSPECT SPREADER BAR ON THE STRAP OF THE LIFT FOR DAMAGE OR CRACKS. MAKE SURE ALL ATTACHMENTS ARE PROPERLY SECURED (e.g. split ring). FORMCHECKBOX FORMCHECKBOX FORMTEXT ?????INSPECTION FOR LIFT CASSETTE: FORMCHECKBOX FORMCHECKBOX REPLACE STRAP. FORMCHECKBOX FORMCHECKBOX FORMTEXT ?????INSPECT FRAME PARTS INTERLOCK AND HARDWARE FOR MALFUNCTION AND MAKE SURE THERE ARE NO PARTS MISSING. FORMCHECKBOX FORMCHECKBOX FORMTEXT ?????INSPECT GEARS FOR WEAR. FORMCHECKBOX FORMCHECKBOX FORMTEXT ?????INSPECT CONNECTING JOINTS FOR PROPER ATTACHMENT (TROLLEY AND SPREADER BAR). FORMCHECKBOX FORMCHECKBOX FORMTEXT ?????VERIFY THAT THE EMERGENCY BRAKE ON THE DRUM IS TURNING FREELY. FORMCHECKBOX FORMCHECKBOX FORMTEXT ?????VERIFY THE EMERGENCY BRAKE. FORMCHECKBOX FORMCHECKBOX FORMTEXT ?????VERIFY THE EMERGENCY LOWERING MECHANISM. FORMCHECKBOX FORMCHECKBOX FORMTEXT ?????VERIFY ALTERNATIVE UP AND DOWN BUTTONS ON CASSETTE. FORMCHECKBOX FORMCHECKBOX FORMTEXT ?????LOAD TEST WITH THE SWL (SAFE WORKING LOAD) RECOMMENDED. FORMCHECKBOX FORMCHECKBOX FORMTEXT ?????INSPECTIONS FOR RAILS: FORMCHECKBOX FORMCHECKBOX FORMTEXT ?????TORQUE END STOPPERS TO 20 N. m. (15lbf.ft.). FORMCHECKBOX FORMCHECKBOX FORMTEXT ?????MAKE SURE THAT THE BRACKET LOCKING DEVISE IS NOT VISIBLE. FORMCHECKBOX FORMCHECKBOX FORMTEXT ?????MAKE SURE RAIL JOINTS ARE CLOSED AND THAT THE SPRING PINS ARE CENTERED. FORMCHECKBOX FORMCHECKBOX FORMTEXT ?????MAKE SURE THE RAIL IS STRAIGHT WHEN IT IS NOT LOADED, FORMCHECKBOX FORMCHECKBOX FORMTEXT ?????MAKE SURE THE ADJUSTED LOAD SETTING OF THE LIFT IS EQUAL OR LOWER THAN THE SAFE WORKING LOAD OF THE INSTALLATION. FORMCHECKBOX FORMCHECKBOX FORMTEXT ?????CHECK THAT THE ACCESSORIES (TURNTABLE AND EXCHANGER) ARE COMPLETE AND CORRECTLY MAINTAINED. FORMCHECKBOX FORMCHECKBOX FORMTEXT ?????MAKE SURE THAT THE ATTACHMENTS (CEILING BRACKETS, WALL POST, WALL BRACKETS) HAVE NO BEEN DISPLACED. FORMCHECKBOX FORMCHECKBOX FORMTEXT ?????INSPECT TRACK END STOPPERS. INSPECT AND TIGHTEN HARDWARE (IF NECESSARY). FORMCHECKBOX FORMCHECKBOX SPH EQUIPMENT PM CHECKLISTEquipment Name/Location: ARJO ALENTIDate: FORMTEXT ?????EE/Serial #: FORMTEXT ?????ACTION/CHECKEVERY 12 MONTHSEVERY 2 YEARSEVERY 3 YEARSVisually check all exposed partsCheck of mechanical attachmentsCheck handset and cable Check battery charger and battery FORMCHECKBOX FORMCHECKBOX FORMTEXT ?????Check wheels and swivel, clean and lubricateReplace brake pads FORMCHECKBOX FORMCHECKBOX FORMTEXT ?????Perform a safe working load test (local requirements) FORMCHECKBOX FORMCHECKBOX FORMTEXT ?????Lubricate inner profile FORMCHECKBOX FORMCHECKBOX FORMTEXT ?????Check scale calibration (if attached and not verified) FORMCHECKBOX FORMCHECKBOX FORMTEXT ?????Check all vital parts for corrosion/damage FORMCHECKBOX FORMCHECKBOX FORMTEXT ?????Perform full feature functionality test andcheck mechanical attachments FORMCHECKBOX FORMCHECKBOX FORMTEXT ?????Check that the latest upgrades have been implemented FORMCHECKBOX FORMCHECKBOX FORMTEXT ?????Check the safety stop function FORMCHECKBOX FORMCHECKBOX FORMTEXT ?????Replace wheels* FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX *Replace guide pieces, lower bushing and outer profile seal FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Replace the plastic cross on the actuator FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX *NOTE! Wheels may require more or less frequent service/replacement, due to heavy use of the product and exposure to aggressive environment. ANNUAL INSPECTION INSTRUCTIONS FOR GH3 1) Rail System. Inspect all bracket fixings to wall and/or ceiling, rails and stabilizers for tightness. Inspect and retighten the end-stops and make sure they are secure with roll pins. Inspect at all rail connections to ensure correct positioning of the rail connectors and pins. Find the label where the max capacity of the rail is stated and perform a weight test with similar weight. Hang the rated load of the rail system and drive it through the entire system while visually controlling that any bracket gives up to the weight. If the installation does not have the label, use the hoist capacity and the distance between supports as a guide and perform a weight test with a weight equivalent to 1.5 the selected max capacity for 5 minutes at each bracket locating the weight as close as possible to the bracket. If there is a combi-lock, switch track or turn-table in the installation, it should be considered as connecting to a second system and must be test accordingly. After the weight test Inspect level of the rail system with a laser or a box level at least 6 feet long. Mark the rail system with one label stating clearly the max capacity and the next inspection date. Inspect that the rated load of the hoist is less than or equal to the rated load of the rail system. 2) Electrical Connections. Inspect for broken wires, striped insulation and ground connection. Inspect that all cables are secured. 3) Hoist. Remove all covers and inspect all the snap rings and or E-clips between trolley and hoist. Remember snap rings must not be re-used; E-clips can be reused. Insure the strap is properly fitted to the shaft of the hoist and there is a locking ring securing the strap. To do this you have to move the print base out of the way. Perform a full lifting cycle with the rated load of the hoist and listen any abnormal sounds from the hoist and that the hoist can lift the load without any problem. This is, going up all the way until the hoist stops by the end stop switch and going down until the hoist stops by the end stop down. While going up pull the string for the emergency stop and make sure the hoist stops. Do the same in the down direction. After the emergency stop and while the hoist is off, pull the emergency lowering string and make sure the hoist is lowering at a low speed. Place a sticker which includes the next inspection date and your initials. 4) Strap Inspect the whole length of the strap for frayed, hard spots, broken stitches, cut threads and deformations. Inspect the connection of the strap and the hanger. Make sure the Allen screws are tight, if applicable. 5) Lifting Hanger Inspect the welding and sling attachments points for cracks and deformations. Inspect the space between hanger and swivel and make sure the hanger in not wobbling. 6) Combi-Locks, if applicable make sure the safety locks open and close easily manually and electrically whichever is applicable. Make sure they do not open while the traverse is not present. Inspect for corrosion. Inspect attachment to rail. SPH EQUIPMENT PM CHECKLISTEquipment Name/Location: ARJO CarendoDate: FORMTEXT ????? EE/Serial #: FORMTEXT ?????ACTION/CHECKEVERY 12 MONTHSEVERY 2 YEARSEVERY 3 YEARSVisually check all exposed partsCheck of mechanical attachmentsCheck handset and cable Check battery charger and battery FORMCHECKBOX FORMCHECKBOX FORMTEXT ?????Check wheels and swivel, clean and lubricate. Replace wheels recommended.Check cushion/pillowsLubricate locking pins FORMCHECKBOX FORMCHECKBOX FORMTEXT ?????Perform a safe working load test (local requirements)Check the safety stop functionCheck function of emergency lowering FORMCHECKBOX FORMCHECKBOX FORMTEXT ?????Lubricate inner profile: locking pinsVisually check safety strap FORMCHECKBOX FORMCHECKBOX FORMTEXT ?????Check scale calibration (if attached and not verified) FORMCHECKBOX FORMCHECKBOX FORMTEXT ?????Check all vital parts for corrosion/damageCheck that the latest updates have been implemented FORMCHECKBOX FORMCHECKBOX FORMTEXT ?????Perform full feature functionality test andcheck mechanical attachments FORMCHECKBOX FORMCHECKBOX FORMTEXT ?????SPH EQUIPMENT PM CHECKLISTEquipment Name/Location:Bath TrolleyDate: FORMTEXT ????? EE/Serial #: FORMTEXT ?????ACTION/CHECKEVERY 12 MONTHSEVERY 2 YEARSEVERY 3 YEARSExamine the Bath Trolley for damage FORMCHECKBOX FORMCHECKBOX FORMTEXT ?????Check that all screws and nuts are tightened and that there are no gaps. FORMCHECKBOX FORMCHECKBOX FORMTEXT ?????Test normal operation: Raise and lower the Lift Bath Trolley FORMCHECKBOX FORMCHECKBOX FORMTEXT ?????Check the mattress to make sure there are no cracks or tears that would allow water to get into the filing. If there is damage, replace the mattress. FORMCHECKBOX FORMCHECKBOX FORMTEXT ?????SPH EQUIPMENT PM CHECKLISTEquipment Name/Location: ARJO Rhapsody: WhirlpoolDate: FORMTEXT ????? EE/Serial #: FORMTEXT ?????ACTION/CHECKEVERY 12 MONTHSEVERY 2 YEARSEVERY 3 YEARSLubricate moving partsCheck/replace seal kit or complete shower handleCheck oil level FORMCHECKBOX FORMCHECKBOX FORMTEXT ?????Check all vital parts for corrosion and damagePerform full feature functionality testCheck mechanical attachments FORMCHECKBOX FORMCHECKBOX FORMTEXT ?????Check that the latest updates have been implementedCheck function of emergency lowering FORMCHECKBOX FORMCHECKBOX FORMTEXT ?????Check/adjust thermostatic mixer incl.seal kit/complete thermostatic unit Check/replace flow restrictors FORMCHECKBOX FORMCHECKBOX FORMTEXT ?????Check valves and membranes, replace if necessaryCheck dosage disinfectant FORMCHECKBOX FORMCHECKBOX FORMTEXT ?????Check hoses and connections for leaks and damage FORMCHECKBOX FORMCHECKBOX FORMTEXT ?????Check the earth wiring connection FORMCHECKBOX FORMCHECKBOX FORMTEXT ?????Check/clean filters, incoming water FORMCHECKBOX FORMCHECKBOX FORMTEXT ?????Replace batteries FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX SPH EQUIPMENT PM CHECKLISTEquipment Name/Location: ARJO Shower PanelDate: FORMTEXT ????? EE/Serial #: FORMTEXT ?????ACTION/CHECKEVERY 12 MONTHSEVERY 2 YEARSEVERY 3 YEARSCheck and if necessary adjust thermostatic mixer and thermometerCheck/clean filters, incoming water FORMCHECKBOX FORMCHECKBOX FORMTEXT ?????Check/change seal kit or complete shower handleCheck/replace flow restrictor FORMCHECKBOX FORMCHECKBOX FORMTEXT ?????Check/replace flow restrictorsCheck valve, replace if necessaryCheck hoses and connections for leaks and damage FORMCHECKBOX FORMCHECKBOX FORMTEXT ?????Perform full feature functionality testCheck all vital parts for corrosion/damage FORMCHECKBOX FORMCHECKBOX FORMTEXT ?????Check mechanical attachmentsCheck that the latest updates have been implemented FORMCHECKBOX FORMCHECKBOX FORMTEXT ?????Check all vital parts for corrosion/damageCheck that the latest updates have been implemented FORMCHECKBOX FORMCHECKBOX FORMTEXT ?????Check dosage disinfectionCheck back flow prevention FORMCHECKBOX FORMCHECKBOX FORMTEXT ????? ................
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