Northport 2020 PMs.pdf
PDF 2 MB Posted
- Attached to
- J065-- Arjo Patient Lift Preventative Maintenance. Federal contract opportunity
- Solicitation number
- 36C24221Q0471
About this file
This document provides details for a request for quote for preventative maintenance services on Arjo patient lift equipment at the Northport VA Medical Center. The solicitation number is 36C24221Q0471 and will be set aside for Service Disable Veterans Own Small Business. The base period of performance is from March 1, 2021 through February 28, 2022 with four optional one-year extensions. The NAICS code is 811219 with a size standard of $22 million. Questions regarding the RFQ must be submitted in writing by the specified deadline to the identified point of contact. The anticipated award is a firm-fixed price contract to provide preventative maintenance in accordance with the manufacturer's specifications on ceiling-mounted lift equipment at the medical center located at the address provided.
View the file
Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| 36C24221Q0471 0002.docx | DOCX document | |
| 36C24221Q0471 0001.docx | DOCX document | |
| 36C24221Q0471.docx | DOCX document | |
| Past Performance Evaluation Questionnaire.docx | DOCX document | |
| DW 2015-4157.pdf |
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Text version
Corrective and Preventative Maintenance Checklist for Ceiling Mounted Patient Lifts This commissioning for a patient ceiling lift system(s) shall include, but not be limited to, the following points as components of the commissioning procedures.
Verify that ceiling mounted patient lifts are not installed in treatment units with actively suicidal patients.
Structure Complete
Rails/Tracks and Endstops PASS
Lift Unit and Straps
FAIL
PASS FAIL
2020 Patient Lift PM & Load tests
Facility:
Lift Location:
VAMC Contact:
VAMC Contact's Phone Number:
Inspector:
Inspector's Phone Number:
Manufacturer:
Model:
Serial/EE Number:
Mfgr Contact:
Mfgr Contact's Phone Number:
Date:
John Derudder
631-261-4400 x 5544
XX
Arjo
Maxi Sky 600
32748ld481181977
Service Department
Northport VA
B340-200BLD: RM:
Verify proper connections of lift's structural system tot he building's structure (including seismic bracing if applicable).
Verify proper interface at the ceiling (hard deck or soft tile) and proper installation of all protective features around the support rods and rails/tracks.
Verify proper structural components sizing and physical installation to make sure that proper structural system is in place and properly installed to support the lift.
NOTES:
NOTES:
Verification that all fasteners and set screws are properly tightened on the trollies and rails/ tracks.
Ensure that rail/ track is free of gaps (unless required by design). If includedin installation, verify rail turntable function, exchanger function, gate alignment, and safety block installation.
Confirm track is clean and clear of all debris. (Use manufacturer's recommended cleaning materials to avoid damage to the motor case and other components.
Verification that all manufacturer specified end stops or dockking gates are properly installed.
Inspection of lift unit casing for cracks and alignment.
Verification that the lift unit charges properly.
Inspection of activation of hand control for full operation (e.g., up, down, left, right) and "return to charge" function if applicable.
Confirm any and all lift unit indicator lights are functioning. (e.g., red service warning light, charging state light)
Inspection and activation of emergency up/down lift unit control buttons if applicable.
10/9/2020
1-800-323-1245XX
Load Testing
PASS FAIL
needs spreader bar cover
Inspector Complete
VA Representative Complete
Manager of the Service Using the Ceiling Mounted Lifts Complete
SIGNATURE:
TITLE:
Technician
After the activities listed in the above checklist and in the manufactures installation/operations/ owner's manual(s) have been completed, the VA representative shall release the ceiling mounted lift installation to the Manager of the Service using the ceiling mounted lifts..
SIGNATURE:
TITLE:
DATE:
SIGNATURE:
TITLE:
DATE:
Verify and confirm that VA clinical staff have been trained to operate the ceiling mounted patient lift prior to releasing the ceiling mounted lift for use.
NOTES:
NOTES:
Full extension and inspection of lift strap for loose threads or frays.
Inspection of spreader bar and clips for cracks and for loose or missing rings or cotter pins.
Verification of any "soft start" or "soft stop" features and that lifting speed does not exceed 2.5 inches per second with "zero" load.
Verification of load testing and deflection testing at lift listed maximum for each lift unit at its maximum rated lift capacity. Conduct this test in three progressive stages starting with a 100lbs load, then 50% of maximum rated lift capacity, then 100% of maximum rated lift capacity.
Verification of any "soft start" or "soft stop" features and that lifting speed does not exceed 1.5 inches per second under maximum rated lift capacity.
Verification of function of emergency stop at maximum rated lift capacity.
Verification of emergency lowering feature at maximum rated lift capacity.
After the activities listed in the above checklist and in the manufactures installation/operations/ owner's manual(s) have been completed, the inspector shall release the ceiling mounted lift installation to VA representative.
10/9/2020XXX
This commissioning for a patient ceiling lift system(s) shall include, but not be limited to, the following points as components of the commissioning procedures.
Verify that ceiling mounted patient lifts are not installed in treatment units with actively suicidal patients.
Structure Complete
Rails/Tracks and Endstops PASS
Lift Unit and Straps
FAIL
PASS FAIL
2020 Patient Lift PM & Load tests
Facility:
Lift Location:
VAMC Contact:
VAMC Contact's Phone Number:
Inspector:
Inspector's Phone Number:
Manufacturer:
Model:
Serial/EE Number:
Mfgr Contact:
Mfgr Contact's Phone Number:
Date:
John Derudder
631-261-4400 x 5544 xx
Arjo
Maxi Sky 600
31391ld411069530
Service Department
Northport VA
B343-200BLD: RM:
Verify proper connections of lift's structural system tot he building's structure (including seismic bracing if applicable).
Verify proper interface at the ceiling (hard deck or soft tile) and proper installation of all protective features around the support rods and rails/tracks.
Verify proper structural components sizing and physical installation to make sure that proper structural system is in place and properly installed to support the lift.
NOTES:
NOTES:
Verification that all fasteners and set screws are properly tightened on the trollies and rails/ tracks.
Ensure that rail/ track is free of gaps (unless required by design). If includedin installation, verify rail turntable function, exchanger function, gate alignment, and safety block installation.
Confirm track is clean and clear of all debris. (Use manufacturer's recommended cleaning materials to avoid damage to the motor case and other components.
Verification that all manufacturer specified end stops or dockking gates are properly installed.
Inspection of lift unit casing for cracks and alignment.
Verification that the lift unit charges properly.
Inspection of activation of hand control for full operation (e.g., up, down, left, right) and "return to charge" function if applicable.
Confirm any and all lift unit indicator lights are functioning. (e.g., red service warning light, charging state light)
Inspection and activation of emergency up/down lift unit control buttons if applicable.
1-800-323-1245xx
Load Testing
PASS FAIL
Inspector Complete
VA Representative Complete
Manager of the Service Using the Ceiling Mounted Lifts Complete
SIGNATURE:
TITLE:
Technician
After the activities listed in the above checklist and in the manufactures installation/operations/ owner's manual(s) have been completed, the VA representative shall release the ceiling mounted lift installation to the Manager of the Service using the ceiling mounted lifts..
SIGNATURE:
TITLE:
DATE:
SIGNATURE:
TITLE:
DATE:
Verify and confirm that VA clinical staff have been trained to operate the ceiling mounted patient lift prior to releasing the ceiling mounted lift for use.
NOTES:
NOTES:
Full extension and inspection of lift strap for loose threads or frays.
Inspection of spreader bar and clips for cracks and for loose or missing rings or cotter pins.
Verification of any "soft start" or "soft stop" features and that lifting speed does not exceed 2.5 inches per second with "zero" load.
Verification of load testing and deflection testing at lift listed maximum for each lift unit at its maximum rated lift capacity. Conduct this test in three progressive stages starting with a 100lbs load, then 50% of maximum rated lift capacity, then 100% of maximum rated lift capacity.
Verification of any "soft start" or "soft stop" features and that lifting speed does not exceed 1.5 inches per second under maximum rated lift capacity.
Verification of function of emergency stop at maximum rated lift capacity.
Verification of emergency lowering feature at maximum rated lift capacity.
After the activities listed in the above checklist and in the manufactures installation/operations/ owner's manual(s) have been completed, the inspector shall release the ceiling mounted lift
10/9/2020xx
This commissioning for a patient ceiling lift system(s) shall include, but not be limited to, the following points as components of the commissioning procedures.
Verify that ceiling mounted patient lifts are not installed in treatment units with actively suicidal patients.
Structure Complete
Rails/Tracks and Endstops PASS
Lift Unit and Straps
FAIL
PASS FAIL
2020 Patient Lift PM & Load tests
Facility:
Lift Location:
VAMC Contact:
VAMC Contact's Phone Number:
Inspector:
Inspector's Phone Number:
Manufacturer:
Model:
Serial/EE Number:
Mfgr Contact:
Mfgr Contact's Phone Number:
Date:
John Derudder
631-261-4400 x 5544
XX
Arjo
Maxi Sky 600
32749ld481181951
Service Department
Northport VA
B344-200BLD: RM:
Verify proper connections of lift's structural system tot he building's structure (including seismic bracing if applicable).
Verify proper interface at the ceiling (hard deck or soft tile) and proper installation of all protective features around the support rods and rails/tracks.
Verify proper structural components sizing and physical installation to make sure that proper structural system is in place and properly installed to support the lift.
NOTES:
NOTES:
Verification that all fasteners and set screws are properly tightened on the trollies and rails/ tracks.
Ensure that rail/ track is free of gaps (unless required by design). If includedin installation, verify rail turntable function, exchanger function, gate alignment, and safety block installation.
Confirm track is clean and clear of all debris. (Use manufacturer's recommended cleaning materials to avoid damage to the motor case and other components.
Verification that all manufacturer specified end stops or dockking gates are properly installed.
Inspection of lift unit casing for cracks and alignment.
Verification that the lift unit charges properly.
Inspection of activation of hand control for full operation (e.g., up, down, left, right) and "return to charge" function if applicable.
Confirm any and all lift unit indicator lights are functioning. (e.g., red service warning light, charging state light)
Inspection and activation of emergency up/down lift unit control buttons if applicable.
Load Testing
PASS FAIL
changed batteries needs spreader bar cover
Inspector Complete
VA Representative Complete
Manager of the Service Using the Ceiling Mounted Lifts Complete
SIGNATURE:
TITLE:
Technician
After the activities listed in the above checklist and in the manufactures installation/operations/ owner's manual(s) have been completed, the VA representative shall release the ceiling mounted lift installation to the Manager of the Service using the ceiling mounted lifts..
SIGNATURE:
TITLE:
DATE:
SIGNATURE:
TITLE:
DATE:
Verify and confirm that VA clinical staff have been trained to operate the ceiling mounted patient lift prior to releasing the ceiling mounted lift for use.
NOTES:
NOTES:
Full extension and inspection of lift strap for loose threads or frays.
Inspection of spreader bar and clips for cracks and for loose or missing rings or cotter pins.
Verification of any "soft start" or "soft stop" features and that lifting speed does not exceed 2.5 inches per second with "zero" load.
Verification of load testing and deflection testing at lift listed maximum for each lift unit at its maximum rated lift capacity. Conduct this test in three progressive stages starting with a 100lbs load, then 50% of maximum rated lift capacity, then 100% of maximum rated lift capacity.
Verification of any "soft start" or "soft stop" features and that lifting speed does not exceed 1.5 inches per second under maximum rated lift capacity.
Verification of function of emergency stop at maximum rated lift capacity.
Verification of emergency lowering feature at maximum rated lift capacity.
After the activities listed in the above checklist and in the manufactures installation/operations/ owner's manual(s) have been completed, the inspector shall release the ceiling mounted lift
10/9/2020XX
This commissioning for a patient ceiling lift system(s) shall include, but not be limited to, the following points as components of the commissioning procedures.
Verify that ceiling mounted patient lifts are not installed in treatment units with actively suicidal patients.
Structure Complete
Rails/Tracks and Endstops PASS
Lift Unit and Straps
FAIL
PASS FAIL
2020 Patient Lift PM & Load tests
Facility:
Lift Location:
VAMC Contact:
VAMC Contact's Phone Number:
Inspector:
Inspector's Phone Number:
Manufacturer:
Model:
Serial/EE Number:
Mfgr Contact:
Mfgr Contact's Phone Number:
Date:
John Derudder
631-261-4400 x 5544
XX
Arjo
Maxi Sky 600
32750ld481181949
Service Department
Northport VA
B345-200BLD: RM:
Verify proper connections of lift's structural system tot he building's structure (including seismic bracing if applicable).
Verify proper interface at the ceiling (hard deck or soft tile) and proper installation of all protective features around the support rods and rails/tracks.
Verify proper structural components sizing and physical installation to make sure that proper structural system is in place and properly installed to support the lift.
NOTES:
NOTES:
Verification that all fasteners and set screws are properly tightened on the trollies and rails/ tracks.
Ensure that rail/ track is free of gaps (unless required by design). If includedin installation, verify rail turntable function, exchanger function, gate alignment, and safety block installation.
Confirm track is clean and clear of all debris. (Use manufacturer's recommended cleaning materials to avoid damage to the motor case and other components.
Verification that all manufacturer specified end stops or dockking gates are properly installed.
Inspection of lift unit casing for cracks and alignment.
Verification that the lift unit charges properly.
Inspection of activation of hand control for full operation (e.g., up, down, left, right) and "return to charge" function if applicable.
Confirm any and all lift unit indicator lights are functioning. (e.g., red service warning light, charging state light)
Inspection and activation of emergency up/down lift unit control buttons if applicable.
Load Testing
PASS FAIL
Inspector Complete
VA Representative Complete
Manager of the Service Using the Ceiling Mounted Lifts Complete
SIGNATURE:
TITLE:
Technician
After the activities listed in the above checklist and in the manufactures installation/operations/ owner's manual(s) have been completed, the VA representative shall release the ceiling mounted lift installation to the Manager of the Service using the ceiling mounted lifts..
SIGNATURE:
TITLE:
DATE:
SIGNATURE:
TITLE:
DATE:
Verify and confirm that VA clinical staff have been trained to operate the ceiling mounted patient lift prior to releasing the ceiling mounted lift for use.
NOTES:
NOTES:
Full extension and inspection of lift strap for loose threads or frays.
Inspection of spreader bar and clips for cracks and for loose or missing rings or cotter pins.
Verification of any "soft start" or "soft stop" features and that lifting speed does not exceed 2.5 inches per second with "zero" load.
Verification of load testing and deflection testing at lift listed maximum for each lift unit at its maximum rated lift capacity. Conduct this test in three progressive stages starting with a 100lbs load, then 50% of maximum rated lift capacity, then 100% of maximum rated lift capacity.
Verification of any "soft start" or "soft stop" features and that lifting speed does not exceed 1.5 inches per second under maximum rated lift capacity.
Verification of function of emergency stop at maximum rated lift capacity.
Verification of emergency lowering feature at maximum rated lift capacity.
After the activities listed in the above checklist and in the manufactures installation/operations/ owner's manual(s) have been completed, the inspector shall release the ceiling mounted lift
This commissioning for a patient ceiling lift system(s) shall include, but not be limited to, the following points as components of the commissioning procedures.
Verify that ceiling mounted patient lifts are not installed in treatment units with actively suicidal patients.
Structure Complete
Rails/Tracks and Endstops PASS
Lift Unit and Straps
FAIL
PASS FAIL
2020 Patient Lift PM & Load tests
Facility:
Lift Location:
VAMC Contact:
VAMC Contact's Phone Number:
Inspector:
Inspector's Phone Number:
Manufacturer:
Model:
Serial/EE Number:
Mfgr Contact:
Mfgr Contact's Phone Number:
Date:
John Derudder
631-261-4400 x 5544
XX
Arjo
Maxi Sky 600
32751ld481181964
Service Department
Northport VA
B345-200BLD: RM:
Verify proper connections of lift's structural system tot he building's structure (including seismic bracing if applicable).
Verify proper interface at the ceiling (hard deck or soft tile) and proper installation of all protective features around the support rods and rails/tracks.
Verify proper structural components sizing and physical installation to make sure that proper structural system is in place and properly installed to support the lift.
NOTES:
NOTES:
Verification that all fasteners and set screws are properly tightened on the trollies and rails/ tracks.
Ensure that rail/ track is free of gaps (unless required by design). If includedin installation, verify rail turntable function, exchanger function, gate alignment, and safety block installation.
Confirm track is clean and clear of all debris. (Use manufacturer's recommended cleaning materials to avoid damage to the motor case and other components.
Verification that all manufacturer specified end stops or dockking gates are properly installed.
Inspection of lift unit casing for cracks and alignment.
Verification that the lift unit charges properly.
Inspection of activation of hand control for full operation (e.g., up, down, left, right) and "return to charge" function if applicable.
Confirm any and all lift unit indicator lights are functioning. (e.g., red service warning light, charging state light)
Inspection and activation of emergency up/down lift unit control buttons if applicable.
Load Testing
PASS FAIL
changed batteries changed epull cord needs battery brackets and screws
Inspector Complete
VA Representative Complete
Manager of the Service Using the Ceiling Mounted Lifts Complete
SIGNATURE:
TITLE:
Technician
After the activities listed in the above checklist and in the manufactures installation/operations/ owner's manual(s) have been completed, the VA representative shall release the ceiling mounted lift installation to the Manager of the Service using the ceiling mounted lifts..
SIGNATURE:
TITLE:
DATE:
SIGNATURE:
TITLE:
DATE:
Verify and confirm that VA clinical staff have been trained to operate the ceiling mounted patient lift prior to releasing the ceiling mounted lift for use.
NOTES:
NOTES:
Full extension and inspection of lift strap for loose threads or frays.
Inspection of spreader bar and clips for cracks and for loose or missing rings or cotter pins.
Verification of any "soft start" or "soft stop" features and that lifting speed does not exceed 2.5 inches per second with "zero" load.
Verification of load testing and deflection testing at lift listed maximum for each lift unit at its maximum rated lift capacity. Conduct this test in three progressive stages starting with a 100lbs load, then 50% of maximum rated lift capacity, then 100% of maximum rated lift capacity.
Verification of any "soft start" or "soft stop" features and that lifting speed does not exceed 1.5 inches per second under maximum rated lift capacity.
Verification of function of emergency stop at maximum rated lift capacity.
Verification of emergency lowering feature at maximum rated lift capacity.
After the activities listed in the above checklist and in the manufactures installation/operations/ owner's manual(s) have been completed, the inspector shall release the ceiling mounted lift
This commissioning for a patient ceiling lift system(s) shall include, but not be limited to, the following points as components of the commissioning procedures.
Verify that ceiling mounted patient lifts are not installed in treatment units with actively suicidal patients.
Structure Complete
Rails/Tracks and Endstops PASS
Lift Unit and Straps
FAIL
PASS FAIL
2020 Patient Lift PM & Load tests
Facility:
Lift Location:
VAMC Contact:
VAMC Contact's Phone Number:
Inspector:
Inspector's Phone Number:
Manufacturer:
Model:
Serial/EE Number:
Mfgr Contact:
Mfgr Contact's Phone Number:
Date:
John Derudder
631-261-4400 x 5544
XX
Arjo
Maxi Sky 600
31357ld411069527
Service Department
Northport VA
B346-200BLD: RM:
Verify proper connections of lift's structural system tot he building's structure (including seismic bracing if applicable).
Verify proper interface at the ceiling (hard deck or soft tile) and proper installation of all protective features around the support rods and rails/tracks.
Verify proper structural components sizing and physical installation to make sure that proper structural system is in place and properly installed to support the lift.
NOTES:
NOTES:
Verification that all fasteners and set screws are properly tightened on the trollies and rails/ tracks.
Ensure that rail/ track is free of gaps (unless required by design). If includedin installation, verify rail turntable function, exchanger function, gate alignment, and safety block installation.
Confirm track is clean and clear of all debris. (Use manufacturer's recommended cleaning materials to avoid damage to the motor case and other components.
Verification that all manufacturer specified end stops or dockking gates are properly installed.
Inspection of lift unit casing for cracks and alignment.
Verification that the lift unit charges properly.
Inspection of activation of hand control for full operation (e.g., up, down, left, right) and "return to charge" function if applicable.
Confirm any and all lift unit indicator lights are functioning. (e.g., red service warning light, charging state light)
Inspection and activation of emergency up/down lift unit control buttons if applicable.
Load Testing
PASS FAIL
Inspector Complete
VA Representative Complete
Manager of the Service Using the Ceiling Mounted Lifts Complete
SIGNATURE:
TITLE:
Technician
After the activities listed in the above checklist and in the manufactures installation/operations/ owner's manual(s) have been completed, the VA representative shall release the ceiling mounted lift installation to the Manager of the Service using the ceiling mounted lifts..
SIGNATURE:
TITLE:
DATE:
SIGNATURE:
TITLE:
DATE:
Verify and confirm that VA clinical staff have been trained to operate the ceiling mounted patient lift prior to releasing the ceiling mounted lift for use.
NOTES:
NOTES:
Full extension and inspection of lift strap for loose threads or frays.
Inspection of spreader bar and clips for cracks and for loose or missing rings or cotter pins.
Verification of any "soft start" or "soft stop" features and that lifting speed does not exceed 2.5 inches per second with "zero" load.
Verification of load testing and deflection testing at lift listed maximum for each lift unit at its maximum rated lift capacity. Conduct this test in three progressive stages starting with a 100lbs load, then 50% of maximum rated lift capacity, then 100% of maximum rated lift capacity.
Verification of any "soft start" or "soft stop" features and that lifting speed does not exceed 1.5 inches per second under maximum rated lift capacity.
Verification of function of emergency stop at maximum rated lift capacity.
Verification of emergency lowering feature at maximum rated lift capacity.
After the activities listed in the above checklist and in the manufactures installation/operations/ owner's manual(s) have been completed, the inspector shall release the ceiling mounted lift
This commissioning for a patient ceiling lift system(s) shall include, but not be limited to, the following points as components of the commissioning procedures.
Verify that ceiling mounted patient lifts are not installed in treatment units with actively suicidal patients.
Structure Complete
Rails/Tracks and Endstops PASS
Lift Unit and Straps
FAIL
PASS FAIL
2020 Patient Lift PM & Load tests
Facility:
Lift Location:
VAMC Contact:
VAMC Contact's Phone Number:
Inspector:
Inspector's Phone Number:
Manufacturer:
Model:
Serial/EE Number:
Mfgr Contact:
Mfgr Contact's Phone Number:
Date:
John Derudder
631-261-4400 x 5544
XX
Arjo
Maxi Sky 600
32964ld481181974
Service Department
Northport VA
B347-200BLD: RM:
Verify proper connections of lift's structural system tot he building's structure (including seismic bracing if applicable).
Verify proper interface at the ceiling (hard deck or soft tile) and proper installation of all protective features around the support rods and rails/tracks.
Verify proper structural components sizing and physical installation to make sure that proper structural system is in place and properly installed to support the lift.
NOTES:
NOTES:
Verification that all fasteners and set screws are properly tightened on the trollies and rails/ tracks.
Ensure that rail/ track is free of gaps (unless required by design). If includedin installation, verify rail turntable function, exchanger function, gate alignment, and safety block installation.
Confirm track is clean and clear of all debris. (Use manufacturer's recommended cleaning materials to avoid damage to the motor case and other components.
Verification that all manufacturer specified end stops or dockking gates are properly installed.
Inspection of lift unit casing for cracks and alignment.
Verification that the lift unit charges properly.
Inspection of activation of hand control for full operation (e.g., up, down, left, right) and "return to charge" function if applicable.
Confirm any and all lift unit indicator lights are functioning. (e.g., red service warning light, charging state light)
Inspection and activation of emergency up/down lift unit control buttons if applicable.
Load Testing
PASS FAIL
Inspector Complete
VA Representative Complete
Manager of the Service Using the Ceiling Mounted Lifts Complete
SIGNATURE:
TITLE:
Technician
After the activities listed in the above checklist and in the manufactures installation/operations/ owner's manual(s) have been completed, the VA representative shall release the ceiling mounted lift installation to the Manager of the Service using the ceiling mounted lifts..
SIGNATURE:
TITLE:
DATE:
SIGNATURE:
TITLE:
DATE:
Verify and confirm that VA clinical staff have been trained to operate the ceiling mounted patient lift prior to releasing the ceiling mounted lift for use.
NOTES:
NOTES:
Full extension and inspection of lift strap for loose threads or frays.
Inspection of spreader bar and clips for cracks and for loose or missing rings or cotter pins.
Verification of any "soft start" or "soft stop" features and that lifting speed does not exceed 2.5 inches per second with "zero" load.
Verification of load testing and deflection testing at lift listed maximum for each lift unit at its maximum rated lift capacity. Conduct this test in three progressive stages starting with a 100lbs load, then 50% of maximum rated lift capacity, then 100% of maximum rated lift capacity.
Verification of any "soft start" or "soft stop" features and that lifting speed does not exceed 1.5 inches per second under maximum rated lift capacity.
Verification of function of emergency stop at maximum rated lift capacity.
Verification of emergency lowering feature at maximum rated lift capacity.
After the activities listed in the above checklist and in the manufactures installation/operations/ owner's manual(s) have been completed, the inspector shall release the ceiling mounted lift
This commissioning for a patient ceiling lift system(s) shall include, but not be limited to, the following points as components of the commissioning procedures.
Verify that ceiling mounted patient lifts are not installed in treatment units with actively suicidal patients.
Structure Complete
Rails/Tracks and Endstops PASS
Lift Unit and Straps
FAIL
PASS FAIL
2020 Patient Lift PM & Load tests
Facility:
Lift Location:
VAMC Contact:
VAMC Contact's Phone Number:
Inspector:
Inspector's Phone Number:
Manufacturer:
Model:
Serial/EE Number:
Mfgr Contact:
Mfgr Contact's Phone Number:
Date:
John Derudder
631-261-4400 x 5544
XX
Arjo
Maxi Sky 600
31356ld411069534
Service Department
Northport VA
B354-200BLD: RM:
Verify proper connections of lift's structural system tot he building's structure (including seismic bracing if applicable).
Verify proper interface at the ceiling (hard deck or soft tile) and proper installation of all protective features around the support rods and rails/tracks.
Verify proper structural components sizing and physical installation to make sure that proper structural system is in place and properly installed to support the lift.
NOTES:
NOTES:
Verification that all fasteners and set screws are properly tightened on the trollies and rails/ tracks.
Ensure that rail/ track is free of gaps (unless required by design). If includedin installation, verify rail turntable function, exchanger function, gate alignment, and safety block installation.
Confirm track is clean and clear of all debris. (Use manufacturer's recommended cleaning materials to avoid damage to the motor case and other components.
Verification that all manufacturer specified end stops or dockking gates are properly installed.
Inspection of lift unit casing for cracks and alignment.
Verification that the lift unit charges properly.
Inspection of activation of hand control for full operation (e.g., up, down, left, right) and "return to charge" function if applicable.
Confirm any and all lift unit indicator lights are functioning. (e.g., red service warning light, charging state light)
Inspection and activation of emergency up/down lift unit control buttons if applicable.
Load Testing
PASS FAIL
Inspector Complete
VA Representative Complete
Manager of the Service Using the Ceiling Mounted Lifts Complete
SIGNATURE:
TITLE:
Technician
After the activities listed in the above checklist and in the manufactures installation/operations/ owner's manual(s) have been completed, the VA representative shall release the ceiling mounted lift installation to the Manager of the Service using the ceiling mounted lifts..
SIGNATURE:
TITLE:
DATE:
SIGNATURE:
TITLE:
DATE:
Verify and confirm that VA clinical staff have been trained to operate the ceiling mounted patient lift prior to releasing the ceiling mounted lift for use.
NOTES:
NOTES:
Full extension and inspection of lift strap for loose threads or frays.
Inspection of spreader bar and clips for cracks and for loose or missing rings or cotter pins.
Verification of any "soft start" or "soft stop" features and that lifting speed does not exceed 2.5 inches per second with "zero" load.
Verification of load testing and deflection testing at lift listed maximum for each lift unit at its maximum rated lift capacity. Conduct this test in three progressive stages starting with a 100lbs load, then 50% of maximum rated lift capacity, then 100% of maximum rated lift capacity.
Verification of any "soft start" or "soft stop" features and that lifting speed does not exceed 1.5 inches per second under maximum rated lift capacity.
Verification of function of emergency stop at maximum rated lift capacity.
Verification of emergency lowering feature at maximum rated lift capacity.
After the activities listed in the above checklist and in the manufactures installation/operations/ owner's manual(s) have been completed, the inspector shall release the ceiling mounted lift
This commissioning for a patient ceiling lift system(s) shall include, but not be limited to, the following points as components of the commissioning procedures.
Verify that ceiling mounted patient lifts are not installed in treatment units with actively suicidal patients.
Structure Complete
Rails/Tracks and Endstops PASS
Lift Unit and Straps
FAIL
PASS FAIL
2020 Patient Lift PM & Load tests
Facility:
Lift Location:
VAMC Contact:
VAMC Contact's Phone Number:
Inspector:
Inspector's Phone Number:
Manufacturer:
Model:
Serial/EE Number:
Mfgr Contact:
Mfgr Contact's Phone Number:
Date:
John Derudder
631-261-4400 x 5544
XX
Arjo
Maxi Sky 600
31355ld411069536
Service Department
Northport VA
B362-200BLD: RM:
Verify proper connections of lift's structural system tot he building's structure (including seismic bracing if applicable).
Verify proper interface at the ceiling (hard deck or soft tile) and proper installation of all protective features around the support rods and rails/tracks.
Verify proper structural components sizing and physical installation to make sure that proper structural system is in place and properly installed to support the lift.
NOTES:
NOTES:
Verification that all fasteners and set screws are properly tightened on the trollies and rails/ tracks.
Ensure that rail/ track is free of gaps (unless required by design). If includedin installation, verify rail turntable function, exchanger function, gate alignment, and safety block installation.
Confirm track is clean and clear of all debris. (Use manufacturer's recommended cleaning materials to avoid damage to the motor case and other components.
Verification that all manufacturer specified end stops or dockking gates are properly installed.
Inspection of lift unit casing for cracks and alignment.
Verification that the lift unit charges properly.
Inspection of activation of hand control for full operation (e.g., up, down, left, right) and "return to charge" function if applicable.
Confirm any and all lift unit indicator lights are functioning. (e.g., red service warning light, charging state light)
Inspection and activation of emergency up/down lift unit control buttons if applicable.
Load Testing
PASS FAIL
changed batteries needs spreader bar cover
Inspector Complete
VA Representative Complete
Manager of the Service Using the Ceiling Mounted Lifts Complete
SIGNATURE:
TITLE:
Technician
After the activities listed in the above checklist and in the manufactures installation/operations/ owner's manual(s) have been completed, the VA representative shall release the ceiling mounted lift installation to the Manager of the Service using the ceiling mounted lifts..
SIGNATURE:
TITLE:
DATE:
SIGNATURE:
TITLE:
DATE:
Verify and confirm that VA clinical staff have been trained to operate the ceiling mounted patient lift prior to releasing the ceiling mounted lift for use.
NOTES:
NOTES:
Full extension and inspection of lift strap for loose threads or frays.
Inspection of spreader bar and clips for cracks and for loose or missing rings or cotter pins.
Verification of any "soft start" or "soft stop" features and that lifting speed does not exceed 2.5 inches per second with "zero" load.
Verification of load testing and deflection testing at lift listed maximum for each lift unit at its maximum rated lift capacity. Conduct this test in three progressive stages starting with a 100lbs load, then 50% of maximum rated lift capacity, then 100% of maximum rated lift capacity.
Verification of any "soft start" or "soft stop" features and that lifting speed does not exceed 1.5 inches per second under maximum rated lift capacity.
Verification of function of emergency stop at maximum rated lift capacity.
Verification of emergency lowering feature at maximum rated lift capacity.
After the activities listed in the above checklist and in the manufactures installation/operations/ owner's manual(s) have been completed, the inspector shall release the ceiling mounted lift
This commissioning for a patient ceiling lift system(s) shall include, but not be limited to, the following points as components of the commissioning procedures.
Verify that ceiling mounted patient lifts are not installed in treatment units with actively suicidal patients.
Structure Complete
Rails/Tracks and Endstops PASS
Lift Unit and Straps
FAIL
PASS FAIL
2020 Patient Lift PM & Load tests
Facility:
Lift Location:
VAMC Contact:
VAMC Contact's Phone Number:
Inspector:
Inspector's Phone Number:
Manufacturer:
Model:
Serial/EE Number:
Mfgr Contact:
Mfgr Contact's Phone Number:
Date:
John Derudder
631-261-4400 x 5544
XX
Arjo
Maxi Sky 600
31354ld411069568
Service Department
Northport VA
B364-200BLD: RM:
Verify proper connections of lift's structural system tot he building's structure (including seismic bracing if applicable).
Verify proper interface at the ceiling (hard deck or soft tile) and proper installation of all protective features around the support rods and rails/tracks.
Verify proper structural components sizing and physical installation to make sure that proper structural system is in place and properly installed to support the lift.
NOTES:
NOTES:
Verification that all fasteners and set screws are properly tightened on the trollies and rails/ tracks.
Ensure that rail/ track is free of gaps (unless required by design). If includedin installation, verify rail turntable function, exchanger function, gate alignment, and safety block installation.
Confirm track is clean and clear of all debris. (Use manufacturer's recommended cleaning materials to avoid damage to the motor case and other components.
Verification that all manufacturer specified end stops or dockking gates are properly installed.
Inspection of lift unit casing for cracks and alignment.
Verification that the lift unit charges properly.
Inspection of activation of hand control for full operation (e.g., up, down, left, right) and "return to charge" function if applicable.
Confirm any and all lift unit indicator lights are functioning. (e.g., red service warning light, charging state light)
Inspection and activation of emergency up/down lift unit control buttons if applicable.
Load Testing
PASS FAIL
needs strap needs spreader bar cover
Inspector Complete
VA Representative Complete
Manager of the Service Using the Ceiling Mounted Lifts Complete
SIGNATURE:
TITLE:
Technician
After the activities listed in the above checklist and in the manufactures installation/operations/ owner's manual(s) have been completed, the VA representative shall release the ceiling mounted lift installation to the Manager of the Service using the ceiling mounted lifts..
SIGNATURE:
TITLE:
DATE:
SIGNATURE:
TITLE:
DATE:
Verify and confirm that VA clinical staff have been trained to operate the ceiling mounted patient lift prior to releasing the ceiling mounted lift for use.
NOTES:
NOTES:
Full extension and inspection of lift strap for loose threads or frays.
Inspection of spreader bar and clips for cracks and for loose or missing rings or cotter pins.
Verification of any "soft start" or "soft stop" features and that lifting speed does not exceed 2.5 inches per second with "zero" load.
Verification of load testing and deflection testing at lift listed maximum for each lift unit at its maximum rated lift capacity. Conduct this test in three progressive stages starting with a 100lbs load, then 50% of maximum rated lift capacity, then 100% of maximum rated lift capacity.
Verification of any "soft start" or "soft stop" features and that lifting speed does not exceed 1.5 inches per second under maximum rated lift capacity.
Verification of function of emergency stop at maximum rated lift capacity.
Verification of emergency lowering feature at maximum rated lift capacity.
After the activities listed in the above checklist and in the manufactures installation/operations/ owner's manual(s) have been completed, the inspector shall release the ceiling mounted lift
This commissioning for a patient ceiling lift system(s) shall include, but not be limited to, the following points as components of the commissioning procedures.
Verify that ceiling mounted patient lifts are not installed in treatment units with actively suicidal patients.
Structure Complete
Rails/Tracks and Endstops PASS
Lift Unit and Straps
FAIL
PASS FAIL
2020 Patient Lift PM & Load tests
Facility:
Lift Location:
VAMC Contact:
VAMC Contact's Phone Number:
Inspector:
Inspector's Phone Number:
Manufacturer:
Model:
Serial/EE Number:
Mfgr Contact:
Mfgr Contact's Phone Number:
Date:
John Derudder
631-261-4400 x 5544
XX
Arjo
Maxi Sky 600
32752ld481181961
Service Department
Northport VA
B35-200BLD: RM:
Verify proper connections of lift's structural system tot he building's structure (including seismic bracing if applicable).
Verify proper interface at the ceiling (hard deck or soft tile) and proper installation of all protective features around the support rods and rails/tracks.
Verify proper structural components sizing and physical installation to make sure that proper structural system is in place and properly installed to support the lift.
NOTES:
NOTES:
Verification that all fasteners and set screws are properly tightened on the trollies and rails/ tracks.
Ensure that rail/ track is free of gaps (unless required by design). If includedin installation, verify rail turntable function, exchanger function, gate alignment, and safety block installation.
Confirm track is clean and clear of all debris. (Use manufacturer's recommended cleaning materials to avoid damage to the motor case and other components.
Verification that all manufacturer specified end stops or dockking gates are properly installed.
Inspection of lift unit casing for cracks and alignment.
Verification that the lift unit charges properly.
Inspection of activation of hand control for full operation (e.g., up, down, left, right) and "return to charge" function if applicable.
Confirm any and all lift unit indicator lights are functioning. (e.g., red service warning light, charging state light)
Inspection and activation of emergency up/down lift unit control buttons if applicable.
Load Testing
PASS FAIL
changed batteries needs spreader bar cover
Inspector Complete
VA Representative Complete
Manager of the Service Using the Ceiling Mounted Lifts Complete
SIGNATURE:
TITLE:
Technician
After the activities listed in the above checklist and in the manufactures installation/operations/ owner's manual(s) have been completed, the VA representative shall release the ceiling mounted lift installation to the Manager of the Service using the ceiling mounted lifts..
SIGNATURE:
TITLE:
DATE:
SIGNATURE:
TITLE:
DATE:
Verify and confirm that VA clinical staff have been trained to operate the ceiling mounted patient lift prior to releasing the ceiling mounted lift for use.
NOTES:
NOTES:
Full extension and inspection of lift strap for loose threads or frays.
Inspection of spreader bar and clips for cracks and for loose or missing rings or cotter pins.
Verification of any "soft start" or "soft stop" features and that lifting speed does not exceed 2.5 inches per second with "zero" load.
Verification of load testing and deflection testing at lift listed maximum for each lift unit at its maximum rated lift capacity. Conduct this test in three progressive stages starting with a 100lbs load, then 50% of maximum rated lift capacity, then 100% of maximum rated lift capacity.
Verification of any "soft start" or "soft stop" features and that lifting speed does not exceed 1.5 inches per second under maximum rated lift capacity.
Verification of function of emergency stop at maximum rated lift capacity.
Verification of emergency lowering feature at maximum rated lift capacity.
After the activities listed in the above checklist and in the manufactures installation/operations/ owner's manual(s) have been completed, the inspector shall release the ceiling mounted lift
This commissioning for a patient ceiling lift system(s) shall include, but not be limited to, the following points as components of the commissioning procedures.
Verify that ceiling mounted patient lifts are not installed in treatment units with actively suicidal patients.
Structure Complete
Rails/Tracks and Endstops PASS
Lift Unit and Straps
FAIL
PASS FAIL
2020 Patient Lift PM & Load tests
Facility:
Lift Location:
VAMC Contact:
VAMC Contact's Phone Number:
Inspector:
Inspector's Phone Number:
Manufacturer:
Model:
Serial/EE Number:
Mfgr Contact:
Mfgr Contact's Phone Number:
Date:
John Derudder
631-261-4400 x 5544
XX
Arjo
Maxi Sky 600
32753ld411069561
Service Department
Northport VA
B35-200BLD: RM:
Verify proper connections of lift's structural system tot he building's structure (including seismic bracing if applicable).
Verify proper interface at the ceiling (hard deck or soft tile) and proper installation of all protective features around the support rods and rails/tracks.
Verify proper structural components sizing and physical installation to make sure that proper structural system is in place and properly installed to support the lift.
NOTES:
NOTES:
Verification that all fasteners and set screws are properly tightened on the trollies and rails/ tracks.
Ensure that rail/ track is free of gaps (unless required by design). If includedin installation, verify rail turntable function, exchanger function, gate alignment, and safety block installation.
Confirm track is clean and clear of all debris. (Use manufacturer's recommended cleaning materials to avoid damage to the motor case and other components.
Verification that all manufacturer specified end stops or dockking gates are properly installed.
Inspection of lift unit casing for cracks and alignment.
Verification that the lift unit charges properly.
Inspection of activation of hand control for full operation (e.g., up, down, left, right) and "return to charge" function if applicable.
Confirm any and all lift unit indicator lights are functioning. (e.g., red service warning light, charging state light)
Inspection and activation of emergency up/down lift unit control buttons if applicable.
Load Testing
PASS FAIL
changed batteries
Inspector Complete
VA Representative Complete
Manager of the Service Using the Ceiling Mounted Lifts Complete
SIGNATURE:
TITLE:
Technician
After the activities listed in the above checklist and in the manufactures installation/operations/ owner's manual(s) have been completed, the VA representative shall release the ceiling mounted lift installation to the Manager of the Service using the ceiling mounted lifts..
SIGNATURE:
TITLE:
DATE:
SIGNATURE:
TITLE:
DATE:
Verify and confirm that VA clinical staff have been trained to operate the ceiling mounted patient lift prior to releasing the ceiling mounted lift for use.
NOTES:
NOTES:
Full extension and inspection of lift strap for loose threads or frays.
Inspection of spreader bar and clips for cracks and for loose or missing rings or cotter pins.
Verification of any "soft start" or "soft stop" features and that lifting speed does not exceed 2.5 inches per second with "zero" load.
Verification of load testing and deflection testing at lift listed maximum for each lift unit at its maximum rated lift capacity. Conduct this test in three progressive stages starting with a 100lbs load, then 50% of maximum rated lift capacity, then 100% of maximum rated lift capacity.
Verification of any "soft start" or "soft stop" features and that lifting speed does not exceed 1.5 inches per second under maximum rated lift capacity.
Verification of function of emergency stop at maximum rated lift capacity.
Verification of emergency lowering feature at maximum rated lift capacity.
After the activities listed in the above checklist and in the manufactures installation/operations/ owner's manual(s) have been completed, the inspector shall release the ceiling mounted lift
This commissioning for a patient ceiling lift system(s) shall include, but not be limited to, the following points as components of the commissioning procedures.
Verify that ceiling mounted patient lifts are not installed in treatment units with actively suicidal patients.
Structure Complete
Rails/Tracks and Endstops PASS
Lift Unit and Straps
FAIL
PASS FAIL
2020 Patient Lift PM & Load tests
Facility:
Lift Location:
VAMC Contact:
VAMC Contact's Phone Number:
Inspector:
Inspector's Phone Number:
Manufacturer:
Model:
Serial/EE Number:
Mfgr Contact:
Mfgr Contact's Phone Number:
Date:
John Derudder
631-261-4400 x 5544
XX
Arjo
Maxi Sky 600
32754ld481181962
Service Department
Northport VA
B36-200BLD: RM:
Verify proper connections of lift's structural system tot he building's structure (including seismic bracing if applicable).
Verify proper interface at the ceiling (hard deck or soft tile) and proper installation of all protective features around the support rods and rails/tracks.
Verify proper structural components sizing and physical installation to make sure that proper structural system is in place and properly installed to support the lift.
NOTES:
NOTES:
Verification that all fasteners and set screws are properly tightened on the trollies and rails/ tracks.
Ensure that rail/ track is free of gaps (unless required by design). If includedin installation, verify rail turntable function, exchanger function, gate alignment, and safety block installation.
Confirm track is clean and clear of all debris. (Use manufacturer's recommended cleaning materials to avoid damage to the motor case and other components.
Verification that all manufacturer specified end stops or dockking gates are properly installed.
Inspection of lift unit casing for cracks and alignment.
Verification that the lift unit charges properly.
Inspection of activation of hand control for full operation (e.g., up, down, left, right) and "return to charge" function if applicable.
Confirm any and all lift unit indicator lights are functioning. (e.g., red service warning light, charging state light)
Inspection and activation of emergency up/down lift unit control buttons if applicable.
Load Testing
PASS FAIL
Inspector Complete
VA Representative Complete
Manager of the Service Using the Ceiling Mounted Lifts Complete
SIGNATURE:
TITLE:
Technician
After the activities listed in the above checklist and in the manufactures installation/operations/ owner's manual(s) have been completed, the VA representative shall release the ceiling mounted lift installation to the Manager of the Service using the ceiling mounted lifts..
SIGNATURE:
TITLE:
DATE:
SIGNATURE:
TITLE:
DATE:
Verify and confirm that VA clinical staff have been trained to operate the ceiling mounted patient lift prior to releasing the ceiling mounted lift for use.
NOTES:
NOTES:
Full extension and inspection of lift strap for loose threads or frays.
Inspection of spreader bar and clips for cracks and for loose or missing rings or cotter pins.
Verification of any "soft start" or "soft stop" features and that lifting speed does not exceed 2.5 inches per second with "zero" load.
Verification of load testing and deflection testing at lift listed maximum for each lift unit at its maximum rated lift capacity.
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