AL14-07 PSA Checklist for CM and PM Jul 28 2014.pdf

1 of 2 Serial Number: __________________________

PASS FAIL

PASS FAIL

The 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.

Facility:

Lift Location:

VAMC Contact's Phone Number:

Inspector:

VAMC Contact:

Manufacturer:

Model:

Serial Number:

Inspector's Phone Number:

Structure

Rails/Tracks and End Stops

NOTES:

Lift Unit and Straps

NOTES:

Verify proper structural component sizing and physical installation to make sure that proper structural system is in place and properly installed to support the lift.

Verification that all fasteners and set screws are properly tightened on the trollies and rails/tracks.

Ensure that the rail/track is free of gaps (unless required by design). If included in 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 docking gates are properly installed.

Inspection of lift unit casing for cracks and alignment.

Inspection and activation of hand control for full operation (e.g., up, down, left, right) and “return to charge” function if applicable.

Corrective and Preventive Maintenance Checklist for Ceiling Mounted Patient Lifts

Mfgr Contact's Phone Number:

Date:

Mfgr Contact:

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.

Inspection of spreader bar and clips for cracks and for loose or missing rings or cotter pins.

Full extension and inspection of lift strap for loose threads or frays.

Complete

Verification that the lift unit charges properly.

Verify proper connections of the lift's structural system to the 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.

2 of 2 Serial Number: __________________________

PASS FAIL

NOTES:

After the activities listed in the above checklist and in the manufacturers installation/operations/owner’s manual(s) have been completed, the inspector shall release the ceiling mounted lift installation to VA representative.

SIGNATURE:

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.

SIGNATURE:

TITLE:

Manager of the Service Using the Ceiling Mounted Lifts COMPLETE

TITLE:

VA Representative After the activities listed in the above checklist and in the manufacturers 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:

COMPLETE

Inspector COMPLETE

DATE:

DATE:

DATE:

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 100 lbs load, then 50% of maximum rated lift capacity, then 100% of maximum rated lift capacity.

Verification of any “soft start” and “soft stop” features and that lifting speed does not exceed 1.5 inches per second under maximum rated lift capacity.

Verification of emergency lowering feature at maximum rated lift capacity.

TITLE:

Verification of function of emergency stop at maximum rated lift capacity.

NOTES:

Load Testing

Inspection