AL14-07 PSA Checklist for Installation and Relocation Jul 28 2014.pdf

1 of 4 Serial Number: __________________________

Verify that the lift is listed by the manufacturer to be installed and operated in the environment that the lift is operating under. (For example, water tight lifts shall be installed and operated in wet, damp or humid locations such as pools or bathrooms.)

Verify NFPA 13 compliance for fire sprinkler system (including but not limited to fire sprinkler heads and piping).

If the facility is located in a seismic area, as identified in VA Handbook H-18-8 Seismic Design Requirements, verify that the ceiling mounted patient lift system installation is in compliance with the requirements of VA Directive 7512 Seismic Safety of VA Buildings and VA Master Design Specification

13.05.041 Seismic Restraint Requirements for Non-Structural Components.

Perform site survey of the pre-existing conditions and as-built drawings above and below finish ceiling at the installation location to confirm existing structural and ceiling conditions.

Installation or Relocation Checklist for Ceiling Mounted Patient Lifts 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:

Pre-Installation COMPLETE

Obtain structural and related engineering design drawings and calculations for the new lift installation.

Design drawings shall be developed for specific lift installation under specific pre-existing conditions of the facility.

Mfgr Contact's Phone Number:

Date:Installer's Phone Number:

Verify NFPA 99 and NFPA 70 compliance for proper grounding and bonding.

Verify NFPA 99 and NFPA 70 compliance for access to electrical and safety systems.

Verify required access to mechanical, HVAC, and fire systems components within the lift installation area.

Verifiy minimum clearances for operation are compliant with manufacturer recommendations. (Ensure room clearance and that the ceiling height is adequate for lift usage.)

Perform pre-installation walkthrough to confirm full understanding and consensus of design drawing(s) and installation conditions.

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.

NOTES:

Installation

Manufacturer:

Model:

Serial Number:

COMPLETE

Mfgr Contact:VAMC Contact's Phone Number:

Installer:

2 of 4 Serial Number: __________________________

PASS FAIL

PASS FAIL

Perform operational test to verify lift functionality.

NOTES:

Rails/Tracks and End Stops

NOTES:

Lift Unit and Straps

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.

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.

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.

Perform walkthrough to ensure compliance of the installation per the design drawing(s) and manufacturer's instructions.

Verification that the lift unit charges properly.

Post-Installation

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.

Verify proper installation of electric motor per manufacturer's instructions to ensure operational rigidity of motor mounting.

Verify proper electrical connections per design drawings and manufacturer's instructions.

COMPLETE

3 of 4 Serial Number: __________________________

PASS FAIL

NOTES:

Load Testing

NOTES:

Manuals

NOTES:

Training

NOTES:

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

Confirm that the manufacturer's operating and maintenance manuals for this lift have been received.

Verify that manufacturer or manufacturer’s representative has provided training on the use of patient handling equipment to clinicians and other staff who move and handle patients.

COMPLETE

COMPLETE

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

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 lb 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 function of emergency stop at maximum rated lift capacity.

Verification of emergency lowering feature at maximum rated lift capacity.

Verify that training and competency are documented prior to release for use with patients.

4 of 4 Serial Number: __________________________

COMPLETE

SIGNATURE:

Installing Contractor

ADDITIONAL NOTES:

Manager of the Service Using the Ceiling Mounted Lifts COMPLETE Verify and confirm that VA clinical staff have been trained to operate the ceiling mounted patient lift, as required in the Training section.

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

SIGNATURE:

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.

COMPLETE

SIGNATURE:

TITLE:

TITLE:

DATE:

DATE:

DATE:

Install and Relocation