PM Checklist.pdf

Correct ive a n d Preventive iVtaihtcmiriue Checklist fo r f eiling M o u n t e d Pat ien t Lifts The commissioning for a patient ceiling lift systemfs) shall include, birr nm be limited to, the following points as components of tho commissioning pro'.^tkites.

NOTE: Ceiling mounted patient lifts are not to be installed in treatment units with actively suicidal patients.

Facility: Work Ordei: Manufacturer;

Lift Location: Model:

VAMC Contact: Serial Number: EE Numher:

VAMC Contact's Phone Number: Mfgr Contact:

Installer; Mfgr Contact's Phone Number:

Installer's Phone Number: Date:

Structure Cyirifjitic:

i Perform a visual inspection to verify proper connections of the life's structural system to the building's structure {including seismic bracing if applicable).

Perform a vir-ua' inspection to verify proper interface at the ceiling {hard deck or soft tile) and proper installation of nil protective features around the support rods and rails/tracks.

Perform a visusi inspection to verify structural component sizing and physical installation to ensure that the correct structural system is in place and properly installed to support the lift.

NOTES:

R.nih/lMfl;s ami End Stop;

vti ilicotion thcrt i«ll ia'Acmtu and sec >trt ws cii r pfupeily tighu-nui >m iin; trollies and raiis/traefcs.

PASS f Alt

Ensure that the rail/track is free of gsps (unfess required by cksi;n). If included in installation, verify rail turntable function, exchanger function, gate alignment, and safety block installation.

.3 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.)

4 Verification that all manufacturer specified end stops or docking gates are properly installed.

NOTES:

i in unit and Straps I'AS'J FAIL

1 Inspection of lift unit casing for cracks and alignment.

7 Verification that the lift unit charges properly.

Inspection and activation of hand control for full operation (e.g., up, down, left, light) 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 tight)

5 Inspection and verification of all emergency functions of the lift unit.

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

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

Revision 2.1 l o f 2 Serial*:

Attachment B cont.

MOTES:

.. Load Testing PASS I'M i Verification of any "soft stare" or "soft stop" features aitd that lifting speed does not exceed 2.S inches per second with "zero" load.

Verification of load testing and deflection testing at the manufacturer's specified maximum rated lift capacity.

Verification of any "soft start" and "soft stop" features and that lifting speed does not exceed i.S inches per second under maximum rated lift capacity.

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

5 Verification of emergency lowering feature at maximum rated lift capacity.

MOTES:

Inspector COMPIETE

Artei the actwrties listed in the ahove checklist and in the manufacturers instaliation/operai ions/owner's in.-, ni id lis' MdVe U e i completed, the inspector shaii release the ceiling mounted lift installation to VA representative.

SIGNATURE: DATE:

TITLE;

• VA Representative f OMPtETE

After the activities listed in tl ie above checklist and in the manufacturer's instaliation/operations/owiitr':..

manual^) have been completed, the VA leoresentalive shall levicw tho;e items with 1 he inspector prior to ielecting tlie ceiling mutinied life hack into seivice to ensure completion ol all requirements.

SIGNATURE: DATE":

TITLE:

vOriii-trTE

After the activities listed in the above checklist and in the manufacturer's installation/operations/owner's manual!:} have been completed, the manager of the service using the ceiling mounted lifts confirms that the current staff have received initial training on ceiling mounted lifts and that there is a process in piace to provide ongoing training on the proper use of ceiling mounted lifts.

SIGNATURE: DATE:

TITLE;

Revision 2.1 2 of 2 Serial #: