SOW Attachment 2 - Corrective and Preventive Maintenance Checklist.pdf

Revision 2.1 1 of 2 Serial #: ____________________

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.

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

Lift Location:

VAMC Contact's Phone Number:

Installer:

VAMC Contact:

Manufacturer:

Model:

Facility: Work Order:

Serial Number: EE Number:

Installer's Phone Number:

Structure

Rails/Tracks and End Stops

NOTES:

Lift Unit and Straps

NOTES:

Perform a visual 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.

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 verification of all emergency functions of the lift unit.

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.

Perform a visual inspection to verify proper connections of the lift's structural system to the building’s structure (including seismic bracing if applicable).

Perform a visual inspection to 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.

Revision 2.1 2 of 2 Serial #: ____________________

PASS FAIL

NOTES:

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

SIGNATURE:

After the activities listed in the above checklist and in the manufacturer's installation/operations/owner’s manual(s) 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 place to provide ongoing training on the proper use of ceiling mounted lifts.

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 manufacturer's installation/operations/owner’s manual(s) have been completed, the VA representative shall review those items with the inspector prior to releasing the ceiling mounted lift back into service to ensure completion of all requirements.

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 the manufacturer's specified 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