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Preventive Maintenance & Security Controls
STAND-UP LIFT PREVENTIVE MAINTENANCE
Date of intervention:
Stamp of the service provider:
Name of the referent institution:
Brand:
Model:
Equipment number:
Manufacturer serial number:
Actuator / lifting arm assembly check
1
Actuator / mast or base assembly check
2
Mast / lifting arm assembly check
3
Mast / base assembly check
4
Mast / handlebar assembly check
5
Castors fixation check
6
Slide of under patella support check
7
Sling fixation hooks check
8
State of the frame and of the painting check
9
Foot pedal or opening legs actuator check
10
Spreaded legs system check
11
Assemblies of the right and left feet on the base check
12
Lifting actuator operation check
Remote control check
Control box check (emercgency button, plugs)
Battery check (please perfome 3 complete cycles)
Opening legs actuator operation check
Observations
o
Breakage/misuse mauvaise utilisation du client
o
Wear
o
Replaced by N°
Provider signature
Checks done on:
Manufactured by NAUSICAA Médical S.A.S. / Approved by Ghizlane Labrosse (Biomedical Engineer)
20
DESCRIPTION
Additional checks for models with opening base legs
Checks made by:
User Manual - Stand-Up Lift: WAYUP 5 Range
Name and first name of the service agent:
Room number :
□
Leased equipment
□
Equipment belonging to the
establishment
Conform
Establishment stamp
Non-
Diagnostic
conform
Scheduled date of next check:
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