23
Annual Service Inspection, Rise III
Service Contract No.:
Product:
12C10, Rise III, Shower & Commode
Frame- & Batch No.:
Client:
Department / User:
Contact person:
Valid from:
July 1
st
2009
Automatic renewal date:
July 1st , every year
Telephone:
Fax:
Client Responsible:
Service Inspection performed by:
Date:
Control point:
Description:
A
ll r
igh
t:
L
ubr
ic
at
ed
N
o
is
e /
Irre
gu
la
ri
ty
T
ight
ene
d:
Co
m
m
en
t N
r.:
Release of seat tilt
Actuator runs both ways
Release of seat tilt
Actuator lubricated
Switch for selection of Lift / Tilt
Works & is securely fastened
Cables for switch & tilt actuator
Intact and secured with strips
Gas springs
Securely tightened
Backrest
Securely tightened
Seat
Easy to remove and put back on the chair
Seat
PU-surface is intact
Arm rests
Securely fastened and move smoothly
Arm rests
PU is intact
Foot plates on footrests
Fold up/down, securely fastened
Footrests
Height-adjustability works
Footrests
Easy to remove
Emergency Stop
Works and releases again
Lifting mechanism
Lifts from bottom to top whit full load
Lifting Actuator
Correctly mounted / Locking rings in place
Lifting Actuator
O-Ring intact., greased &correctly inserted
Lifting Actuator
Piston lubricated
Hand Control
”Hold to activate” works
Hand Control
Charging- & Activity lights work
Hand Control
O-Ring intact., greased &correctly inserted
Wall Charging Station
Intact & correctly mounted on the wall
Wall Charging Station
Gold-plated contacts are intact
