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Facility:
Contract
Dates:
To:
Address:
Scheduled:
Actual:
Room
Number:
Next
PM
Check:
Lift
Model:
Number
of
Lifts
Since
Last
PM:
Lift
Serial
Number:
Additional
Service
Needed?
PASS
FAIL
Lift
Functions:
Description:
UP,
DOWN,
EMRG.
DOWN,
TRAVERSE,
ON/OFF,
EMRG.
ON/OFF
Check
functions
using
the
buttons
on
the
lift.
PASS
FAIL
N/A
PASS
FAIL
Mechanical
Functions:
Description:
Load
Test
Per
CSA
Z10535.2-17
Lift
100%
of
the
load
capacity
of
the
Motor
20"
off
of
the
ground
N/A
Trolley
Wheels
Inspect
wheels
for
flat
spots,
and
excessive
wear
and
tear
N/A
Portable
Trolley
Ensure
nut
and
pin
are
intact
and
tight
N/A
Motor,
Gears,
and
Traversing
Drive
Inspect
for
damage
and
excessive
noise
N/A
Carry
Bar
Inspect
for
damage;
verify
insert
and
hooks
and strap pass through hole.
N/A
Fraying
of
Strap
Edges
Lower
the
strap
down
to
the
ground
and
inspect
the
full
length
of
the
edges.
Remove
the
plug
from
the
carry
bar;
inspect
the
strap
integrity
around
the
pin.
N/A
Pneumatic
Hand
Control:
Description:
UP,
DOWN,
EMRG.
DOWN,
TRAVERSE,
ON/OFF
Press
each
button
on
hand
control
for
10
seconds,
make
sure
button
function
works
continuously.
N/A
Airline
Tubing
Inspect
for
damage/leaks
N/A
Grommet
Connectors
Check
that
they
are
tight
N/A
Limit
Switches:
Description:
Hold
UP
until
the
carry
bar
is
at
the
top.
Motor
should
stop
automatically.
N/A
Let
the
strap
out
all
the
way
to
the
ground.
Motor
should
stop
before
strap
winds
backwards.
N/A
While
using
either
UP
or
Down
,
angle
the
strap
more
than
15
degrees.
Motor
should
stop
automatically.
N/A
Slack
Tape
Switch
Hold
DOWN
and
lift
up
on
the
carry
bar.
Motor
should
stop
automatically.
N/A
Electrical
Functions:
Description:
Battery
Voltage:
Check
batteries
with
multimeter
and
confirm
12V
reading
while
engaging
the
motor
during
load
test.
Be
sure
to
fully
tighten
brackets
after
removal.
N/A
Charing End Stop
Confirm that lift enters
charging end stop without
resistance; lift docks and
charges properly.
N/A
Miscellaneous
Description:
LCD
Screen:
Check
that
LCD
works
properly
N/A
LED
Light:
Check
that
light
turns
green
when
on,
dark
when
off,
and
amber
when
charging.
N/A
Casing
Check
for
cracks
or
wear
in
case
N/A
PM
Reset
Use
hand
control
to
end
program
mode.
Log
#
of
lifts
in
upper
right
corner
on
this
sheet.
Reset
the
PM
Counter.
N/A
Vancare Distributor
:
Customer:
Upper
Limit
Switch
and Angle
Detection
Pass
Inspection:
Fixed:
Problems:
Problems:
Fixed:
Pass
Inspection:
Pass
Inspection:
Fixed:
Problems:
Problems:
Problems:
Ceiling
Lift
‐
Quarterly & Annual
Preventative
Maintenance
Pass
Inspection:
Pass
Inspection:
Fixed:
Fixed:
Pass
Inspection:
Problems:
Fixed:
VCD.408 Rev
2 2018
Battery
Inspection
Check physical condition and
ensure battery has install date
on it.
N/A
PASS
FAIL
PASS
FAIL
PASS
FAIL
PASS
FAIL
PASS
FAIL
PASS
FAIL
PASS
FAIL
PASS
FAIL
PASS
FAIL
PASS
FAIL
PASS
FAIL
PASS
FAIL
PASS
FAIL
PASS
FAIL
PASS
FAIL
PASS
FAIL
PASS
FAIL
PASS
FAIL
PASS
FAIL
PASS
FAIL
PASS
FAIL
PASS
FAIL
PASS
FAIL
PASS
FAIL
PASS
FAIL
PASS
FAIL
PASS
FAIL
PASS
FAIL
PASS
FAIL
PASS
FAIL
PASS
FAIL
PASS
FAIL
PASS
FAIL
PASS
FAIL
PASS
FAIL
PASS
FAIL
PASS
FAIL
PASS
FAIL
PASS
FAIL
PASS
FAIL
PM Sticker (8-620710
Complete and place a PM
Sticker on the track.
SWL Sticker (8-620720)
Ensure SWL information is still
accurate and readable
N/A
PASS
FAIL
N/A
PASS
FAIL
PASS
FAIL
PASS
FAIL