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?
YES
NO
Lift
Functions:
Description:
UP,
DOWN,
EMRG.
DOWN,
TRAVERSE,
ON/OFF,
EMRG.
ON/OFF
Check
functions
using
the
buttons
on
the
lift.
YES
NO
N/A
YES
NO
Mechanical
Functions:
Description:
Load
Test
Per
ISO10535
Lift
100%
of
the
load
capacity
of
the
Motor
20"
off
of
the
ground
YES
NO
N/A
YES
NO
Trolley
Wheels
Inspect
wheels
for
flat
spots,
and
excessive
wear
and
tear
YES
NO
N/A
YES
NO
Portable
Trolley
Ensure
nut
and
pin
are
intact
and
tight
YES
NO
N/A
YES
NO
Motor,
Gears,
and
Traversing
Drive
Inspect
for
damage
and
excessive
noise
YES
NO
N/A
YES
NO
Carry
Bar
Inspect
for
damage;
verify
insert
and
hooks
YES
NO
N/A
YES
NO
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.
YES
NO
N/A
YES
NO
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.
YES
NO
N/A
YES
NO
Airline
Tubing
Inspect
for
damage/leaks
YES
NO
N/A
YES
NO
Grommet
Connectors
Check
that
they
are
tight
YES
NO
N/A
YES
NO
Limit
Switches:
Description:
Hold
UP
until
the
carry
bar
is
at
the
top.
Motor
should
stop
automatically.
YES
NO
N/A
YES
NO
Let
the
strap
out
all
the
way
to
the
ground.
Motor
should
stop
before
strap
winds
backwards.
YES
NO
N/A
YES
NO
While
using
either
UP
or
Down
,
angle
the
strap
more
than
15
degrees.
Motor
should
stop
automatically.
YES
NO
N/A
YES
NO
Slack
Tape
Switch
Hold
DOWN
and
lift
up
on
the
carry
bar.
Motor
should
stop
automatically.
YES
NO
N/A
YES
NO
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.
YES
NO
N/A
YES
NO
Charger:
Engage
unit
with
charger
and
check
that
unit
is
charging
properly.
Light
on
the
lift
should
turn
amber.
YES
NO
N/A
YES
NO
Miscellaneous
Description:
LCD
Screen:
Check
that
LCD
works
properly
YES
NO
N/A
YES
NO
LED
Light:
Check
that
light
turns
green
when
on,
dark
when
off,
and
amber
when
charging.
YES
NO
N/A
YES
NO
Casing
Check
for
cracks
or
wear
in
case
YES
NO
N/A
YES
NO
PM
Reset
Use
hand
control
to
end
program
mode.
Log
#
of
lifts
in
upper
right
corner
on
this
sheet.
Reset
the
PM
Counter.
YES
NO
N/A
YES
NO
Vancare, Inc.
:
Customer:
Upper
Limit
Switch
Pass
Inspection:
Fixed:
Problems:
Problems:
Fixed:
Pass
Inspection:
Pass
Inspection:
Fixed:
Problems:
Problems:
Problems:
Ceiling
Lift
‐
Preventative
Maintenance
Pass
Inspection:
Pass
Inspection:
Fixed:
Fixed:
Pass
Inspection:
Problems:
Fixed:
C-450/C-625 Technical Manual
031417
Page 49
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