DEP Cyclical Maintenance JOB SHEET - Stroller
Client Details
Given Names: / Surname:
Contact Phone: / Address:
Location of Work:
Date Next Cyclical Maintenance Required: / //
Equipment Details
Equipment Type: / Serial No.:
Equipment Brand/Make/Model:
Age of item (if known): / Under Manufacturer’s Warranty? / Yes / No
Job Details
Works above $300 for non-powered and $500 for powered nominated equipment items require a quote to DEP.
If equipment is deemed as irreparable, complete Job Sheet and notify DEP for arrangements to return equipment.
Prior To Commencing Work - Is a quote to DEP required? / Yes / No
If Yes, send quote to DEP. Date quote sent: / // / If No, proceed with job
DEP Approval Received? / Yes - Proceed with job / No - Do Not Proceed with job
Maintenance Checklist
This list should not be considered exhaustive, further component checks may be required. If so please list under OTHER.
Component / Ok / Faulty / Description
Batteries/ Chargers / · Check batteries are holding and producing charge. Check for corrosion or cracking of batteries.
· Replace batteries if required.
Controls / · Check flexible ‘boot’ between joystick and control module, and all buttons on the keypad for wear and cracks. Replace ‘boot’ or control box cover if required.
· Check correlation of buttons/joystick operation to correct function. If faulty reapply software.
· If control box is unserviceable report concerns to the Disability Equipment Program (DEP) Work Unit for further direction.
Cables and Connections / · Inspect to Australian test and tag specifications cables and plug-in connections including that they are secure and not worn. If cables are frayed, showing through insulated cable housing, or plugs are showing bare wire repair according to electrical safety specifications.
· Tag equipment.
Motor / · Open and clean electric motor.
· Check bearings.
· Check and clean commutator. Ensure free of carbon build up and check for wear. Ensure maximum contact of brush on commentator, refurbish as necessary.
Frame / · Clean entire frame. Use a damp cloth and mild detergent and disinfectant. DO NOT use bleach.
· Polish chrome plated parts. Use a commercially available polish or metal protectant spray.
· Check all welds for cracks. Check general frame for cracks, kinks, and rust. Appropriate lubricant to moving parts if needed. Report any safety concerns regarding cracks, kinks or rust to the DEP Work Unit.
· Replace all missing knobs and dust caps.
· Check hand grips and replace if missing or damaged.
· Anti tip wheels and rubbers. Check in sound working order.
Nuts and Bolts / · Check all nuts and bolts are in place and correctly tightened.
· Replace any missing nuts or bolts with Therapeutic Goods Administration (TGA) approved replacements.
Upholstery / · Clean. Use a damp cloth and mild detergent and disinfectant. DO NOT use bleach.
· Nourish vinyl. Use a commercial upholstery restorer or general purpose protectant spray.
· Check upholstery is not sagging, rough, damaged or torn. If upholstery is sagging adjust tension if possible. Repair damaged upholstery.
· Check padded foam seat has spring action or ‘memory’ left in the foam if factory supplied option. If foam found to be damaged or fatigued please contact the DEP Work Unit to request Allied Health Professional (AHP) review.
· If chair has custom made or customised seating system check upholstery is not rough, damaged or torn. If upholstery is damaged please contact the DEP Work Unit to request AHP review.
Drive Wheels, Tyres and Tubes / · Remove hair, lint and dirt from axles. Clean using a damp cloth and mild detergent and disinfectant. DO NOT use bleach.
· Check wheels for buckles, loose fitting or damage. If buckled or damaged replace. If loose, tighten.
· Replace wheel bearings if required.
· Apply appropriate lubricant.
· Check tyres for wear and replace if needed. Check tyres and inflate to correct air pressure.
· Check axle and axle bush for wear replace if needed.
· Check required wheels touch the ground at the same time and they are all level.
· Check wheels nuts and tighten if required.
Freewheel Mechanism / · Disengage the drive mechanism using the freewheeling device (hubs or lever operated). The chair should be able to be pushed manually. If found to be faulty consult product manual for repair details.
Park Brakes / · Disengage the drive mechanism using the freewheeling device as described above. Apply the park brakes. The drive wheels should be locked and chair will not roll. If found to be faulty consult product manual for repair details.
Castors / · Remove hair, lint and dirt from axles. Check that castors are freely moving in all directions. Check front castors for wear and replace if needed.
· Replace front castor bearing (only if you did not replace front castor).
· Replace pintle bearing and pintle bush if required.
· Check fork for wear and damage replace if needed.
· Apply appropriate lubricant.
Armrests / · Clean with soft cloth and mild detergent. DO NOT use bleach.
· Check they can be easily moved or swung away. Check foam and upholstery if applicable. Replace foam/upholstery if required.
· Check if safety restraint bars can be moved and lock in place.
· Check if safety restraint strap Velcro is serviceable and straps are not frayed.
· Apply appropriate lubricant to moving parts.
Foot Plates or Footboard / · Clean with soft cloth and mild detergent.
· Check footplates are straight and straighten if not. Check frame for cracks, kinks and rust. Check serviceability of moving components. Replace if there are signs of cracks, rust or seizure of moving components.
· Check all screws and fittings are tight.
· Apply appropriate lubricant to moving parts.
Calf Supports / · Clean with soft cloth and mild detergent. DO NOT use bleach.
· Check they can be easily moved or swung away. Check foam and upholstery if applicable. Replace foam/upholstery if required.
· Check if safety restraint bars can be moved and lock in place.
· Apply appropriate lubricant to moving parts.
Headrests and Posture Supports / · Clean. Use a damp cloth, mild detergent and disinfectant. DO NOT use bleach.
· Check they can be easily moved or swung away. Check foam and upholstery if applicable. Replace upholstery if required. If there is excessive wear or ‘flat’ spots in foam please contact the DEP Work Unit to request AHP review.
· Check all mounting screws and fittings are tight.
· Apply appropriate lubricant to moving parts.
Other / ·
Comments:
Time Record
Date / // / // / // / // / // / //
Time Taken
Materials Used
Item Description / Qty / Cost
$ / Total
$ / Source
(DEP Parts/New/Other)
Total Materials Cost
Technician Name:
Signature: / Date: //
Client/Carer Name (verifying work undertaken):
Signature: / Date: //
Thesemaintenance guidelines have been adapted from the MASS (Medical Aid Subsidy Scheme) Queensland Equipment Resources whichare available at the following site: http://www.health.qld.gov.au/mass/resourcesequip.asp
This information is a guideline. Refer to manufacturers’ equipment documentation for further information, as required.
Aged and Disability Program | DEP CM-2 Version: 1.0 Created: March 2012 | Review: March 2013
Page 4 of 4 Department of Health is a Smoke Free Workplace