Title Page

  • Site conducted

  • Conducted on

  • Prepared by

  • Location

Untitled Page

  • Site & Operational Survey

Part 1 Site Inspection Review

People

  • Team members are up to date on required Arjo trainings

  • Annual competency assessment completed. (Check training report) Not required in 2023

  • Have team members participated in a building evacuation/fire drill within the last 12 months. Drill conducted within 45 days of a facility move

  • New team member participated in an evacuation drill within 30 days of employment

  • Do all team members know what constitutes a product complaint and how to document and submit them? (Do team members know what a nonconformity is?)

  • Are all team members up to date on required immunizations if not vendor credentialed?

  • Are all required team members up to date on vendor credentialing?

  • All Service Consultants have up to date DQ files

Document Retention

  • Previous cushion testing logs are available for review

  • SteriFab Treatment Logs are available and correct

  • Quarterly Ecolab reports are available for review for a rolling 12 months (digital or paper)

  • Quarterly Terminix visit reports available for review for a rolling 12 months (digital or paper)

  • Any waste manifests for hazardous waste shipped to a disposal site. (Maintain the waste manifest for one year)

  • Battery disposal invoices/ receipts. The receipt must include the name of the company, address and phone number accepting the batteries. If using an LQHUW check on EPA ID number. SQHUW no EPA # required. (File onsite for 3 years then dispose.)

  • 5 years of OSHA 300A Logs on file

  • Post disaster evaluation forms drill/evacuation completed within last 12 months. Disaster documents available for review

  • Safety meeting and local training rosters are available for review

  • All team members have signed a signature log or signature sheets

  • Up to date facility local supplier list

  • Up to date facility equipment (fixed assets) list

  • Most recent selfinspection and improvement plan available for review. (Paper or digital – keep rolling 6 months)

  • Most recent audit report and associated documents indicating status of findings. (Paper or digital report keep until next scheduled audit)

Facility Postings

  • Business Licenses/Tax Permits (City and State)

  • Regulatory licenses as required by state: (e.g. Bedding/Sanitation permits/licenses)

  • POL001 Quality Policy & POL002 Environmental Policy

  • Service Center Organizational Chart

  • Proof of Liability Insurance

  • Locally developed Emergency Evacuation Route/Map

  • Quality 1 – What If

  • Quality 2 – What do they need from me?

  • Code of Conduct

  • Federal Labor Law Posters (5 in 1 OSHA Poster)

  • State Labor Law Posters, as required by State

  • EVerify Posting / EEO Poster Supplement

  • Right to Work (English/Spanish)

  • Pay Day Notice (US Only), if required by State

  • Notice of Workers’ Compensation Carrier by State (May be included in State Labor Law)

  • Emergency Procedures Flip Chart Completed with current management information

  • OSHA Form 300A (If between February 1st and April 30th )

  • Labor Relations Act (NLRA) Posting (may be included in the 5 in 1 OSHA poster)

  • Federal Motor Carrier Safety Administration HOS Poster

  • Current HR Department _Who’s Who (found on ADP)

  • Building Exit Signs (1C138 or equivalent)

  • Post identifying signage on doorway or room. Restrooms clearly identified and labeled

  • Emergency lighting signage identifying all emergency lights

  • Fire extinguisher signage identifying fire extinguisher locations

  • No smoking facility post by each entrance

  • Infection Control / Hand Hygiene Procedures posted at each sink

  • First aid signage posted by first aid kits

  • Current hazard communication SOP (unless located within SDS binder) SOPSVCUS0046 on NA site

General Facility Requirements

  • Areas of warehouse are taped correctly with appropriate signage/poster

  • Warehouse is clean and organized – clear evidence of daily/2x monthly mopping and trash bins regularly emptied

  • IT room/area is kept free of debris and is readily accessible

  • Shipping and receiving area has proper signage and postings. Battery and Chemical Postings

  • Hazardous substances are properly labeled and stored. (e.g. EcoLab chemicals)

  • Flammable liquids kept in closed containers and stored in an approved fire locker. (if needed)

  • ABC fire extinguishers, mounted, identified and fully charged. Annual tag documented with monthly check dates

  • Breakroom and bathrooms are clean and orderly

  • Service center has appropriate and functioning lighting in all areas. Emergency lighting available

  • All storage locations/shelving labeled

Quality Processing Area Postings

  • Hand Hygiene visual work instruction

  • PPE visual work instruction

  • How to Prevent Infection / Did You Wash Your Hands?

  • Chemical Testing and Hand Mixing Process visual work instruction

  • QC process visual work instruction: Visual work instructions appropriate for each service center (e.g. SteriFab Application; RotoProne Visual Standards)

  • Eye Wash Station has identifying and visible posting

  • Processing area has appropriate slippery floor or equivalent posting for when there is a potential for wet/slippery floors

Quality Processing Area- General Requirements

  • Dirty hold area taped and labeled. All dirty products are covered with blue covers or bags

  • Approved Sharps container; a mail back regulated medical waste container and/or a red plastic bag are available for use

  • Regulated Waste log maintained. Required in PA, otherwise only if handled regulated waste.

  • SDS binder if required by local/state laws

  • Employees have access to appropriate PPE and know how and when to use it

  • Chemical spill kit is available, and employees know how to use it. (Check shelf life)

  • Eyewash station drains properly, covers and unit are clean and calcium free – eye wash station checks correctly documented

  • SteriFab sprayers have marbles for proper disbursement Correct log being used for SteriFab Correct Sanitation (Law) Labels are attached to assets Oklahoma: Revenue Stamp is attached to Sanitation Label

  • Processing carts are available with all necessary supplies. Secondary containers have correct HMIS/WHMIS labels

  • Clean assets are covered/bagged in clear plastic

  • Quality processing area has all necessary tools and equipment. Calibrated equipment have stickers displaying current calibration dates

  • Employees know process for missing/expired calibration dates or test equipment failure

  • Weights are verified and labeled correctly. 100g weight available if needed

  • Cushion tester is labeled correctly including a current PM sticker

  • All employees know how to use and test cushion tester, logging results correctly

  • All paint and approved chemicals are labeled correctly and not expired

  • Any parts used in quality processing, including replacement cushions, are covered or placed in containers with correct labeling

  • Process for accessories is followed (Lift Poles, IV Poles, O2 Holders, Trapeze)

  • All used batteries stored properly in closed plastic container with vented lid

  • Evidence that quality processing area garbage cans emptied daily when used

  • Evidence that qualityprocessing area is mopped when used. Mops and rags cleaned and maintained correctly

  • Team members know how to access appropriate information on Connect SharePoint site Product information Quality Process Decks Approved Suppliers Link to NA Documentation site

  • All employees know how to locate SDS documents on 3E site. Know and understand how to read and use SDS

General Asset Requirements

  • Customer owned products stored in appropriate hold location and labeled correctly

  • Assets used for customer demo and/trials stored in appropriate location and labeled correctly. Demo tag in use

  • Product files available for all frame products in the service center

Assets-Ready Area

  • All products in “Ready” meet quality and infection control standards. Good aesthetics QRG and/or QR Code PM and battery stickers

  • All assets in “Ready” have all required legible manufacture labels

  • Pumps must be in an individual bag with QC sheet visible inside bag and stored correctly

  • Skin IQ on a Citadel frame is installed with the cover folded down and the fan unplugged

Assets-Repair Area

  • Assets requiring repair identified with down tag and found in correct ERP system location

  • Assets in “Repair” have appropriate quality control checklists on them

  • All repair parts are stored and labeled appropriately

  • Chemicals, lubricants and paint are labeled, stored correctly and not expired

  • Repair area has all necessary equipment, and calibrated tools have stickers displaying current calibration dates

  • Tools and equipment used in repair area are labeled and stored appropriately

General Vehicle Requirement

  • Geotab telematics device installed and working

  • Service Consultants know how to view previous DVIR in Geotab Drive. Hard copy DVIR on file for 90 days

  • Truck cab/exterior is clean and free of trash and debris

  • Truck cargo area is clean and all equipment loading and functioning

  • Required equipment to secure frames is available, including foam for truck sides

  • Product is loaded appropriately

  • Dirty/clean product is clearly identified and separated

  • PPE located in vehicle along with First Aid Kit

  • Fire Extinguishers are in cab and fully charged; emergency triangles are available

  • Preventive Maintenance Receipts uploaded to Holman

  • Repair Receipts uploaded to Holman

  • If using hard copy DVIR, required DVIR in vehicle: Previous driver DVIR Current driver DVIR

  • Required paperwork in vehicle binder Valid insurance/registration Valid fuel card HOS Public Safety Letter 150 air mile map/CA 100 air mile map

  • View all truck cargo area posting. Loading Inventory Diagram Wall Position Loading Diagram Proper Use of Ratchet

Part 2 Operational Checks

  • Do all team members know how to use TCard system? Are they completing TCard activities?

  • Check on use of the Daily/Weekly Walkabout form

  • Check prior day's DVIR report for Pre/Post trip Inspections. Verify there are no missing inspections when comparing to truck trips in GeoTab

  • All required team members compliant with use of Truce

  • Vehicle maintenance up to date – no past due PMs or required inspections

  • Check schedule for any necessary changes to cover planner and ensure changes will not result in HOS violations

  • Review MyMediset / Reservation Monitor for any issues. What are the daily practices for managing open and aging orders?

  • Review IW73 / IW72 for any pending order issues. What are the daily practices for managing open and aging orders?

  • Download report from either IH08 or Z15_D102 for storage location 9100 (Quality Processing)

  • Are all products in dirty storage found in the report? What is the process for reconciliation?

  • Review most recent past inventory report. All missing assets been located and/or reconciled. Are month;y inventory reports acceesible?

  • Random Check of Ready assets: *Asset is clean and covered with clear plastic *Copy of SAP QC sheet found on asset *QRG and/or QR Code attached *Blue return cover included *Correct labels on asset *Battery and PM dates are not expired/past due

  • Random check on 2 PM documents both electronic and hard copy files. Review for PM Date in Class Overview: and 2 yrs of PM checklists in file. Checklist attached to WO in SAP

  • Box units needing repair have been shipped to designated depot and transferred correctly in SAP

  • All shipments from distribution warehouse are opened, verified and received in SAP

  • Down tag check – product handled appropriately within requirement timeframe

  • Product disposal – check paperwork and SAP SO for correctness. No evidence of scrapped products >30 days in overflow or repair

  • Quality processing observation of team member

  • Team members demonstrate knowledge and skill with all required SAP transactions. Review hygiene transactions, truck movements, SO transactions and overall documentation

  • Review SAP service order documentation 6 random serial numbers and 3 random service orders completed in the most recent 3 months. *ZCRE / *ZSRPM / *ZSRBAT / *ZSRRTR / *ZSRUPG

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.