2025 Site Inspection Workbook

• Site conducted

  Select

• Conducted on

  Date

• Prepared by

• Location
  Address

Pre-Visit Work

• Have ready for review or scan and upload, email prior to arrival. 2 weeks to visit community request - deadline for email = 3 business days before arrival

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• 4. Safety meeting and local training rosters are available for review.

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• * 6. Are 4 most recent Pest control reports available?

  Yes

  No

  N/A

• 7. Are the 4 most recent Ecolab reports available?

  Yes

  No

  N/A

Safety Checks

• 8. Locally developed Emergency Evacuation Route/Map

  Yes

  No

  N/A

• 9. Emergency Procedures Flip Chart - Completed with current management information, available at each entrance.

  Yes

  No

  N/A

• 10. Appropriate exit signs

  Yes

  No

  N/A

• 11. Emergency lighting signage identifying all emergency lights.

  Yes

  No

  N/A

• 12. First aid signage posted by first aid kits

  Yes

  No

  N/A

• 13. Current hazard communication SOP (unless located within SDS binder) SOP-SVC-US-0046 on NA site

  Yes

  No

  N/A

• 14. Chemical solutions and or Hazardous substances are clearly labeled with hazard and expiration dates and stored properly. (e.g. EcoLab chemicals)

  Yes

  No

  N/A

• 15. Any chemical solutions that is taken out of its original container must be properly labeled with the product in the bucket/container and have a HMIS/WHIMS label (includes cleaning cart buckets).

  Yes

  No

  N/A

• 16. Chemical spill kit is available, and employees know how to use it. *Only needed at SVC that have laundry facilities* (Check shelf life)

  Yes

  No

  N/A

• 17. Fire extinguisher signage identifying fire extinguisher locations ABC fire extinguishers, mounted, identified and fully charged. Annual tag documented with monthly check dates.

  Yes

  No

  N/A

• 18. Eye Wash Station has identifying and visible posting, drains properly, covers and unit are clean and calcium free – eye wash station weekly checks correctly documented on the eye wash tag.

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

Fleet

• 21. Geotab telematics device installed and working.

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• 24. If using hard copy DVIR, required DVIR in vehicle:<br>Previous driver DVIR<br>Current driver DVIR

  Yes

  No

  N/A

• 25. All required team members compliant with use of Truce.

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• 27. Vehicles have a binder with all the required documents. Refer to SOP-SVC-US-0079-A, B or C for required documents.

  Yes

  No

  N/A

• 28. Driver qualification: have all drivers show you their license and medical certificate. Are all compliant?

  Yes

  No

  N/A

• 29. PPE located in vehicle along with First Aid Kit.

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• 31. Truck cab, exterior and cargo areas are clean and all equipment loading and functioning.

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• 33. View all truck cargo area postings.<br>Loading Inventory Diagram<br>Wall Position Loading Diagram<br>Proper Use of Ratchet

  Yes

  No

  N/A

• 34. Observation of product loaded appropriately.

  Yes

  No

  N/A

• 35. Dirty/clean product is clearly identified and separated.

  Yes

  No

  N/A

Operational

• 36. Warehouse and Common areas are clean and organized. <br>*Clear evidence of bi-monthly mopping in warehouse; weekly cleaning of common areas. <br>*All trash bins and laundry carts have clean liners and/or plastic liners are replaced daily. <br>*Evidence of daily mopping and trash bins emptied in Processing area.

  Yes

  No

  N/A

• 37. T-Card System is being used correctly. Initialed and dates showing.

  Yes

  No

  N/A

• 38. Evidence of appropriate signage in all locations. i.e. Dirty, Processing, Ready, etc.

  Yes

  No

  N/A

• 39. Quality processing observation of team member. If Contract Worker, have they been trained correctly?

  Yes

  No

  N/A

• 40. All products not currently be worked on are appropriately covered; blue for dirty/clear for clean.

  Yes

  No

  N/A

• 41. Processing carts have needed supplies, are neat and labeled. Correct HMIS for One Step process.

  Yes

  No

  N/A

• 42. Team members are wearing appropriate PPE. Are they removing it before leaving the Dirty and Processing areas?

  Yes

  No

  N/A

• 43. Tools/Test equipment are appropriately stored in Processing and Repair areas and available for use.

  Yes

  No

  N/A

• 44. Weights are labeled and verified---100g weight available if needed (only for Roto-Rest).

  Yes

  No

  N/A

• 45. Mattress tester has current PM label and correct log is in use.

  Yes

  No

  N/A

• 46. (if required) Steri-Fab sprayers have marbles for proper disbursement. Correct log being used and completed correctly. Law labels available.

  Yes

  No

  N/A

• 47. All parts are easily viewed and clearly labeled.

  Yes

  No

  N/A

• 48. Repair area and parking bays are clean and orderly.

  Yes

  No

  N/A

• 49. Random Check of Ready assets:<br>*Product is clean and covered with clear plastic.<br>*Copy of Service Order Inspection Lot found on product.<br>*QRG attached/ QR codes appropriately located.<br>*Blue return cover included.<br>*Correct labels on product; LOOK for new Arjo Rental Sticker AND Secondary Serial number labels. Refer to WI-SVC-US-0210.<br>*Battery and PM dates are not expired/past due.<br>*Box units are in clear plastic bags on top of the plastic bed cover w/Service Order Inspection Lot visible.<br>*Beds are in Transport configuration; Collapsed to transport length, mattress deflated and siderails lowered on Citadel, Frame is lowered.

  Yes

  No

  N/A

• 50. Down Unit Tag check – product handled appropriately within requirement timeframe. Products in repair must be covered in clear plastic with a copy of the completed Service Order Inspection Lot and Down Unit Tag indicating the required repair and any parts ordered.

  Yes

  No

  N/A

• 51. Random check with team member on knowledge of how to find: controlled procedures, SDS website or other online tools. List team member name and action performed below:

  Yes

  No

  N/A

• 52. 5S- SCORE * Scoring: * 5 points- 90-100 * 4 points- 80-89 * 3 points- 70-79 * 2 points- 60-69 * 1 point- 50-59 * 0 points- 49- 0

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  • 0
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  • 5

• 53. Employees understand customer complaint process - how service swaps are handled?

• 54. Overall, any notable observed issues? Or are there any observations/findings from the most recent Audit which have either not been corrected or have resurfaced?

SAP

• 55. Review MyMediset / Reservation Monitor for any issues. What are the daily practices for managing open and aging orders? WI-SVC-US-0122

  Compliant

  Non-Compliant

  N/A

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

  Compliant

  Non-Compliant

  N/A

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

  Compliant

  Non-Compliant

  N/A

• 58. Box units needing repair have been shipped to designated depot and transferred correctly in SAP. (Weekly basis) If Box units are still in SVC do they have a correctly completed Down Unit Tag and Service Order Inspection Lot including FTRE Boxes and are they Simple Repairs?

  Compliant

  Non-Compliant

  N/A

• 59. Product disposal – check paperwork and SAP SO for correctness. No evidence of scrapped products >60 days repair.

  Compliant

  Non-Compliant

  N/A

• 60. Use Quarterly SAP Review using WI-SVC-US-0141-A. The review includes: 2 FTRE which includes the RE3, ZRCE and the ZSR. <br>1 ZSM with the attached ZRCE. 1 Box repair order which may include the RE3, ZRCE and the ZSR and if the Box was shipped to the San Antonio repair depot. <br>There may be some variation depending upon service orders available for review.

  Compliant

  Non-Compliant

  N/A

• 61. Team members demonstrate knowledge and skill with all required SAP transactions. Are Contract Workers present? Do they have an SAP Login and have they been trained to transact a Hygiene order? Review hygiene transactions, truck movements, SO transactions and overall documentation.

  Compliant

  Non-Compliant

  N/A

Sign-off

• Completed by

  Sign