Arjo 2022 Self Inspection w/Score

• Site conducted

  Select

• undefined

• Conducted on

  Date

• Prepared by

• Facility Headcount

Previous Audits

• Date of Previous Audit

  Date

• List Previous Audit Findings

Licensure & Signage - (Review US State Licensure List) found in SharePoint>Service Compliance & QA Audit>Resource Documents

• LIS-SCR-NA-001. Review State Licensure Requirements for Rental Operations. Is Business License Current?

  Yes

  No

  N/A

• LIS-SCR-NA-001. Review Certificate of Liability Insurance for Rental Operations. Is Certificate of Liability Current?

  Yes

  No

  N/A

• LIS-SCR-NA-001. Review State Licensure Requirements for Rental Operations. Is the regulatory license current?

  Yes

  No

  N/A

• Review bulletin Board. Is the Environmental Arjo Policy visible and compliant? (POL-002 in Careview)

  Yes

  No

  N/A

• Review bulletin Board. Is the Quality Arjo Policy visible and compliant? (POL-001 in Careview)

  Yes

  No

  N/A

• Review bulletin Board. Is there a Complaint Reporting Handling Poster? (100071155)

  Yes

  No

  N/A

• Review bulletin Board. Review Second Hand/Refurbished Mattress Retailer Permit (License for SteriFab use). Is the license current?

  Yes

  No

  N/A

• Review bulletin Board. Is there a Federal/State/Province labor law poster?

  Yes

  No

  N/A

• Review bulletin Board. Is there a e-verify right to work poster? (English / Spanish)

  Yes

  No

  N/A

• Review bulletin Board. Is there a Federal employee rights to work poster?

  Yes

  No

  N/A

• Review bulletin Board. Is there an Emergency Procedures Flip Chart? (SOP-SVS-US-0043)

  Yes

  No

  N/A

• US Only: Review bulletin Board. Review OSHA-300A form. Is the 2022 form available? (Filed after April)

  Yes

  No

  N/A

Document and Record Control

• Review Signature Employee Identification Log form: SOP-101-A. Is it available?

  Yes

  No

  N/A

• Has the NEW employees (6 months) review SOP-101-A . Are they included in the log? (Signature Log Sheet)

  Yes

  No

  N/A

• Request US Arjo Commercial Motor Vehicle (CMV) Driver Checklist for new employees. Is the CMV Driver Checklist complete for the new employee? (SOP-SVC-US-0039-A)

  Yes

  No

  N/A

• Request Monthly Asset Inventory Report from SAP/M3 with first column as date of last movement. Are the last three months available? (SOP-SVC-US-0048)

  Yes

  No

  N/A

• Request current Asset Inventory Record. Perform a random sampling of 11 beds. Are the current inventory records corresponding to physical asset location? (most recent - Today's) (SOP-012)

  Yes

  No

  N/A

• Inspect Quality Checklist sheets from 11 random samples of Ready assets. Is the physical Quality Checklist included with the asset? (Including: beds, pumps, mattresses, etc.)*Check TrackWise with serial number for complaints.

  Yes

  No

  N/A

• Review samples. Is the serial number matching the physical asset inside the "Ready/Clean" area?

  Yes

  No

  N/A

Preventive Maintenance

• Request Preventative Maintenance Asset Report (Sample 11 records). Are the records available?

  Yes

  No

  N/A

• Review Preventative Maintenance records. Provide random sampling of Assets. Are they available?

  Yes

  No

  N/A

• Review Preventative Maintenance records. Refer to the service manual/IFU. Are all steps completed?

  Yes

  No

  N/A

Asset Disposal

• Request Asset disposal forms. Are there 11 records available?

  Yes

  No

  N/A

• Review random asset disposal forms. Are they fill out completely and correctly:

  Yes

  No

  N/A

Cushion Tester

• Inspect cushion log testing (log). Is the mattress tester control sheet available?

  Yes

  No

  N/A

• Review Preventative Maintenance label on cushion tester. Is it current?

  Yes

  No

  N/A

• Is the PM label location correct? (On the rear of the unit)

  Yes

  No

  N/A

Sterifab

• Review Steri-Fab Treatment log. Is it available? (SOP‐SVC‐US‐0044‐C)

  Yes

  No

  N/A

• Review Steri-Fab Treatment log. Is the chemical lot # available on the log sheet?

  Yes

  No

  N/A

• Review Regulated Waste Log. If there was any regulated waste disposed of in the last 12 months, was the form filled out completely?

  Yes

  No

  N/A

• Request EcoLab Quarterly Reports. Are the last 4 quarters available? (SOP-SVC-US-0043-B)

  Yes

  No

  N/A

• Review the EcoLab Report does it contains the following information: PH, Water Temperature, Water Hardness, Number of cycles, etc.

  Yes

  No

  N/A

• Review Pest Control Treatment Records. Are the last 12 months available? (SOP-SVC-US-0043)

  Yes

  No

  N/A

• Review battery disposal records, recycle invoices or receipts. If there was any battery recycled , are the records available from the last 12 months?

  Yes

  No

  N/A

• Review Local Approved Supplier List. Is it available?

  Yes

  No

  N/A

• Review SSU employee signed job descriptions. Are they available?

  Yes

  No

  N/A

• Review SSU employee Block Training with James Ponder. Is the training completed?

  Yes

  No

  N/A

• Review SSU employee training records from MyLearning. Are all courses assigned more than 30 days ago completed? (SOP-SVC-US-0025)

  Yes

  No

  N/A

• Review my learning Complaint Handling Training records. Is the training certificate available for each employee?

  Yes

  No

  N/A

• Review Mandatory Open TAN's training material. Has the training been completed? (SOP-SVC-US-0022)

  Yes

  No

  N/A

• Review my learning HIPAA and patient rights and confidentiality training records. Is the training certificate available for each employee? (SOP-061-C)

  Yes

  No

  N/A

• Review my learning Blood Borne Pathogen Training records. Is the training certificate available for each employee? (100121909)

  Yes

  No

  N/A

• Request SSU Arjo employee to explain the basic process of reporting a complaint. Is the process known by the employee? (SOP-SVC-US-0042)

  Yes

  No

  N/A

• Request SSU Arjo employee to explain where to find Standard Operation Procedures and Work Instructions (CareView, Connect and North America Documentation Central). Is the process known by the employee?

  Yes

  No

  N/A

• Request SSU Arjo employee to explain how to navigate connect. Is the process known by the employee?

  Yes

  No

  N/A

• Request SSU Arjo employee to explain how to locate chemical SDS/MSDS electronically through the 3E system. Is the process known by the employee? (Found on right side of Connect Home page)

  Yes

  No

  N/A

• Review the latest Service Center Self-Inspection Tool. Is there a copy available in the last 6 months?

  Yes

  No

  N/A

• Review Walkabout form - has the svc completed daily/weekly/quarterly tasks?

  Yes

  No

  N/A

• Do employees and managers have the necessary tools and materials to ensure the safety of all employees? (SOP-SVC-US-0045)

  Yes

  No

  N/A

T-Card (WI-SVC-US-0082)

• Review the T-cards System. Are they available?

  Yes

  No

  N/A

• Review a random completed Daily T-card. Is it signed and dated according to process?

  Yes

  No

  N/A

• Review a random completed Weekly T-card. Is it signed and dated according to process?

  Yes

  No

  N/A

• Review a random completed Monthly T-card. Is it signed and dated according to process?

  Yes

  No

  N/A

• Review a random completed Quarterly T-card. Is it signed and dated according to process?

  Yes

  No

  N/A

• Review a random completed Yearly T-card. Is it signed and dated according to process?

  Yes

  No

  N/A

• Review Over due T-cads. Are they aware?

  Yes

  No

  N/A

• Review gemba walks. Is the last gemba walk performed within the last month?

  Yes

  No

  N/A

• Review Annual t-card task. Is the date written on the t-card within the last year?

  Yes

  No

  N/A

Washing Laundry

• Review Washer Water Temperature Check Procedure. Do the employees know how to check the temperature?

  Yes

  No

  N/A

• Do the employees know the proper temperature range for the washer?

  Yes

  No

  N/A

• Inspect Laundry Baskets. Is the appropriate color cover for the section on each basket? (Blue - Dirty, Clear - Clean)

  Yes

  No

  N/A

• Are the laundry baskets labeled "Dirty, Clean, Transport Bin" and completely covered?

  Yes

  No

  N/A

Facility Setup

• Inspect Rental Operations Facility Floor. Is the designated areas "Clean, In-Process, Dirty" clearly marked and 6ft apart? (SOP-082)

  Yes

  No

  N/A

• Are the physical assets inside the designated areas "Clean, In-Process, Dirty"?

  Yes

  No

  N/A

• Is there a defined and labeled: storage area or customer owned area?

  Yes

  No

  N/A

Testing Equipment

• Request an SSU employee how to properly use the Mattress tester. Is the process known by the employee?

  Yes

  No

  N/A

• Review calibration equipment. Is the calibration for equipment current? (Random sampling for Torque, Safety Analyzer, Flow meters, etc.) (SOP-SVC-US-0030)

  Yes

  No

  N/A

• Request an SSU employee how to properly use the Safety Analyzer tester. Is the process known by the employee?

  Yes

  No

  N/A

Battery Disposal Container

• Is there a defined container for battery disposal?

  Yes

  No

  N/A

• Is it labeled correctly?

  Yes

  No

  N/A

• Does the container have ventilation holes?

  Yes

  No

  N/A

• Review Infection Control Hand Hygiene Procedure Poster. Is it clear and visible?

  Yes

  No

  N/A

• Review Personal Protective Equipment (PPE) equipment removal process. Is it clear and visible?

  Yes

  No

  N/A

• Review Chemical Mixing and Testing Poster. Is it clear and visible?

  Yes

  No

  N/A

• Ask an SSU employee to demonstrate either Eco-sand or Micro-quad mixing and testing. Do they know the process?

  Yes

  No

  N/A

• Is the chemical mix working properly meaning did it pass the testing?

  Yes

  No

  N/A

• Are Micro-Quad strips in the facility current?

  Yes

  No

  N/A

• Are Eco-sand strips in the facility current?

  Yes

  No

  N/A

• Review Steri-Fab Treatment. Are there marbles inside the container?

  Yes

  No

  N/A

• Review US Fleet Policy. Is the employee aware of the principles and expectations of Arjo US Policy?

  Yes

  No

  N/A

• Request Arjo US Service Organization Company Device Policy Records. Are the Policy Agreements available per employee with name, sign and date? Uploaded in MyLearning

  Yes

  No

  N/A

• Are there any records for the Road Test available? Is the form fully completed?

  Yes

  No

  N/A

• Are they any trucks NOT in service? Provide evidence of reasoning.

  Yes

  No

  N/A

• How long has the truck unit(s) been out of service?

  Yes

  No

  N/A

• Review Federal and State Department of Transportation (DOT) Hours of Service (HOS) Regulations for Property Carrying Vehicles for any employees currently On-site. (JJ Keller provided by Kristi Lloyd). Are the DOT medical employee cards for every SSU employee current ?

  Yes

  No

  N/A

• Service Consultant drivers license for every SSU employee current?

  Yes

  No

  N/A

• Review MCSA-5876 Medical Examiner's Certificate. Is the certificate for every SSU employee current?

  Yes

  No

  N/A

• Review 11 records from driver's Vehicle Inspection Report (VIR). Are records for trucks at SSU available?

  Yes

  No

  N/A

• Provide evidence of truck unit from VIR sheets available:

  Yes

  No

  N/A

• Review random truck unit Inspection for Arjo CMVs (delivery trucks). Are there any trucks available to be inspected?

  Yes

  No

  N/A

• In the last 12 months was there a PM performed for vehicle(s)? Provide evidence of List of Truck Unit(s).

  Yes

  No

  N/A

• Check the T card system for Truck Unit(s). Is the date on the back of the card current?

  Yes

  No

  N/A

• Is the exterior of the truck washed?

  Yes

  No

  N/A

• Is the inside front cabin of the truck clean and organized?

  Yes

  No

  N/A

• Is there a poster for loading instructions available?

  Yes

  No

  N/A

• Is there Citadel loading foam available?

  Yes

  No

  N/A

• Is the railing in good condition?

  Yes

  No

  N/A

• Are there safety hazards straps: 2x10', 10x4' and t-straps available?

  Yes

  No

  N/A

• Is there a safety hazards kit available?

  Yes

  No

  N/A

• Is there a labeled fire extinguisher available inside the truck?

  Yes

  No

  N/A

Service Consultant Vehicle Binders

• Is there a binder content available for Service Consultant Vehicle(s)?

  Yes

  No

  N/A

• Is the Registration card current?

  Yes

  No

  N/A

• Is the Gas Card current?

  Yes

  No

  N/A

• Public Safety Letter in binder?

  Yes

  No

  N/A

• Is the Insurance current?

  Yes

  No

  N/A

• Review Rounding Forms. Are they available?

  Yes

  No

  N/A

• Review Safety Meetings record sheet. Is the last 12 months available?

  Yes

  No

  N/A

• Provide date evidence of last Fire drill:

  Date

• Is the fire drill process known by SSU employee?

  Yes

  No

  N/A

• Does the SSU employee knowns the meeting location?

  Yes

  No

  N/A

• Inspect fire extinguisher(s) tag. Is it current?

  Yes

  No

  N/A

• Inspect First Aid Kit. Is it properly stock with Roll of Adhesive, paramedic scissors, bandage rolls, adhesive strips, etc.? (14 required items per OSHA requirements)

  Yes

  No

  N/A

• Review Personal Protective Equipment (PPE) supplies storage. Example: Are there safety glasses, disposable garments, disposable gloves or disposable shoe covers available?

  Yes

  No

  N/A

• Review Eco-Lab containers. Is the opening date provided?

  Yes

  No

  N/A

• Inspect chemicals in the storage area. Are expiration dates current?

  Yes

  No

  N/A

• Review Eco-sand and Micro-quad mixing solutions on cleaning cart. Are the safety health labels legible?

  Yes

  No

  N/A

• Ask a service center employee to test the Emergency Eye Wash station for 2 minutes. Is it properly maintained and clean of debris?

  Yes

  No

  N/A

• Is the Emergency Eye Wash station working properly for a total of 2 consecutive minutes?

  Yes

  No

  N/A

• Review SSU Local Part Cycle Count (email format source). Are the last three months available?

  Yes

  No

  N/A

• Inspect Production and Service Provisions. Is the area clean?

  Yes

  No

  N/A

• Are spare parts organized?

  Yes

  No

  N/A

• Are spare parts labeled?

  Yes

  No

  N/A

Rotoprones

• Is this a Rotoprone Center

  Yes

  No

• Inspect Rotoprone beds. Are there any On-site beds in the "Ready" area available?

  Yes

  No

  N/A

• Review Quality Checklist (QC) sheet? Is the original 3 page hard QC Sheet available on file?

  Yes

  No

  N/A

• Is it a 3 page hard QC Sheet available on asset?

  Yes

  No

  N/A

• Validate each step for QC Sheet. Is the QC filled out correctly? (Battery change due date, PM due date, Calibration due date for Safety Analyzer, Calibration due date for multimeter)

  Yes

  No

  N/A

• Check the battery sticker. Is it current?

  Yes

  No

  N/A

• Check the Preventative Maintenance sticker. Is it current?

  Yes

  No

  N/A

• Is ALL the Rotoprone labeling display in place?

  Yes

  No

  N/A

• Is the RotoProne visible clean in all areas? (cushions, metal frame, latches, foams, handles, face pack, etc.)

  Yes

  No

  N/A

• Is IFU under bead version current (208662-AH- Rev E. 04/2019)?

  Yes

  No

  N/A

• Is the accessory bag clean?

  Yes

  No

  N/A

• Is there a CPR handle zip lock?

  Yes

  No

  N/A

Citadel / Citadel Plus

• Inspect Citadel/Citadel Plus beds. Are there any On-site beds in the "Ready" area available?

  Yes

  No

  N/A

• Inspect printed Quality Checklist (QC) sheet. Are all steps validated?

  Yes

  No

  N/A

• Is the date of product quality inspection between 30 days?

  Yes

  No

  N/A

• Is the Citadel bed clean in all areas? (footboard, castor frame, castors, mattress, headboard, side riles)

  Yes

  No

  N/A

• Is the Quality Reference Guide (QRG) attached to bed?

  Yes

  No

  N/A

• Is the Preventative Maintenance (PM) label current? Provide evidence

  Yes

  No

  N/A

• Is Battery expiration date current? Provide evidence

  Yes

  No

  N/A

• Does bed have a Skin IQ integrated product? Is it working properly?

  Yes

  No

  N/A

• Are there any visible stains, ripped or tears in the mattress?

  Yes

  No

  N/A

• Inspect Wire S9465-D is it in good condition and placed properly? (Inspect for any wire showing or white plastic C-clamps broken that holds cable in place, preventing power loss-disconnection)

  Yes

  No

  N/A

Pumps

• Inspect Pumps. Are they any On-site pumps in the "Ready" area?

  Yes

  No

  N/A

• Inspect printed Quality Checklist (QC) sheet. Are all steps validated?

  Yes

  No

  N/A

• Is the Quality Reference Guide (QRG) attached to the pump?

  Yes

  No

  N/A

• Is the power cord available and attached to the pump?

  Yes

  No

  N/A

Mattresses

• Inspect Mattresses. Are they any On-site mattresses available in the "Ready" area?

  Yes

  No

  N/A

• Inspect foam inside mattress if Steri-Fab chemical was applied. Is cleaning the Steri-Fab label fill out correctly?

  Yes

  No

  N/A

• Are there any visible stains, ripped or tears in the mattress?

  Yes

  No

  N/A