CLH Service Inspection Report

• Examination Address

  As Above

  Other
• Please specify the examination address:
  Address

• Date of examination

  Date

Equipment

• Type of Equipment

  Select Hoist Loler Bath Sling Weighscale Calibration Wheelchair Bed Thorough Examination

  • Hoist Loler
  • Bath
  • Sling
  • Weighscale Calibration
  • Wheelchair
  • Bed
  • Thorough Examination

• LOLER: Thorough Examination Report Lifting Operations & Lifting Equipment Regulations 1998 Schedule 1

• Manufacturer

  Invacare

  Oxford

  Arjo

  Drive

  Other

• Please Specify:

• Model

• Serial number:

• Date of manufacture

• Safe working load (Kg)

• Date of last examination:

• Commissioning exam:

  Yes

  No

  Other

• Has the equipment been installed / assembled correctly?

  Yes

  No

  N/A

• Periodic examination:

  Yes

  No

  Other

• Interval of examination:

  6 Months

  12 Months

  Other

• Please specify Interval:

• Next examination due date

  Date

• Load test conducted according to

  BS EN ISO 10535

  Other

  N/A

• Please Specify:

• Defective parts requiring immediate attention

  Yes

  None

Defective parts requiring immediate attention

• Please specify defect:

• Take photos of the defect.

  Media

• Immediate action required/ Comments:

• Defects requiring rectification at a later date

  Yes

  None
Defect

• Please specify defect:

• Take photos of the defect.

  Media

• Action plans/ Comments:

• Comments

• Safe to operate:

  YES

  NO - DO NOT USE

• Bath Inspection

• Make

• Model

• Serial Number

• Date of last examination

• Periodic Examination

  Yes

  No

  Other

• Interval of examination:

  6 Months

  12 Months

  Other

• Please Specify:

  6 Months

  12 Months

  Other

• Next Examination Due Date

  Date

• TMV3 - Bath Degrees Celcius

• TMV3 - Shower Degrees Celcius

• Check Bath Fill Level

  Pass

  Fail

  N/A

• Fill Time (Minutes:Seconds)

• WRAS

  Compliant

  Non-Compliant

  N/A

• Appliance Operation

  Fully Functional

  Malfunctioning

• Is the appliance water tight?

  Yes

  No

• Have moving parts been lubricated?

  Yes

  No

• If applicable, are hydrotherapy, aromatherapy, and chromotherapy options working correctly?

  Yes

  No

  N/A

• Comments / Recommendations

• Is the bath safe to use?

  YES

  NO - DO NOT USE

• Sling Inspection

• Manufacturer

  Select Oxford Silvalea Invacare Other Prism CLH

  • Oxford
  • Silvalea
  • Invacare
  • Other
  • Prism
  • CLH

• Please Specify:

• Type

• Serial Number

• Size

  Select Extra Small Small Medium Large Extra Large Extra Extra Large Other

  • Extra Small
  • Small
  • Medium
  • Large
  • Extra Large
  • Extra Extra Large
  • Other

• Please Specify:

• Colour

• Fabric

  Spacer

  Polyester

  Net

  Other

• Please Specify

• Full legibility of: manufacturer name, washing instructions, safe working load (S.W.L.), size & serial number

  Yes

  No

• Are there any indications of stitching breakdown?

  Yes

  No

• Tape fraying or wear?

  Yes

  No

• Are there indications of fabric thinning, stress or fading?

  Yes

  No

• Is the sling irrevocably soiled?

  Yes

  No

• Comments

• Is the sling safe to use?

  YES

  NO - DO NOT USE

• Weighscale Test & Calibration

• Manufacturer & model

• Serial number:

• Capacity (Kg)

• Weigh scale type

  Select Digital Mechanical

  • Digital
  • Mechanical

• Test weight applied (Kg)

• Applied weight reading (Kg)

• Comments

• Are the Weighscales safe to use?

  YES

  NO - DO NOT USE

• Wheelchair Inspection

• Manufacturer

• Model

• Serial number:

• Date of manufacture

• Safe working load (Kg)

• Date of last examination:

• Periodic examination:

  Yes

  No

  Other

• Interval of examination:

  6 Months

  12 Months

  Other

• Please specify Interval:

• Next examination due date

  Date

• Defective parts requiring immediate attention

  Yes

  None

• Defective parts (Immediate attention):

Defect

• Please specify defect:

• Take photos of the defect.

  Media

• Immediate action required/ Comments:

• Defects requiring rectification at a later date

  Yes

  None

• Defects requiring rectification at a later date:

Defect

• Please specify defect:

• Take photos of the defect.

  Media

• Action plans/ Comments:

• Comments

• Safe to operate:

  YES

  NO - DO NOT USE

• Bed Inspection

• Manufacturer

• Model

• Serial number:

• Date of manufacture

• Safe working load (Kg)

• Date of last examination:

• Periodic examination:

  Yes

  No

  Other

• Interval of examination:

  6 Months

  12 Months

  Other

• Please specify Interval:

• Next examination due date

  Date

• Defective parts requiring immediate attention

  Yes

  None

• Defective parts (Immediate attention):

Defect

• Please specify defect:

• Take photos of the defect.

  Media

• Immediate action required/ Comments:

• Defects requiring rectification at a later date

  Yes

  None

• Defects requiring rectification at a later date:

Defect

• Please specify defect:

• Take photos of the defect.

  Media

• Action plans/ Comments:

• Comments

• Safe to operate:

  YES

  NO - DO NOT USE

• Thorough Examination

• Manufacturer

• Model

• Serial Number

• Date of manufacture

• Safe working load (Kg)

• Date of last examination

• Periodic examination

  Yes

  No

  Other

• Please specify interval

• Next examination due date

  Date

• Defective parts requiring immediate attention

  Yes

  No

• Please specify defect

• Take photos of the defect

  Media

• Defects requiring rectification at a later date

  Yes

  No

• Please specify defect

• Take a photo of the defect

  Media

• Safe to operate

  YES

  NO - DO NOT USE

• Comments

• Date of examination

  Date

• How would you like to receive your report?

  Post

  Email

• Email address for reports:

• Customer Signature

  Sign

• Examiner Signature

  Sign

• Gordon Leary - Service Manager.
  CLH Group Ltd, Devonshire House, Exeter, EX2 8QW