OR Table and Trolley Mattress Integrity With Issue Audit Tool

• Audit Title

• Department

• Location / Storage area

• Conducted on

  Date

• Prepared by

• Personnel

Make

Asset / Reference number

Action Plan / Issue Management

• Date and time of issue report

  Date

• Report received by :

• Employee Id

• Email

• Contact number

• Reported to Manager / Supervisor / Charge Nurse

• Reported to Biomed

• For replacement

• For repair

• To order new Parts

• For evaluation

• Temporary replacement / Back up

• With biomed

• To condemn

Resolved issue

• Was the issue resolved?

  Yes

  No

  N/A

• Repaired / Refurbished

• Replaced / New

• Partial repair

• Temporary Back up Replacement

• Attach photo as needed

  Media

Sign to complete once issue resolved

• Complete

• Employee ID

• Sign here

  Sign