Title Page

  • Audit Title

  • Department

  • Location / Storage area

  • Conducted on

  • Prepared by

  • Personnel

Device name

Reference number

Mattress integrity

  • There is no evidence of perishing; namely changes in color, thickness, strength and texture of the impermeable mattress cover?

  • There are no tears on either sides of the mattress and the cover is intact?

  • Are all the seams intact with no splitting or loose parts?

  • Is the foam recoiling to the standard size when compressed?

  • Is the size of the mattress proportionate to the size of the bed frame?

Function / Safety

  • Is the device complete and with no loose or any missing parts?

  • Is the device free from any damage?

  • Attach photo as necessary

Proper placement and cleanliness

  • Is the device properly placed in the right location?

  • Is the device clean?

Employee ID ang Signature

  • Employee ID

  • Sign here

Action Plan / Issue Management

  • Date and time of issue report

  • 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?

  • Repaired / Refurbished

  • Replaced / New

  • Partial repair

  • Temporary Back up Replacement

  • Attach photo as needed

Sign to complete once issue resolved

  • Complete

  • Employee ID

  • Sign here

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.