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
Please note that this checklist is a hypothetical example and provides basic information only. It is not intended to take the place of, among other things, workplace, health and safety advice; medical advice, diagnosis, or treatment; or other applicable laws. You should also seek your own professional advice to determine if the use of such checklist is permissible in your workplace or jurisdiction.