Asset / 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 Table complete and with no loose or any missing parts?
Is the Table free from any damage?

Is the remote matching and working with Table?

Is the Table Stable?

Is the Table clean?
Employee ID ang Signature

Employee ID

Sign here
Action Plan / Issue Management
Date and time of issue report

Report received by :

Employee Id


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


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.