OR Trolley Mattress Integrity Audit Tool

• Audit Title

• Department

• Location / Storage area

• Conducted on

  Date

• Prepared by

• Personnel

Make

Asset / Reference number

Mattress integrity

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

Function / Safety

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

  Select Yes No With loose parts With missing part/s Safe to use

  • Yes
  • No
  • With loose parts
  • With missing part/s
  • Safe to use

• Is the trolley free from any damage?

  Select Yes No With minor dents / bumps / nicks With huge damage Safe to use Some Adjustment is not working

  • Yes
  • No
  • With minor dents / bumps / nicks
  • With huge damage
  • Safe to use
  • Some Adjustment is not working

• Is the Side Rails working Properly?

  Yes

  No

  N/A

• Are the wheel Breaks working Properly?

  Yes

  No

  N/A

Cleanliness

• Is the Trolley clean?

  Select Yes No Minimal stains Huge stain

  • Yes
  • No
  • Minimal stains
  • Huge stain

Employee ID ang Signature

• Employee ID

• Sign here

  Sign