Title Page

  • Document No.

  • Environmental Stress Cracking: Patient Lifter Audit

  • Health Service

  • Box Hill Hospital

  • Monash Medical Centre

  • University Hospital Geelong

  • Austin Hospital

  • Ballarat Base Hospital

  • The Alfred

  • The Royal Victorian Eye and Ear Hospital

  • Conducted on

  • Personnel

  • Location

Department 1

Department:

Cleaning / Disinfectant

  • What is the principal cleaning / disinfectant used?

  • Provide brand

  • Provide additional details

  • How frequently are the high touch items cleaned?

  • Provide details including dilution.

  • How frequently are the high touch items cleaned?

  • Provide additional details, type, where the technology is used and frequency of use?

  • How frequently are the high touch items cleaned?

  • Has the cleaning regime changed recently for this category of equipment? (> 12 months)

  • What was the previous principal cleaning / disinfectant used?

  • Provide brand

  • Provide additional details

  • How frequently was this category of equipment previously cleaned?

  • Provide details including dilution.

  • How frequently was this category of equipment previously cleaned?

  • Provide additional details, type, where the technology was used and frequency of use?

  • How frequently were the high touch items cleaned?

  • Provide any additional details as required?

  • Has the cleaning regime change, resulted in revised staff training procedures?

  • Please provide details of training provided including competency and the craft groups that received the new training?

  • Have there been a change in cleaning services within the previous 12 months. <br>In-house service to external contracted service<br>external service to in-house service<br>change in external provider.<br>

  • Please provide additional details?

  • Have any items been reported as showing environmental stress cracking? <br>N/A (no damage reported) <br>Low (Damage reported every 8 - 12 months)<br>Minor (Damage reported every 6 - 8 months)<br>Medium (Damage reported every 3 - 6months)<br>High (Damage reported every 1- 3 months)<br>

  • Provide additional details

  • Environmental Stress Cracking
    ESC may be:
    • Brittle cracking with no indication of yielding or indentation.
    • Fine hairline cracks.
    • Multiple initiation points.
    • Repeated cracking in the same item.

  • PATIENT LIFTER

  • Patient Lifter
  • Provide brand and model no:

  • In what year was this equipment purchased?

  • Add photos

  • ESC<br>1 – Minor (1 or 2 small cracks)<br>2 – Major (multiple cracking)<br>3 – Severe (extensive cracking and resulting material loss and damage

Department 2

Department:

Cleaning / Disinfectant

  • What is the principal cleaning / disinfectant used?

  • Provide brand

  • Provide additional details

  • How frequently are the high touch items cleaned?

  • Provide details including dilution.

  • How frequently are the high touch items cleaned?

  • Provide additional details, type, where the technology is used and frequency of use?

  • How frequently are the high touch items cleaned?

  • Has the cleaning regime changed recently for this category of equipment? (> 12 months)

  • What was the previous principal cleaning / disinfectant used?

  • Provide brand

  • Provide additional details

  • How frequently was this category of equipment previously cleaned?

  • Provide details including dilution.

  • How frequently was this category of equipment previously cleaned?

  • Provide additional details, type, where the technology was used and frequency of use?

  • How frequently were the high touch items cleaned?

  • Provide any additional details as required?

  • Has the cleaning regime change, resulted in revised staff training procedures?

  • Please provide details of training provided including competency and the craft groups that received the new training?

  • Have there been a change in cleaning services within the previous 12 months. <br>In-house service to external contracted service<br>external service to in-house service<br>change in external provider.<br>

  • Please provide additional details?

  • Have any items been reported as showing environmental stress cracking? <br>N/A (no damage reported) <br>Low (Damage reported every 8 - 12 months)<br>Minor (Damage reported every 6 - 8 months)<br>Medium (Damage reported every 3 - 6months)<br>High (Damage reported every 1- 3 months)<br>

  • Provide additional details

  • Environmental Stress Cracking
    ESC may be:
    • Brittle cracking with no indication of yielding or indentation.
    • Fine hairline cracks.
    • Multiple initiation points.
    • Repeated cracking in the same item.

  • PATIENT LIFTER

  • Patient Lifter
  • Provide brand and model no:

  • In what year was this equipment purchased?

  • Add photos

  • ESC<br>1 – Minor (1 or 2 small cracks)<br>2 – Major (multiple cracking)<br>3 – Severe (extensive cracking and resulting material loss and damage

Department 3

Department:

Cleaning / Disinfectant

  • What is the principal cleaning / disinfectant used?

  • Provide brand

  • Provide additional details

  • How frequently are the high touch items cleaned?

  • Provide details including dilution.

  • How frequently are the high touch items cleaned?

  • Provide additional details, type, where the technology is used and frequency of use?

  • How frequently are the high touch items cleaned?

  • Has the cleaning regime changed recently for this category of equipment? (> 12 months)

  • What was the previous principal cleaning / disinfectant used?

  • Provide brand

  • Provide additional details

  • How frequently was this category of equipment previously cleaned?

  • Provide details including dilution.

  • How frequently was this category of equipment previously cleaned?

  • Provide additional details, type, where the technology was used and frequency of use?

  • How frequently were the high touch items cleaned?

  • Provide any additional details as required?

  • Has the cleaning regime change, resulted in revised staff training procedures?

  • Please provide details of training provided including competency and the craft groups that received the new training?

  • Have there been a change in cleaning services within the previous 12 months. <br>In-house service to external contracted service<br>external service to in-house service<br>change in external provider.<br>

  • Please provide additional details?

  • Have any items been reported as showing environmental stress cracking? <br>N/A (no damage reported) <br>Low (Damage reported every 8 - 12 months)<br>Minor (Damage reported every 6 - 8 months)<br>Medium (Damage reported every 3 - 6months)<br>High (Damage reported every 1- 3 months)<br>

  • Provide additional details

  • Environmental Stress Cracking
    ESC may be:
    • Brittle cracking with no indication of yielding or indentation.
    • Fine hairline cracks.
    • Multiple initiation points.
    • Repeated cracking in the same item.

  • PATIENT LIFTER

  • Patient Lifter
  • Provide brand and model no:

  • In what year was this equipment purchased?

  • Add photos

  • ESC<br>1 – Minor (1 or 2 small cracks)<br>2 – Major (multiple cracking)<br>3 – Severe (extensive cracking and resulting material loss and damage

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