Periodic Inspection Sabina www.liko.com
55
Sabina™ 6.0
Sabina ll EE/EM, Sabina 200
Periodic inspection
Prod. No. 2020003, 2020004, 2020020
2014-02-14
Customer references
Agreement No: .............................................................
Name: .......................................................................
Address: .......................................................................
Post code: ....................................................................
Inspection performed in accordance with ISO 10535:2006 Annex B- Periodic inspection
Approval to use the Sabina sit-to-stand lift Approved Not approved To be actioned
Not approved: If the sit-to-stand lift has one or more check points with result “Not approved” RollOn must not be used.
To be actioned: Actions according to the “Instructions for the check points” should be performed immediatley. After
performed actions sign below. If anything is unclear or if you have questions, please contact Hill-Rom/
Liko or your local Hill-Rom/Liko representative. Contact information is to be found at www.liko.com.
Inspection performed by: __________________________________ Date:____________________
Final approval by: _____________________________________ Approval date: ___________
Next inspection: _____________________________________
The Sabina sit-to-stand lift must be thoroughly inspected at least once per year. Inspection and service must be carried out by
Hill-Rom/Liko authorized personnel. Instructions for check points, from next page.
Product information
Product: ...................................................................
Product No................................................................
S/N: ....................................................................
Prod Year: ...............................................................
Check points:
Approved Not To be actioned:
approved
1 General inspection ...................................................................
Base
2 Type/modelidenticationdecal .................................................................................
3 Castor wheels .................................................................................
4 Castor brakes .................................................................................
5 Base opening and closing linkage .................................................................................
6 Base frame castor play & levelling ...................................................................
7 Foot tray .................................................................................
Mast
8 Locking handles ...................................................................
9 Lift arm hardware & covers ...................................................................
10 SlingBar ...................................................................
11 Adjustable lower-leg support ...................................................................
12 Mast actuator ...................................................................
13 Battery & electrical cable installations ...................................................................
14 Functions on the hand control ...................................................................
15 Emergency Stop ...................................................................
16 Electrical emergency-lowering device ...................................................................
17 Charger ...................................................................
Load testing
18 Load Test ...................................................................
Documentation
19 Instructions / Instruction guide ...................................................................