MITY Tilt Recliner Wheelchair V4

Warning: Test the chair without a resident in it.

Chair's functions tested as described in Section 3

If any function is not operating correctly, take the chair out of service.

Was the chair taken out of service?

Note: Seat tilt, back recline, and footrest operations will be more difficult without a resident.

Footrest elevation operation tested

Warning: Do not use lubricants that contain solvents.

Warning: This maintenance check requires trained personnel with PPE!

Chair visually inspected for signs of wear, damage, loose or missing fasteners, and other safety concerns

Any breakage, defect, or operational problem detected?

If any problem is detected, the chair must be successfully repaired, inspected and tested for function before it is returned to service.

Select the type of resident using the chair

Was the chair used by any of the above mentioned types of residents?

If the chair was used by any of the above mentioned types of residents, it should be inspected and tested as often as each use.

Any lubricants containing solvents used?

Warning: This inspection requires trained personnel!

Cylinders that position the seat tilt, back recline, and independent leg rest elevation in good condition?

Vinyl straps used in the seat, back, leg rest, footrest and wings in good condition?

3 black handles and cables in good condition?

Armrest height adjustment pins in good condition?

Check all installed accessories that are in good condition

Sign off on the wheelchair inspection

BRODA chairs should be wiped clean with soap and water. Diluted household strength ammonia or chlorine based cleaner, as well as a hospital grade cleaner may be used if necessary.

Refer to the following guide for cleaning certain staining agents (Applies to the Permablok3® vinyl, as per the vinyl manufacturer’s recommendations) The frame and components of the chair can be cleaned using the same procedure as the vinyl.

The steps below are also located in the Cleaning Guide found on the back of the Broda chair:

Step 1: Remove excess spill with a damp cloth. Clean with a 1:1 mix of Ivory® liquid and water. Rinse with clean water and dry.

Step 2: Use a straight application of concentrated cleaners such as Formula 409® or Fantastik® Spray Cleaner. Then wipe with a clean cloth. If using a hospital grade cleaner, follow the diluting instructions on the label.

Step 3: Use a 1:1 mix of ammonia and water or a 1:4 mix of bleach and water. Rinse with clean water and dry.

Step 4: Use a straight application of naphtha (lighter fluid). Rinse thoroughly with clean water and pat surface dry.

Step 5: Use a 1:1 mix of isopropyl alcohol and water. If the stain persists, use straight alcohol. Rinse thoroughly with clean water and pat dry. If the stain remains, use a 1:1 mix of acetone and water. Rinse with clean water and pat surface dry.

*Note: for cleaning that requires steps 4 or 5 – Use a soft cotton cloth saturated with the cleaning material and rub the stain in circles 10 times. Pat dry with another soft cotton cloth, and check results.

Warning: If the chair does not appear to be ready to use upon receipt, immediately contact your supplier and do not put the chair into service until any concerns have been resolved.

Chair appears ready to use upon receipt

Visual inspection for missing parts

Visual inspection for loose fasteners

Functional testing must be successfully completed after visual inspection and before use.

Functional testing completed successfully

Sign off on the Tilt Recliner Wheelchair Check