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RECEIPT FORM FOR EXECUTED WASHING AND

REFURBISHMENT PROCEDURE

•

Frame number/serial number:

•

PROCEDURE EXECUTED OK:

• Cleaning procedure

• Refurbishment procedure

• Function control

All the points above have been executed and the wheelchair is ready for delivery

Company name:

.......................................................................... ..............................................................................

Place - Datum:

.......................................................................... ..............................................................................

This filled out refurbishment manual shall follow the refurbished wheelchair to the end user, document-

ing that the wheelchair has been refurbished according to the wheelchair manufacturer recommenda-

tions. This assures maintaining the end user safety and the long life wheelchair function.

Technician:

Signature:

Washing manual for manual wheelchairs

Version: 2022-05