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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.
14
Technician:
Signature:
Washing manual for manual wheelchairs
Version: 2022-05