V10 Instructions for Use rev9 April 2011

Printed in Canada BHM Medical Inc. reserves the right to change or discontinue any specifications, design, features, model or accessories shown without notice. TM Trade-mark of BHM Medical Inc. All rights reserved. © BHM Medical Inc., 2010 The content of this publication may not be copied either whole or in part without the consent of BHM Medical.

Table of Contents General Information ... 5 Foreword ... 5 Service and support ... 5 Manufacturer Information ... 6 Authorized European Representative ... 6 Definitions Used in this Manual: ... 6 Intended Use ... 6 Operational Life ... 6 Equipment Identification ... 7 Verifying the Package Contents ... 7 How to Use this Manual ... 7 Symbols Used ... 8 Safety Instructions... 9 General Instructions ... 9 Safe Working Load ... 9 Important Safety Directions ... 10 Shock Prevention ... 10 Fire and Explosion Prevention ... 11 Human and Environmental Safety Practices ... 11 Battery and Battery Charger Safety Practices ... 11 Equipment Warning Labels ... 11 Part Designation ... 12 V10 Ceiling Lift and Charger Station ... 12 Legend ... 12 Handset ... 13 Chargers ... 13 Sling ... 14 Compatible Sling ... 14 How to Use the V10 Ceiling Lift ... 15 Return to Charge (RTC) ... 16 Emergency Stop (red cord) ... 16 Emergency Lowering ... 16 Emergency Brake ... 16 Battery Information ... 18 Indicator Lights ... 18 Charging the Batteries ... 18 Programming the Ceiling Lift ... 20 Using the FIDO Function (Pre-Programmed Positions) ... 20 Use of Slings ... 20 Spreader Bar ... 20 Before Approaching the Patient ... 20 To Lift a Patient from a Bed ... 20 To Lift a Patient from the Floor ... 23

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Table of Contents Procedure for Using Bariatric Loop Slings ... 23 Procedure for Attaching Bariatric Loop Slings to the Four-Point Spreader Bar ... 24 V10 Programming ... 25 Changing the Speed of Movement ... 25 Adjusting the Spreader Bar Height ... 26 Enable/Disable Return to Charge (RTC) ... 27 Care and Maintenance ... 28 Preventive Maintenance Schedule ... 28 User Inspections ... 28 Inspections by an Authorized Service Technician ... 29 Daily Checklist ... 31 Inspection and Cleaning ... 31 Strap Inspection ... 31 Handling and Storage ... 32 Battery Replacement ... 32 Verification of the Charger’s Power Source ... 32 Sling Inspection and Care ... 32 Regular Inspections ... 32 Sling Laundering ... 32 Annual Inspection ... 33 Maintenance Requirements ... 33 Troubleshooting... 34 Labels on the Lift... 36 Technical Specifications... 37 Lift Dimensions ... 39 Electromagnetic Compatibility ... 40 Electromagnetic Compliance ... 40 Electromagnetic Emissions ... 40 Electromagnetic Immunity ... 41 Logbook ... 44 Limited Warranty ... 46

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General Information Thank you for purchasing the V10 ceiling lift from BHM Medical. Your V10 is part of a series of quality products designed specially for home care, nursing homes and other health care uses. We are dedicated to serving your needs and providing the best products available along with training that will bring your staff maximum benefit from every BHM Medical product. Please read this manual thoroughly, and contact us if you have any questions about the operation or maintenance of your BHM Medical equipment.

Foreword Please read this manual in its entirety before using your V10. The information in this manual is crucial to the proper operation and maintenance of the equipment, and will help protect your product as well as ensure that the equipment performs to your satisfaction. Lifting and transferring a person always presents a potential risk. Some of the information in this manual is important for your safety and must be read and understood to help prevent injuries. BHM Medical strongly advises and warns that to avoid injuries that can be attributed to the use of inadequate parts, only parts designated by BHM Medical should be used on equipment and other appliances supplied by BHM Medical. Furthermore, unauthorized modifications on any BHM Medical equipment may affect its safety. BHM Medical will not be held responsible for any accidents, incidents or deficiencies of performance that occur as a result of any unauthorized modification to its products. Tested according to standards by TÜV Product Service and

Service and support A service routine must be performed on your V10 by qualified service personnel. This will ensure the safety and good functioning of your product. See section called “Care and Maintenance” in this manual. If you require further information, please contact your local BHM Medical representative which can offer comprehensive support and service programs to maximize the long-term reliability, safety and value of the product. Contact your local representative for replacement parts. Additional copies of this manual can be purchased from your local BHM Medical representative. When ordering, include the User Manual product number (see front page) and equipment identification number.

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General Information Manufacturer Information

Operational Life

This product has been manufactured by: BHM Medical Inc. 2001 Tanguay Street Magog (Quebec) Canada J1X 5Y5

The equipment is designed and tested for a useful life of seven (7) years or 10 000 transfers-whichever comes first-subject to preventative maintenance as specified in the “Care and Maintenance” section in this manual. Time equivalence between the number of transfers versus the number of years is made clear in the table in Fig. 1.

Authorized European Representative Huntleigh Healthcare Ltd. 310-312 Dallow rd. Luton, UK LU1 1TD

Years

Definitions Used in this Manual: WARNING:

Transfers per Day

(10,000 transfers)

4

7

6

4.5

8

3.5 Fig. 1

Means: Failure to understand and follow these instructions may result in injury to yourself and others.

WARNING: The manufacturer cannot ensure full safety for a ceiling lift or an accessory of which the life span has been exceeded.

CAUTION:

Means: Failure to follow these instructions may cause damage to the product.

The red indicator light on the ceiling lift will blink when it is about halfway to its useful life, and again to indicate the end of the useful life period.

NOTE:

The operating life of this equipment corresponds directly to the safe operating time period before a complete overhaul is required. Aging of the cassette, frequency of use (transfers per day), the weight of the patient and maintenance frequency are factors that have an impact on the V10’s life span. A transfer is defined as the displacement of a patient from one point to another. A transfer cycle includes a lifting and a descending action.

Means: This is important information regarding the correct use of the equipment.

Intended Use The V10 is designed for lifting patients in a homecare setting, at nursing homes and other assisted living centers. Patient transferring is performed under the supervision of an appropriately trained caregiver staff in accordance with the instructions outlined in this manual. All other uses must be avoided.

The expected operational life for fabric slings and fabric stretchers is approximately two years from date of purchase. This life expectancy only applies if the slings and stretchers have been cleaned, maintained and inspected in accordance with the BHM Medical Sling Application Guide, the Instructions for Use and the Preventive Maintenance Schedule.

The equipment must only be used for the purposes stated above, and must be installed by BHM Medical authorized personnel and in accordance with local codes.

The expected life for other consumable products, such as batteries, fuses, lamps, slings, straps and cords is dependent upon the care and usage of the

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General Information equipment concerned. Consumables must be maintained in accordance with published Instructions for Use and the “Preventive Maintenance Schedule”.

Equipment Identification The unit's identification number (specification, model, serial number) appears on a silver nameplate attached at one end of the lift.

Verifying the Package Contents Always ensure that the ceiling lift will be installed by a contractor or installer that has been authorized by BHM Medical. Upon receipt of the equipment, verify it against the packing list to ensure it is complete and inspect the equipment for possible damage due to shipping. If there is any damage, notify the carrier immediately to file a claim. Provide complete information concerning damage claims or shipping errors to your local BHM Medical representative. Include all equipment identification numbers and group part numbers (if any) as described above along with a full description of damaged parts.

How to Use this Manual WARNING: Do not attempt to use this equipment without fully understanding the information contained in this manual. To ensure the safe operation of the V10, read the entire manual carefully, especially the “Safety Instructions” section, before installing, operating, or servicing this equipment. If anything is not completely understood, please contact your local BHM Medical representative for more details. Failure to comply with warnings in this manual may result in injuries. Keep this manual with the lift and refer to it as required. Make sure that all operators are regularly trained in the use of the equipment according to the information found therein.

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General Information Symbols Used Symbol

Key to symbols This symbol is accompanied by the name and the address of the authorized representative in the European Community.

This symbol is accompanied by a date to indicate the date of manufacture and by the address of the manufacturer.

This symbol indicates the products comply with the medical device directive 93/42/EEC. This symbol is accompanied by the manufacturer's catalogue number.

This symbol is accompanied by the manufacturer's serial number.

This symbol indicates “separate collection” for all batteries and accumulators as per the WEEE Directive.

These symbols refer to the Instructions for Use.

This symbol indicates a class II electrical equipment: term referring to electrical equipment in which protection against electric shock does not rely on basic insulation only.

This symbol indicates a type B applied part.

This symbol indicates a risk of pinching

This symbol locates the emergency stop system on the lift

This symbol locates the emergency lowering system on the lift.

Fig. 2

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Safety Instructions The equipment must be used in accordance with these safety instructions.

General Instructions Keep these safety instructions with the ceiling lift at all times.

Anyone using the equipment must also have read and understood the instructions in this manual.

Read the instructions for use in this manual before installing, operating, or servicing this equipment.

If there is anything you are not sure about, contact your local BHM Medical representative.

WARNING: The V10 is for transferring patients only. Do not use the lift for any other purpose.

WARNING: Always place the sling around the patient according to the instructions enclosed. Failure to do so may result in injuries to you or to others.

CAUTION: Do not drop either the ceiling lift cassette or the batteries, since they may cause internal damage that is not easily seen. If the ceiling lift is suspected to be damaged, contact your local BHM Medical representative for servicing.

Safe Working Load The V10 has been designed with a lifting capacity of 455 kg (1000 lb). WARNING: The V10 is intended to be used for patients whose weight is within a specified safe working load. Do not attempt to lift more than the lowest weight limit indicated on the following: •

the track system;

•

the “maximum load” label on the V10;

•

on the spreader bar;

•

on the accessories;

•

on the sling.

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Safety Instructions Important Safety Directions

NOTE: BHM Medical ceiling lifts are specifically designed for KWIKtrak ceiling rail systems, and BHM Medical slings and accessories.

Always ensure that: •

The ceiling lift is installed by an authorized BHM Medical contractor or installer.

•

The equipment is used by trained staff.

•

The track installation will accept a load equal to that of the ceiling lift.

•

Before an attempt is made to move the patient, an assessment is performed by a qualified professional.

•

You are prepared before attempting to transfer a patient.

•

An assessment of the suitability for transfer of a patient who is connected to electrodes, catheters or other medical devices is conducted by qualified personnel before performing the transfer.

Shock Prevention

•

Violent impact during transfers is avoided.

•

•

The spreader bar being used is intended to be used with the V10 and is capable of bearing the patient’s weight.

•

The sling is intended to be used for this lift and can take the weight of the patient.

Do not touch or use a lift with bare conductors or a damaged power cord. Electrically live equipment can result in serious injuries. If the lift or charger has any exposed or damaged wires, contact your local BHM Medical representative immediately.

•

•

The sling is not damaged, torn or frayed.

Do not splash or expose electric parts of the device to water or moisture.

•

The lifting procedures outlined in this manual are followed.

•

•

All controls and safety features are used only according to the rules specified in this manual. Never attempt to force a control or button on the lift.

Check nameplate for input voltage and frequency requirements. These requirements differ by country. Do not attempt to use the lift in an area that has a different voltage and frequency requirement.

•

Do not attempt to expose, service or repair the lift, battery or charger. If any unit is malfunctioning, contact your local BHM Medical representative.

•

Read batteries and charger instructions thoroughly before using or storing them.

•

The charger is not stored in a shower, bath or other areas with high humidity.

•

The sling straps are in good condition and properly fastened.

•

The daily maintenance is carried out before using the lift.

•

Any precautionary or instruction labels that cannot be easily read are replaced.

•

If storing the V10 when it is not in use, the humidity in the storage area does not exceed 80 % at 20 ºC (68 ºF).

•

The ambient temperature range when storing the V10 is between –10 ºC and 50 ºC (14 ºF to 122 ºF).

CAUTION: Keep all components of the lift clean and dry, and have electrical and mechanical safety checks done as instructed in the “Care and Maintenance” section of this manual

CAUTION: Excessive exposure of the handset to water (or other liquid) could cause malfunction of the device.

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Safety Instructions Fire and Explosion Prevention

Battery and Battery Charger Safety Practices

WARNING: Do not place or store the battery under direct sunlight or near a heat source. Do not expose the batteries or battery charger to flames. Do not use the charger in the presence of flammable anaesthetic gases. •

Do not short circuit the battery terminals.

•

Do not incinerate the battery.

WARNING: Do not expose the battery connector or the battery charger to water. The charger is designed for dry areas only and for normal air humidity conditions.

Human and Environmental Safety Practices •

•

•

Should the battery casing crack, allowing its contents to come into contact with skin or clothing, rinse immediately with water. If the contents comes in contact with the eyes, rinse immediately with plenty of water and seek medical attention.

•

Be careful not to drop the batteries.

•

Only use the charger that has been supplied with the equipment.

•

Do not charge the batteries in an unventilated area.

•

The charger must not be covered or exposed to dust.

•

Do not crush, puncture, open, dismantle or otherwise mechanically interfere with the batteries.

•

Do not store batteries at a temperature higher than 50 ºC (122 ºF).

Equipment Warning Labels

Inhalation of the contents can cause respiratory irritation. Sensitivity to nickel can cause allergic asthma to result. Seek out fresh air and medical attention. For recycling and disposal of the batteries, the rules according to the WEEE directive (Waste of Electronic and Electrical Components) as well as local laws and regulations must be followed. If not they may explode, leak and cause personal injury. When returning batteries, insulate their terminals with adhesive tape. Otherwise, the residual electricity in used batteries may cause fire or explosion. Fig. 3 below shows the symbols for disposal and recycling.

Fig. 3

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•

Carefully read the labels on the battery and follow the instructions.

•

Inspect all precautionary labels on the equipment. Order and replace all labels that cannot be easily read.

Part Designation V10 Ceiling Lift and Charger Station

OR

OR

Fig. 4

Legend 1) 2) 3) 4) 5) 6) 7) 8) 9)

10) Red emergency pull cord 11) Spreader bar 12) Safety latch 13) Allen key 14) Strap 15) Charger (cord-connected or wall-adapted) 16) Handset

Ceiling lift Track Up button Red maintenance/overload light Down button Emergency lowering mechanism Charging station Green power light Amber charging light

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Part Designation The following refers to Fig. 4 on previous page:

Chargers

•

The amber charging light flashes while charging and goes solid when charge is finished.

•

The green power light illuminates once the lift is on and ready for use; the green light flashes when the batteries are low.

The V10 units are equipped with either a cordconnected universal charging system (700.15500) or a wall-adapted charger (700-15501) that can both be customized to fit the AC voltage outlets where they are sold (see Fig. 4).

•

The red light illuminates to confirm that the lift is in the programming mode.

•

The red light also illuminates in the normal mode when the lift goes into overheat protection caused by overuse.

•

The red light flashes when servicing is required (contact customer service).

Handset The V10’s handset unit is used to operate the ceiling lift. Each funtion is described in Fig. 5. The UP and DOWN buttons raise or lower the spreader bar. The “PROGRAMMING MODE” button allows you to modify the functions of the lift. Refer to the “V10 Programming” section for more information.

UP

700.136XX HANDSET

button LEFT

button

RIGHT

button DOWN

button RETURN TO CHARGE button

700-138XX HANDSET

RIGHT

PROGRAMMING MODE button

button UP

button

DOWN

button

LEFT

button

RETURN TO CHARGE

button

PROGRAMMING MODE button

Fig. 5

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Sling Compatible Sling

Bariatric sling (MAA8000-L)

Fig. 6 For more information about sling use, please refer to the documentation that comes with your sling.

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How to Use the V10 Ceiling Lift WARNING: Always read the “Safety Instructions” before using the V10. •

WARNING: Pay close attention to the safety of the patient as you press the control buttons. Before lifting the patient, make sure that all straps are attached to the spreader bar.

The track must be installed and modified only by BHM Medical authorized personnel and in accordance with local codes.

•

All tracks must be closed with end stoppers or connected to other closed track components.

•

Before use, make sure all end stoppers are in place and secured.

Make sure the sling is not caught on any obstructions (for instance, the wheelchair brakes or armrests). Also make sure that the spreader bar is correctly attached to the ceiling lift. See Fig. 7 below.

With split ring

NOTE: The unit will not lift or lower when it is in charging position.

No split ring

To begin the transferring procedure: 1) Install the patient sling around the patient. See “Use of Slings” section in this manual for further information. 2) Move the ceiling lift directly over the patient. Use the LEFT and RIGHT buttons on the handset (see Fig. 5).

Fig. 7

5) To lift the patient, press the UP button. 6) Make sure the patient is clear of any obstacles before moving him/her. Guide the patient’s legs if necessary. 7) When the patient is located above the desired point of transfer, press the DOWN button. 8) Use the handles on the back of the sling to position the patient when transferring into a chair. Hold the handle firmly as the sling will tilt back to position the patient. 9) Once the patient is properly seated and the straps have slackened, remove the sling from around the patient, and off the ceiling lift. 10) Move the ceiling lift away from the patient. 11) When the V10 is no longer required, return the ceiling lift back to the charging station. The charging indicator light on the clip-on charging station must be on for the ceiling lift to detect it.

3) Use the DOWN button on the handset to lower the spreader bar to a point below the chin of the patient (to avoid the risk of it striking the patient’s face due to a sudden movement). If the patient is lying down, lower the spreader bar down near the patient’s thorax, then install the straps.

WARNING: Hold the ceiling lift spreader bar with one hand at all times when near a patient. 4) Attach the straps to the desired position. See “Use of Slings” section.

Verify the green light on the charger station and the amber light (flashing or solid) on the ceiling lift to ensure that the charging function is working properly.

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How to Use the V10 Ceiling Lift

CAUTION: Do not pull the red emergency cord with excessive force. If the cord is jerked too hard, the ceiling lift may become inoperable.

NOTE: The V10 is equipped with a safety system to prevent a misuse of the ceiling lift. If the lift is used above the amount specified by the duty cycle, a heat detection system will signal the processor to block the lifting of a load until the temperature of the transmission cools down. In the meantime, it will still be possible to activate the horizontal displacement and down functions. When the overheat protection is engaged, the red light will stay on during the cooling period. In addition, a buzzer will sound if the UP button is pressed. The cooling period is between 10 to 30 minutes depending on ambient conditions.

2) To reactivate the ceiling lift, pull the red cord gently once. A green light confirms that the V10 is on and ready for use.

Emergency Lowering In the unlikely event of an electrical failure, the V10 has an emergency manual lowering feature. CAUTION: The Emergency lowering feature is to be used only in case of emergency. If the ceiling lift malfunctions when a patient is being transferred, the emergency lowering device provides a safe way of getting the patient down onto a chair, bed or wheelchair (see Fig. 8). To use it:

Return to Charge (RTC) The RTC function is disabled by default. To activate this function, please refer to the “V10 Programming” section in this manual.

1) Pull the red emergency cord. 2) Remove the little black cap located on each side of the lift.

To engage the RTC function, press on the return to charge button on the handset for 3 seconds. The spreader bar will raise all the way up to avoid any obstacles during the run. When the lift is at the charging station, the spreader bar lowers by itself to the preselected height so as to be easily accessible.

3) Find the 8 mm Allen key that came with the ceiling lift. Insert the Allen key deep into the axle. Turn it counterclockwise in order to lower the patient. Each turn of the key will slowly lower the patient. Repeat on the other side of the lift.

NOTE: You can stop the return to charge at any time by pressing any button on the handset or pulling on the red emergency cord. Moreover, a weight detector prevents the RTC from functioning while a person is in the lift.

4

Emergency Stop (red cord)

Emergency Brake

The emergency stop can be activated at any time to stop the functioning of the ceiling lift.

The emergency brake is an additional safety feature that automatically prevents the patient from falling in the unlikely event that of a transmission or motor failure.

Turn the Allen key counter-clockwise to slowly lower the patient. Repeat on the other side of the lift.

Once the patient is lowered and secure within a chair, bed or wheelchair, call a qualified technician to inspect the ceiling lift.

1) To stop the ceiling lift in any emergency, gently pull the red emergency cord once, until you hear a “click” (see Fig. 4 in the “Part Designation” section of this manual).

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How to Use the V10 Ceiling Lift

Access emergency lowering system.

Turn Allen key counterclockwise

Pull red emergency cord.

Fig. 8

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How to Use the V10 Ceiling Lift Battery Information

Indicator Lights

The life cycle (number of charging cycles) of the batteries is largely dependent on the depth of discharge within each cycle. The more the batteries are drained, the shorter their overall life span. The life of the batteries is also related to such factors as varying temperatures and rest periods between when they are charged and discharged.

The ceiling lift and the charging system have many indicator lights. It is important to understand their significance for the proper use and comprehension of the ceiling lift (see Fig. 10).

Charging the Batteries WARNING: Do not operate the charger unit with a damaged cord or if the unit has been dropped or damaged. Do not bend the power cord by force, or place a heavy object on it. This will damage the cord and may cause fire or electrical shock.

NOTE: To prolong battery life, return the ceiling lift to the charger whenever the ceiling lift is not in use. If the low battery indicator beeps, and a green light flashes, be sure to recharge the batteries as soon as possible. Charge the batteries until the charging indicator light is a solid amber before using the lift again. This will extend the life of the batteries.

The steps for recharging the batteries are as follows: 1) Press the return to charge button on the handset. A protection device prevents the ceiling lift from returning to the charger if a patient is in the ceiling lift during this operation.

NOTE: BHM Medical uses sealed lead-acid batteries. These batteries do not have any memory effect. Therefore, batteries should not be completely drained before recharging.

2) The green indicator light will begin flashing if batteries are low and need to be recharged. If the light does not turn on, verify the “Troubleshooting” section of this manual. 3) The amber indicator light will flash when the ceiling lift cassette has returned to the charger and the batteries are being charged. Once the charge is complete the light will stop flashing and become a solid amber light.

CAUTION: Never leave a ceiling lift with the power on for an extended period of time without returning it to the charger. The batteries will be drained and damaged.

WARNING: Batteries need to be charged for a minimum of 8 hours prior to the initial use of the lift.

See Fig. 9 for a graph illustrating the relationship between the number of lifts versus the load being lifted.

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How to Use the V10 Ceiling Lift

Fig. 9

Green power light

Amber charging light

Red maintenance/overheat light

OPERATING THE LIFT Flashing

Low batteries

Solid

The lift is on and ready to use

STATE OF BATTERIES Flashing

In process of charging batteries

Solid

Charging done; batteries charged

MAINTENANCE Flashing

Maintenance required by your local representative

Solid

Lift was powered up in “service mode” or is under overheat protection

CHARGING Clip-on charger station indicator

Solid green

Clip-on charging station power is on

Solid red

Problem with charger; do not use the charger

Fig. 10

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How to Use the V10 Ceiling Lift Use of Slings

If the batteries have been completely drained it could take up to 6-8 hours to completely recharge them. In order to reduce the charging time, refrain from completely draining the batteries and leave the ceiling lift on the charging station between uses.

Spreader Bar WARNING: The V10 comes with a fourhook spreader bar and must be used only with BHM bariatric slings, as indicated in the list of accessories.

Programming the Ceiling Lift The V10 can be programmed so that the user can easily adjust the speed of the horizontal movement, the spreader bar height and the return to charge parameters of the ceiling lift. To learn about the programming mode, see the “V10 Programming Guide” on pages 25-27 of this manual.

WARNING: Spreader bars must only be installed by a qualified person.

WARNING: Before using the V10, always ensure the strap attachment pin is installed correctly through the spreader bar socket and lift strap, and that the split ring is correctly inserted through the hole in the pin (see Fig. 7).

Using the FIDO Function (Pre-Programmed Positions)

Before Approaching the Patient Attendants should always tell the patient what they are about to do. Make sure to have on hand a sling that is of the correct model and of adequate size for transfer with the V10 unit.

WARNING: This function can only be activated by a qualified technician. 1) Using the pre-programmed positions allows the unit to detect stations (positions) located along the track path. The unit will go to the indicated position by using the handset.

To Lift a Patient from a Bed WARNING: When transferring a patient from a bed, have caregivers on each side of it, or raise the bed rails to ensure the patient does not roll off the bed.

2) To do so, indicate to the unit the desired position to go to. For an example, to go to the third station push three times on the PROG button followed by the direction (LEFT or RIGHT buttons).

1) Position the patient onto the sling, by rolling the patient towards you then folding the sling in half and placing it behind the patients back, so that the bottom edge of the sling is aligned with the bottom of the patient’s spine (see Fig. 11 and Fig. 12).

Then the unit will go by itself to the requested station and stay on hold there. If the position you asked for is not correct, you may stop the ceiling lift at any time by pressing any button on the handset. From this position, reprogram the ceiling lift to the new desired position. Count the number of stations from where you are and indicate the direction to go.

2) Position the sling carefully so that when rolled back the patient will lie centrally on the sling. Check that the head support area of the sling is also in position. With heavy patients the use of a slide sheet is recommended.

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