SERVICE WORK (UNSCHEDULED & OTHERS)

FEMS

A. Request Details

Hospital Name / Code Sibu / SWK960 Priority Normal

Service Work No. WO/FEMS/SWK960/1910/000215 Service Request No. SR/SWK960/20191006/F020610

Category Unscheduled Type Corrective Maintenance

Request Date / Time 06-Oct-2019 17:04 Requestor Name MOH REQUESTER (FEMS)

Requestor Location Name Farmasi Satelit Designation Liaison Officer Contact No. 6655

Asset No. 9606802001 Asset Name Inventory Asset

Asset Location Code / Name 6802001 / Farmasi Satelit Type Code 999999
Department Code /
User Area Code / User Area Name US07 / Seminar Room & Satelite Pharmacy P04 / Pharmacy
Department Name
Manufacturer Brand / Model /

Workgroup W3-Civil Engineering Variation Status

PRAYER ROOM IN FRONT SATELLITE PHARMACY 2 - WATER LEAKING FROM CEILING - SN SABRINA / EXT
Request details
5203.

B. Contract/Warranty Information

Contractor Name Contractor Code

Contact Person Phone No.

Start Date End Date

C. Assessment Details

Response By Date Time

Response Finding

User Verification By Date/Time

Signature / Department stamp

Asset Real Time Status … Functioning … Not Functioning …Partially Functioning

D. Part Details

No. Part No. Part Description Qty

E. Employee Details

No. Staff ID Name Start Date/Time End Date/Time

F. Process Status

… Propose for BER … Propose for RW … Equipment In Use … Technical Advise … Equipment not at location

… Loaner Provision … Alternative Service

G. Completion

Performance Test … Done … Not Applicable … Not Done Electrical Safety Test … Done … Not Applicable … Not Done
Date/Time Work
Date/Time Work Start
Completed
Action Taken

QC Code

Completed By Verified By (MoH)

Signature / Date Time Signature / Date Time

Date:06-Oct-2019 17:10