CALIBRATION SCHEDULE - Area….

Date of Month of
Calibration Done. Calibration Due.
Sr. No. Equipment Fab. No. Model Company Codification
1 X-ray us 1234 polydorous Siemens GH/AMB/DH/XRY/001 9/10/2010 11-Sep
2 Defibrillator us 1234 X-50 Schiller GH/AMB/DH/DFB/001 9/10/2010 11-Sep
 PREVENTIVE MAINTENANCE SCHEDULE

S.NO. Company Equipment Fab. No. Model DOI Codification 2010

JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC

1
2
3
4
5
6

7
8
9
10
 EQUIPMENT HANDOVER FORM- INTERNAL USE

Name of the Hospital

FROM
TO
DATE
SUBJECT

Kindly acknowledge the receipt of following equipments along with accessories

S.No Manuals others
S.NO. Description Company Name Model Accessories Asset Code Equipment Service/Operator CD /Software upgrades

This has been certified that the operation & maintenance has been demonstrated to the user.

Sign of the BME Sign of the User

Name of the BME Name of the User
Date Date
 History Sheet

Name of Equipment:- Asset. Code:-

Name of Company/Supplier:- Location:-

Model:- Frequency of Calibration:-

Date of Installation:- Frequency of PM:-
Sr.No.:- contact person
Maintenance Record
S.NO. Date of Complaint Date of Completion Nature of complaint Action Taken
 INSTALLATION CERTIFICATE
HOSP CODE/Hospital name: SUP CODE/Name of supplier

EQPT CODE/Name of the equipment MODEL

SERIAL NO.
Original Equipment Manufacturer
Installation Date

Installed by Service Er name/ID No Mobile no

Service Center address

Service Center Manager's Name Mob No.

Purchase order no Dated Value

Comprehensive From To

Warranty Period
Accessories supplied

Item Qty Serial No. Remarks

Whether a the Demonstration of the equipment with accessories on the Technical specifications/Key features was conducted to the
satisfaction at the time of Installation?
YES/NO (tick one)
her Training was conducted to the satisfaction at the Time of Installation? YES/NO (tick one)
Training to user ,please specify name
Training to Engineer ,please specify name

Short Supply items,if any

Preventive Year 1 Year 2 Year 3

Maintenance 2/4 visits 2/4 visits 2/4 visits
schedule
Remarks of Hospital authorities

Recommend to Release payment The Equipment is Working satisfactorily

Yes No Yes No
Signature of service er. Signature of end User Signature of BME Signature of end User

Name: Name: Name: Name:

ID No. Department Organizati
Date: Date:

Seal of supplier Seal of Hospital:

 PERFORMANCE CERTIFICATE
HOSP CODE/Hospital name: SUP CODE/Name of supplier

EQPT CODE/Name of the equipment MODEL

SERIAL NO.
Original Equipment Manufacturer
Installation Date

Installation Location PROJECT NAME

Purchase order no Dated Value

Whether equipment Working satisfactorily without any Problem for one month? YES NO

If no,details of equipment Failure in the first month(attach additional details if any in a separate sheet)
Details of equipment Failure
Break Down Date Attended date Rectified Date Attended By Details of Breakdown/Service

Present status of equipments Working Satisfactory Not Working satisfactory

Recommended for Final payment

YES No
YES No
Recommended for trial run for one more month
 Condemnation certificate for Medical equipments

Name of the Hospital: Date:

Name of the Department: ----------------------------------------------
Description of the items to be condemned :-----------------------------------------------------------

S. No. Item Name Qty Date Of purchase Capitalized Depreciated Estimated disposal Profit or loss Useful life at the Useful life left on Reason for Supporting
cost/ Purchase value value on disposal time of purchase the date of Condemnation documents
Value proposal for
condemnation
1
2
3
4
5
6
7
8
9
10
11
12
13
Total Value

Alternate Use, if any :_

Mode of Treatment
Mode of Disposal :

HOD – User Deptt BME (Divisional ) CMO/ MS

 Contents of the Equipments File

S.No. Index

1 History sheet

2 Service Reports

3 Comunication with company

4 Internal communication

5 Preventive Maintenance

6 Calibration reports

7 Installation report

8 Supply order
 AMC /CMC Budget
S. No. Name of Equipment Company Name Model Warranty AMC/ From To Amount
upto CMC
 COMPLAINTS
S. Nature Reported Attended Receiving Attend Attend
Date Remarks
No. of Complaint By By whom Time Time Date
 MASTER EQUIPMENT BASE

General Hospital Sirsa

DEPARTMENT - EYE OPD

ASSET COST OF Warranty

S.no Equipment name CODE Qty Manufacturer Model Sr no. of EQUIPMENT AT PO Date DOI Upto AMC/CMC Working status Remarks
Equipment TIME OF
PURCHASE Working/not
Working

1 Slit lamp 1 Shin Nippon N/A N/A N/A N/A Working

2 Auto refractometer 1 Topcon RM8800 4016063 N/A N/A 16-04-07 N/A N/A Working

3 Auto refractometer 1 Shin Nippon SR-7000 9j1671 N/A N/A 27-06-07 N/A N/A Working

Vision
4 Keratometer 1 N/A N/A 19-06-09 N/A N/A Working
instrument

Appasamy Under
5 A-Scan 1
Asssociates
165900/- 7/2/2014 21-03-2014
Warranty
N/A Working

Heine Opto Under

6 Indirect Opthelmoscope 1
technik
N/A 6/11/2014 20-02-2015
Warranty
N/A Working
 Stock Ledger for categorisation of spares
Code/ Ref
No/ Specs and/or New New New
Item Code Item Name Item Type Brand Material Manufacturer Item Nature
Catalog Size Category 1 Category 2 Category 3
S.no No

Biomedical Engineering Department

Biomedical Engineering Department
 Capital expenditure FY 2010-11
Dept. / Item Unit cost (In Justification /
S.No. Area Make Qty Amount
speciality Description Lacs) (R/N)* Remarks

* R= Replacement
N= New

Biomedical Engineering Department