FORM PERBAIKAN ALAT

UNIT:
1. Nama Alat :........................................................... Alat Medis / Non Medis
2. Merk :...........................................................
3. Type :...........................................................
4. Serial Number :...........................................................
5. Jenis Kerusakan :...........................................................
............................................................
6. Tidak dapat diperbaiki karena : Ket :............................................
Harus minta bantuan dari teknisi luar ............................................
Sparepart rusak
Service keluar
Ganti alat baru
Lain-lain.................................. Jakarta,................................

(....................................) (....................................) (....................................)

User Teknisi Kasi IPSRS

FORM PERBAIKAN ALAT

UNIT:
1. Nama Alat :........................................................... Alat Medis / Non Medis
2. Merk :...........................................................
3. Type :...........................................................
4. Serial Number :...........................................................
5. Jenis Kerusakan :...........................................................
............................................................
6. Tidak dapat diperbaiki karena : Ket :............................................
Harus minta bantuan dari teknisi luar ............................................
Sparepart rusak
Service keluar
Ganti alat baru
Lain-lain.................................. Jakarta,.................................

(....................................) (....................................) (....................................)

User Teknisi Kasi IPSRS

FORM PERBAIKAN ALAT

UNIT:
1. Nama Alat :........................................................... Alat Medis / Non Medis
2. Merk :...........................................................
3. Type :...........................................................
4. Serial Number :...........................................................
5. Jenis Kerusakan :...........................................................
............................................................
6. Tidak dapat diperbaiki karena : Ket :............................................
Harus minta bantuan dari teknisi luar ............................................
Sparepart rusak
Service keluar
Ganti alat baru
Lain-lain.................................. Jakarta,.................................

(....................................) (....................................) (....................................)

User Teknisi Kasi IPSRS