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Pull Out Form

This equipment pull-out form from <Hospital/Company Name Here> is used to record the removal of equipment from the facility. It documents the date, description and serial numbers of items removed, number of items, and estimated return date. Approval signatures are required from property officers, engineers, department heads and the pulling party. The supplier is noted as responsible for any lost parts or accessories of removed units.

Uploaded by

Merry Jaine Ortillo
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17K views1 page

Pull Out Form

This equipment pull-out form from <Hospital/Company Name Here> is used to record the removal of equipment from the facility. It documents the date, description and serial numbers of items removed, number of items, and estimated return date. Approval signatures are required from property officers, engineers, department heads and the pulling party. The supplier is noted as responsible for any lost parts or accessories of removed units.

Uploaded by

Merry Jaine Ortillo
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd

<Hospital/Company Name Here>

EQUIPMENT PULL-OUT FORM

DATE :
ESTIMATED
EQUIPMENT QTY SERIAL NO. REASONS
RETURN DATE



NOTE: SUPPLER IS RESPONSIBLE WITH ANY LOST OF PARTS/ACCESSORIES OF THE RECEIVED UNIT/S

APPROVED BY: PULLED OUT BY:

PROPERTY OFFICER/REPRESENTATIVE PRINTED NAME OVER SIGNATURE

ENGINEERING HEAD/REPRESENTATIVE NAME OF THE COMPANY

 
DEPARTMENT HEAD DATE AND TIME

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