PT.

BECTON DICKINSON INDONESIA

SAMPOERNA STRATEGIC SQUARE,SOUTH TOWER
20TH FLOOR
JL. JENDERAL SUDIRMAN KAV 45 – 46
JAKARTA SELATAN, JAKARTA 12930
INDONESIA
TEL +62 21 5771920
SERVICE HOTLINE: +62 021-25983499
SERVICE.SUPPORT@BD.COM

Service Report

TO: FOR:
Puji Elmiasih Work Order Number#: WO-02220059
RSUD BONDOWOSO Case Number#: 01517766
JL. PIERE TENDEAN NO. 3 BDW
BONDOWOSO
BONDOWOSO, JAWA TIMUR,ID,68200

WORK ORDER DETAILS

Preventative
Top-Level Order Type
Maintenance

Serial Number PX2972 Billing Type Time and Material

448100 - Phoenix
Product Customer Down No
Instrument

T111 Preventive
Work Order Task Code    
Maintenance

SERVICE REQUESTED / OBSERVED SYMPTOM / ERROR CODE, BY THE CUSTOMER

PM

IDENTIFIED PROBLEM

WORK PERFORMED

PM Action, Clean instrument, Replace Filter, REplace Normalizer Panel, check Voltages, Go to
Diags, Adjust Front UV and Rear, Adjust RGB, Normalizer CV Test

ADDITIONAL COMMENTS FOR SERVICE REPORT

Extra Filter need to prepare soon

PARTS USED
 Part In Part Number Line Qty

441195 - KIT PREVENTIVE

441195 1
MAINT INSPECTION PHOENIX

447157 - Phoenix Normalizer

447157 4
Panel

LABOR DETAILS

Start Date And End Date And Total Hours Total Rounded
Activity Type
Time Time Worked Hours

0 day(s) 4
11/27/2021 8:00 11/27/2021 12:00
Labor hour(s) 0 4
AM PM
minute(s)

TRAVEL

Start Date And Time End Date And Time Total Hours Work Total Rounded Hours

0 day(s) 6 hour(s) 0
11/27/2021 3:00 PM 11/27/2021 9:00 PM 6
minute(s)

0 day(s) 7 hour(s) 0
11/26/2021 12:00 PM 11/26/2021 7:00 PM 7
minute(s)

OTHER EXPENSES

Expense Type Line Qty

 
DATE: 1/3/2022
 Technician: Triyulianto Dhanny 
Customer Name: Puji Elmiasih
Customer Signature: ____________________________
 

Customer Survey
The customer acknowledges that the services described above have been provided to customer's
satisfaction. Unless otherwise agreed in a valid agreement between the customer and BD, the
customer agrees to pay BD's invoice for the services described above at BD's standard rates and
subject to BD's standard terms and conditions.