SERVICE WORK (UNSCHEDULED & OTHERS)

BEMS

A. Request Details

Hospital Name / Code Tawau / SBH910 Priority Normal

Service Work No. WO/BEMS/SBH910/2105/000003 Service Request No. SR/SBH910/20210502/B003298

Category Unscheduled Type Corrective Maintenance

Request Date / Time 02-May-2021 13:30 Requestor Name Cellor Zonius

Requestor Location Name Icu - Makmal Respi Designation Nurse Contact No. 8411

Asset No. 910005776 Asset Name Ventilators, Intensive Care

Asset Location Code / Name 6002034 / Icu - Makmal Respi Type Code 17-429
Department Code /
User Area Code / User Area Name UI03 / New Intensive Care Unit & Ccu I02 / In-patient Care Services
Department Name
Manufacturer Maquet Critical Care AB Brand / Model Maquet / Maquet Servo-I
V3 - Added installed facilities (new building, plant,
Workgroup W2-Biomedical Engineering Variation Status
equipment or land)
Request details Ventilators machine compressor broken at Picu.

B. Contract/Warranty Information

Contractor Name Contractor Code

Contact Person Phone No.

Start Date End Date

C. Assessment Details

Response By Mohammadoni Tokan Bin Abu Date 02-May-2021 Time 14:00

Response Finding compressor not function

User Verification By Date/Time

Signature / Department stamp

Asset Working 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:04-May-2021 12:49