WOLAITA SODDO UNIVERSITY COMPREHENSIVE SPECIALIZED HOSPITAL

BOMEDICAL ENGINEERING DEPARTMENT

Work Order form

SECTION A; To be completed by user

Equipment name; Date

Inventory number Item location

Name of person marking request signature

Description of problem

Troubleshooting performed (if relevant);

SECTION B; To be completed by Head OF BME

Date request received Work order number
Priority of task (high medium or low) Task allocated to;
SECTION B; To To be completed by Maintenance Engr/Technicial

Was equipment repaired? Yes _______ No_______

If yes, complete CM report form
If No, reason

Equipment returned to: Date returned

Repairs performed by
Name signature