MAINTENANCE FORM

LABORATORIUM TEKNIK ELEKTROMEDIK

UNIVERSITAS MH THAMRIN

EQUIPMENT NAME :
MERK :
MODEL/TYPE :
SERIAL NUMBER :
LOCATION :

DOCUMENT
1. Operation manual Available
2. Maintenance manual Available
3. Service manual Available

VISUAL MONITORING
1. Current supply Battery
2. Voltage supply VDC
3. Power supply VA
4. Steker Good
5. Switch and button Good
6. Graunding Good

PHYSICAL MONITORING
1. Construction Good
2. Body dan surface Good
3. Mechanical Good
4. Support equipment ( head) Good
5. Support equipment ( foot) Good
6. Support equipment ( side rail) Good

EQUIPMENT FUNCTION TESTING

1. Head moving Good
2. Foot moving Good
3. Up down moving Good
4. Break Good
5. Wheel Good

CONCLUSION :
SUGGEST :
Jakarta, …………...……….. 2020
OMEDIK
N

Not available
Not available
Not available

Electric Combination
VAC
Watt Hp
Not Good
Not Good
Not Good

Not Good
Not Good
Not Good
Not Good
Not Good
Not Good

Not Good
Not Good
Not Good
Not Good
Not Good