FIELD SERVICE REPORT

Jl. Raya Kebayoran Lama No. 35

RT. 08/RW. 01, Sukabumi Selatan
Kebon Jeruk Jakarta barat 11560
(021) 22058890, (021) 22058886, (021) 22058894
FSR/
info@indomedik.com

Customer Information

Customer Name Telp No.

Address Machine Info

CP/User

Machine Information

Model/Type Serial No.

Accessories Type Serial No.

Accessories Type Serial No.

In Warraanty Off Warranty

Fault/problem Report by Customer

Fault (s) Confirmed by Engineer

Repair Analysis & Action/work done by Engineer

Spare Part & Consumables Replacement

Part No. Description Qty Remark

Date Started : / Date Started : /

Time Finished : / Time Finished : /

Remark / Additional Information Supporting Data (s) Remark / Additional Information

Incoming Call was received at : Operational
Date Time Not Operational

Working hour equipment : Pending/need part/bring to workshop

To be Monitored

Action performed :

S/W Update Maint/Cleaning User Training

Repair Main/3 month Pack/Move

Reported by Acknowledge and Approved by

Engineer name :
Date :

( ) ( ) ( ) ( )
Field Service Engineer End User Maintenance / IPSRS Hospital Management