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    This document is a work order form from the Medical Technology Branch of the Namibian Defence Force Training Establishment. It is used to report technical problems with medical devices, record service requests, and track the repair process. The form collects information on the department and contact details reporting the issue, location and description of the defect, and records the service engineer's response, repairs, and any necessary follow up work. A progress report section tracks the dates, costs of parts used, work done by technicians, and total repair costs.

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    This document is a work order form from the Medical Technology Branch of the Namibian Defence Force Training Establishment. It is used to report technical problems with medical devices, record service requests, and track the repair process. The form collects information on the department and contact details reporting the issue, location and description of the defect, and records the service engineer's response, repairs, and any necessary follow up work. A progress report section tracks the dates, costs of parts used, work done by technicians, and total repair costs.

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    © All Rights Reserved
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    6 views2 pages

    Request For Service

    Uploaded by

    jim tau
    This document is a work order form from the Medical Technology Branch of the Namibian Defence Force Training Establishment. It is used to report technical problems with medical devices, record service requests, and track the repair process. The form collects information on the department and contact details reporting the issue, location and description of the defect, and records the service engineer's response, repairs, and any necessary follow up work. A progress report section tracks the dates, costs of parts used, work done by technicians, and total repair costs.

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    MEDICAL TECHNOLOGY BRANCH WORK ORDER

    MINISTRY OF DEFENCE AND VETERAN AFFAIRS


    NAMIBIAN DEFENCE FORCE TRAINING ESTABLISHMENT
    VOCATIONAL TRAINING CENTER
    MEDICAL TECHNOLOGYBRANCH

    No.
    __________________________________________________________________________________
    WORK ORDER FORM /SERVICE REQUEST

    Department:_______________________________ Tell:_________________ Email:______________________

    Date:_________________________________________________________

    Clinician/technician reporting problem:__________________________________________

    Location of device:_____________________________________________________________________________________

    Defects description:___________________________________________________________________________________
    ____________________________________________________________________________________________________
    ____________________________________________________________________________________________________

    Date/time:__________________________________________

    Service record
    Service engineer/Technician name:__________________________ Date/time responded:___________________________

    Action taken:_________________________________________________________________________________________

    Has the problem been corrected?_________________ Yes No External Service

    Is follow-up work necessary?________________________________________ Yes No

    When will follow-up work be performed?_________________________________________________________________

    Follow-up action
    Service engineer/Technician name:__________________________________ Date/time responded:_________________

    Action taken:_________________________________________________________________________________________
    ____________________________________________________________________________________________________

    Has the problem been corrected? Yes No External Service Other:________________________________________

    Is further follow-up work necessary? Yes No Other:_____________________________________________________


    (If so, describe on reverse side of this form.)

    Note: Keep this form in the active file for at least 15 days after the completion of final repairs.
    Adapted from: Medical Consultants Network Inc., Reference# 1004 Biomedical Engineering

    For any technical problem, notify Medical Technology Branch immediately.


    SN Mupandeni LI Mangundu
    Clinical Engineering Biomedical Technician
    Office: +264 62 509 4151 Office: +264 62 509 4151
    Cell: +264 81 324 1950 Cell: +264 81 277 9999
    Simeon.Mupandeni@namdefence.org Lazarus.Mangundu@namdefence.org
    jimtau@ymail.com
    ______________________________________________________________________________________________________________________________________________________
    _
    RESTRICTED
    MEDICAL TECHNOLOGY BRANCH WORK ORDER
    MINISTRY OF DEFENCE AND VETERAN AFFAIRS
    NAMIBIAN DEFENCE FORCE TRAINING ESTABLISHMENT
    VOCATIONAL TRAINING CENTER
    MEDICAL TECHNOLOGYBRANCH

    No.
    __________________________________________________________________________________
    PROGRESS REPORT

    Dates Cost Estimate (N$)


    Name of the Engineer/Technician
    From To
    1.
    2.
    3.

    Part Used
    Serial Number Name of parts used Cost (N$)

    Work done by:____________________________ Total Cost (N$):_____________________________

    For any technical problem, notify Medical Technology Branch immediately.


    SN Mupandeni LI Mangundu
    Clinical Engineering Biomedical Technician
    Office: +264 62 509 4151 Office: +264 62 509 4151
    Cell: +264 81 324 1950 Cell: +264 81 277 9999
    Simeon.Mupandeni@namdefence.org Lazarus.Mangundu@namdefence.org
    jimtau@ymail.com
    ______________________________________________________________________________________________________________________________________________________
    _
    RESTRICTED

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