Bon Permintaan Perbaikan Komputer Dan Alat Elektronik Rumah Sakit
Bon Permintaan Perbaikan Komputer Dan Alat Elektronik Rumah Sakit
Ruang / Unit
:
_____________________________________________________________________
Hari / Tanggal
:
_____________________________________________________________________
Kondisi Barang
: Komputer
Baik
Rusak
:
Keyboard
:Rusak
Baik
Baik
Rusak
Mouse
:
Printer
:
Baik
Rusak
Kendala / Masalah
:
_____________________________________________________________________
_____________________________________________________________________
Detail Pekerjaan : _____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
Pelaksana :
.
Diketahui :
Plt. Ka.Sub. Bag SIRS RSUD Dr. Djasamen
Saragih
Ka. Ruangan/Poliklinik/Instansi/Unit
Nama : _______________________
NIP :
: Komputer
Baik
Rusak
:
Keyboard
:Rusak
Baik
Baik
Rusak
Mouse
:
Printer
:
Baik
Rusak
Kendala / Masalah
:
_____________________________________________________________________
_____________________________________________________________________
Detail Pekerjaan : _____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
Pelaksana :
.
Diketahui :
Plt. Ka.Sub. Bag SIRS RSUD Dr.
Djasamen Saragih
Ka. Ruangan/Poliklinik/Instansi/Unit
Nama : _______________________
NIP
: