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RSB.

PERMATA SARANA
HUSADA
Pamulang Permai Blok D3 No: 1-3
Telp: 021-7407421/22
email: psarhus@gmail.com

BERITA ACARA PENARIKAN ALAT


RSB PERMATA SARANA HUSADA
Nama alat medis/ non medis

: ............................................................................................................

Merk

: ............................................................................................................

Serial

: ............................................................................................................

Type

: ............................................................................................................

Instalasi

: ............................................................................................................

Tanggal/ tahun pembelian alat

: ............................................................................................................

Tanggal penarikan alat

: ............................................................................................................

Petugas IPSR / Umum

: ................................

Alasan penarikan alat

: Sifat permanen

Tanda tangan : .................................


sementara

penggantian

...............................................................................................................
.........................................................................................................
Tindak lanjut yang telah dilakukan/ service : Teknisi RSA

Vendor/pihak ke-3

Vendor PPT ..............................................................................


Service kontrak/ non kontrak
Lainnya .....................................................................................
: Ganti baru

Tindak lanjut

Sewa

Pindahan ..........................
Lain-lain : .........................................................................................
Mengetahui,
Manajer Keungan

Manajer Umum & Operasional

Ketua K3

Direktur RSB Permata Sarana Husada

44/BA-PA/RSBPSH/XII/2016

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