RUMAH SAKIT ‘AISYIYAH PARIAMAN

Instalasi Pemeliharaan Sarana Rumah Sakit (IPSRS)

FORMULIR RESPON TIME PERBAIKAN ALAT

Tanggal/Waktu Respon : ......... 20 .../.........

WIB Tanggal/Waktu Selesai Perbaikan : ......... 20 .../.........WIB

JENIS BARANG = MEDIS/NON MEDIS

Nama Barang :.............................................................................
Merk/Type :.............................................................................
Nomor Seri :.............................................................................
Ruangan :.............................................................................
Kerusakan :.............................................................................
Tindakan :
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Keterangan :
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Mengetahui;
Petugas Pemohon Petugas

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Supervisor Keuangan IPSRS & RT

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