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FORM PERBAIKAN ALAT KESEHATAN

Tanggal Laporan : 1,September 2020...............................................................................


Tanggal Perbaikan : 6,September 2020 ..............................................................................
Ruangan : OK .....................................................................................................
Nama Alat : Lampu sterilisator ruangan UV..........................................................
Merk : TRIDENT...........................................................................................
Type : YD-P-238UV......................................................................................
Serial Number : 1001-Z3-0023.....................................................................................
Jumlah : 1..........................................................................................................

KERUSAKAN
PERBAIKAN LAMPU 3 TIDAK MENYALA DAN TRAFO MATI

TINDAK LANJUT
 GANTI LAMPU 3
 GANTI TRAFO LAMPU

Teknisi Kepala Ruangan

(................................................) (................................................)

Mengetahui,
Kepala Instalasi Pemeliharaan Sarana
Rumah Sakit

( SUKIRMAN, SKM. )
NIP. 19721231 199303 1 018

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