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K3 RSRP, Joe

BERITA ACARA PENARIKAN ALAT RS. ROYAL PROGRESS

Nama alat medis / non medis : ..............................................................................................................................

Merk : ...............................................................................................................................

Serial : ..............................................................................................................................

Type : ..............................................................................................................................

Instalasi : ..............................................................................................................................

Tanggal/tahun pembelian alat : .............................................................................................................................

Tanggal penarikan alat : ...............................................................................................................................

Petugas IPSRS / Umum : ........................................... Tanda tangan : .............................................

Alasan penarikan alat : Sifat □ permanaen □ sementara □ penggantian

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Tindak lanjut yang telah dilakukan / service : □ Teknisi RSRP □ Vendor/Pihak ke -3

Vendor PT.......................................................................................................

Service kontral / Non kontrak

Lainnya ...........................................................................................................

Tindak lanjut : □ ganti baru □ sewa □ pindahan ..................................................

□ lain lain : ............................................................................................................

Mengetahui, ............ , ............................... 20....

Manajer/Teknisi ..................... Manajer Umum & Operasional Ketua K3 RSRP

( ) ( ) ( dr. Panudju.D )

Direktur RSRP
K3 RSRP, Joe

( dr. Djoti Atmodjo, SpA, MARS )

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