FORM PEMELIHARAAN LAMPU TINDAKAN

Bagian :...................................................
Nama Alat :...................................................
Tipe :...................................................
Merk :...................................................
Serial Number :..................................................
No Jenis Pengecekan kondisi keterangan
1 Body
2 Lampu
3 Kaki-kaki
4 Arm
Catatan :............................... Tipe Lampu :......................................

Padalarang , .......................20....
Verifikasi Pelaksana,

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

FORM PEMELIHARAAN LAMPU TINDAKAN

Bagian :...................................................
Nama Alat :...................................................
Tipe :...................................................
Merk :...................................................
Serial Number :..................................................
No Jenis Pengecekan kondisi keterangan
1 Body
2 Lampu
3 Kaki-kaki
4 Arm
Catatan :............................... Tipe Lampu :......................................

Padalarang , .......................20....
Verifikasi Pelaksana,

(.................................) (...........................................)
 “PERKUMPULAN PERHIMPUNAN SANTO BORROMEUS”
Ceklist Pemeliharaan Sterilisator /Autoclove
RS. CAHYA KAWALUYAN
(Hospital of Borromeus Group)
Seksi Pemeliharaan Sarana Rumah Sakit (Medical Instrumentation)

Bagian :...................................................
Nama Alat :...................................................
Tipe :...................................................
Merk :...................................................
Serial Number :...................................................
No Jenis Pengecekan kondisi keterangan
1 Body
2 Kontrol panel
3 Heater
4 Suhu Capaian
5 Lain - lain
Catatan :...............................

Mengetahu Kasie. PSRS Ferifikator SPSRS Petugas Pelaksana

Tgl : Tgl : Tgl :

“PERKUMPULAN PERHIMPUNAN SANTO BORROMEUS”

Ceklist Pemeliharaan Sterilisator /Autoclove
RS. CAHYA KAWALUYAN
(Hospital of Borromeus Group)
Seksi Pemeliharaan Sarana Rumah Sakit (Medical Instrumentation)

Bagian :...................................................
Nama Alat :...................................................
Tipe :...................................................
Merk :...................................................
Serial Number :...................................................
No Jenis Pengecekan kondisi keterangan
1 Body
2 Kontrol panel
3 Heater
4 Suhu Capaian
5 Lain - lain
Catatan :...............................

Mengetahu Kasie. PSRS Ferifikator SPSRS Petugas Pelaksana

Tgl : Tgl : Tgl :