Formulir Kegiatan IPSRS

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FORMULIR UNIT PEMELIHARAAN SARANA & PRASARANA RUMAH

SAKIT
(UPSRS) RUMAH SAKIT ISLAM NAMIRA PANCOR
Ruang Pelapo Petuga
Complaint Penanganan Nama & No. Alat
an/Unit r s
Waktu
Hari/Tg Wak Hari/Tg
Sele
l tu l Start
sai

. FORMULIR SERVICE
Kerusakan :
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Perbaikan : Tenaga Umum UPSRS Kondisi : Baik


Kurang Baik
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Analisa : Tenaga Ahli UKS

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Tindakan : Kondisi : Baik


Kurang Baik
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I. FORMULIR SERVICE PENARIKAN ALAT


Alasan Penarikan :
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II. FORMULIR USULAN PENGADAAN


Sparepart Alat Baru
Nama / Jenis Barang Merk / Tipe / Spesifikasi Jumlah
Permintaan
Mengetahui,
Kepala Tenaga Ahli Koordinator
Unit/Petugas UPSRS

(___________________) (___________________) (___________________)

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