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ADVANCEDMED SUPPLY & TECHNICAL SOLUTIONS

Importers &Dealers in Hospital, Lab, Dental, EENT, Ortho/Rehab,


Surgical Devices& Instruments, Medical, & Health/Wellness consumables, Installation, Maintenance, &Repair.

FIELD SERVICE REPORT.

CUSTOMER Y N

ADRESS PPM
EQUIPMENT NEW
INSTALATION
MAKE AND MODEL PREVENTIVE
SERIAL NO CORRECTIVE
ON CALL
WARANTY
JOB COMPLETED

CONTRACT
FAULT REPORTED BY CUSTOMER

DIAGONISED BY ENG/ WORK DESCRIPTION

PARTS USED AND DESCRIPTION QNTY COST

WORK TIME TABULATION


DATE TIME WORK DONE START END WORK
DONE
TOTAL COST

RECOMMENDATION

CUSTOMER REPRESENTATIVE ………………………….SIGN…………………………….DATE………….........

ENG………………………………… SIGN………………………………DATE………………………………………….

PHONE CONTACT: +254718138191/+254740407491


EMAIL:AdvancedMedKenya@gmail.com
RINGROAD KISUMU

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