S&R EMEA Service Centers - Offline Service Report Form

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D00080821 Revision C Page 1 of 3

Employee number: Service order #:

GOKDEC2 (If available) N/A
Customer information

KEMA SAGLIK / ABDULKADIR NALBANT

Equipment information
Serial number: MBB1511507 Model number & BEDSIDE
name:

Customer N/A Device working N/A

equipment ID: hours (if
applicable):
Service Activity
PM Repair
■
FCA Software update Installation / replacement
Type:
Damage/cause/action
Complaint information: http://mpxr.medtronic.com mPXR number:

Incoming inspection: CIHAZDA PROBLEM YOKTUR.

Damage code: N/A

Description of TUM TESTLER GUNCEL SERVIS MANUALINE GORE BASARIYLA
service performed: TAMAMLANMISTIR.

Functional test: N/A

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 S&R EMEA Service Centers - Offline Service Report Form
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D00080821 Revision C Page 2 of 3

Description of N/A
diagnosed cause:

Cause code: N/A

Test equipment identifiers and description
ID#: A00252 ID#: A00143 ID#: A00288 ID#: A00291
Serial#: N/A Serial#: G15800025 Serial#: Q120022 Serial#: 5458075
ID#: ID#: ID#: ID#:
Serial#: Serial#: Serial#: Serial#:
ID#: ID#: ID#: ID#:
Serial#: Serial#: Serial#: Serial#:
Parts removed and/or installed
Material number & description: Serial /Batch # installed: Quantity:

Serviced performed by
(Employee #): GOKDEC2
Service completed date: Chargeable labor
05.04.2023 time: 1
Equipment (use) status: ☐
■
Product can be fully used
☐ With limitations, as described in “Description of Service Performed”
☐ Do not use
☐ Scrapped
☐ On-hold, because:……..

Technician signature:

To be completed by Customer Care

Notification #: N/A Service Order #: N/A
Date entered in SAP: N/A Sold-to Customer #: N/A

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 S&R EMEA Service Centers - Offline Service Report Form
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D00080821 Revision C Page 3 of 3

To be completed by Service Center CoE (WMS) – NOT TO BE SENT TO CUSTOMER

Service order
Employee number: #:
(If available)
Model number
Serial number:
& name:
Parts Picked:
Material number: Serial /Batch #: Quantity: Storage type: Storage bin:

Product Location:
Picked from: Relocated to:
User status:
Storage type: Storage bin: Storage type: Storage bin:

This document is electronically controlled M edtronic Controlled I nform ation