SERVICE WORK (UNSCHEDULED & OTHERS)

BEMS

A. Request Details
Hospital Wanita dan Kanak-Kanak /
Hospital Name / Code Priority Normal
SBH915
Service Work No. WO/BEMS/SBH915/2407/000038 Service Request No. SR/SBH915/20240711/B005942

Category Unscheduled Type Corrective Maintenance

Request Date / Time 11-Jul-2024 22:50 Requestor Name Margrate Ak Mosen @ Moeng

Requestor Location Name L5_neonat - Clean Utility Room Designation Nurse Contact No. 829

Asset No. 915002346 Asset Name Infusion Pumps, Syringe

Asset Location Code / Name 0104012 / L5_neonat - Clean Utility Room Type Code 13-217
Department Code /
User Area Code / User Area Name UN03 / Nicu L 3 I02 / In-patient Care Services
Department Name
Manufacturer TOP Corp Brand / Model TOP / TOP-5300
V3 - Added installed facilities (new building, plant,
Workgroup W2-Biomedical Engineering Variation Status
equipment or land)
Request details To check and repair Infusion Pumps, Syringe unable to charge at Nicu Level 3

B. Contract/Warranty Information

Contractor Name Contractor Code

Contact Person Phone No.

Start Date End Date

C. Assessment Details

Response By Date Time

Response Finding

User Verification By Date/Time

Signature / Department stamp

Asset Working Status ¨ Functioning ¨ Not Functioning ¨ Partially Functioning

D. Part Details

No. Part No. Part Description Qty

E. Employee Details

No. Staff ID Name Start Date/Time End Date/Time

F. Process Status

¨ Propose for BER ¨ Propose for RW ¨ Equipment In Use ¨ Technical Advise ¨ Equipment not at location

¨ Loaner Provision ¨ Alternative Service

G. Completion

Performance Test ¨ Done ¨ Not Applicable ¨ Not Done Electrical Safety Test ¨ Done ¨ Not Applicable ¨ Not Done
Date/Time Work
Date/Time Work Start
Completed
Action Taken

QC Code

Completed By Verified By (MoH)

Signature / Date Time Signature / Date Time

Date:11-Jul-2024 23:35