Hospitals & healthcare
Medical equipment maintenance request template
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Preview — Formal concise
Medical Equipment Maintenance Request
Date: Date – Time: Time
To: Biomedical Engineering
Please repair the Device Name, asset (BK) no. Asset Number, serial no. Serial Number, located in Department – Location. Fault: Fault Description. Effect on service: Effect on Patient Care. Priority: Urgent / High / Normal.
Requested by: Requester Name – ext. Extension
Signature: Signature