Asset Data Information Proforma

• Document No.

• Conducted on

  Date

Equipment Description

• Please Enter Description of Equipment

Location Details

• Building Name

  Chapel Allerton Hospital

  Leeds General Infirmary

  Seacroft Hospital

  St James Hospital

• Location Description

• Floor Level

  Select Ground Floor Mezzanine Floor First Floor Second Floor Third Floor Fourth Floor Fifth Floor Sixth Floor Seventh Floor Eighth Floor Ninth Floor Tenth Floor Eleventh Floor Twelfth Floor Thirteenth Floor Fourteenth Floor Fifteenth Floor Sixteenth Floor Seventeen Floor Eighteenth Floor Nineteenth Floor Twentieth Floor

  • Ground Floor
  • Mezzanine Floor
  • First Floor
  • Second Floor
  • Third Floor
  • Fourth Floor
  • Fifth Floor
  • Sixth Floor
  • Seventh Floor
  • Eighth Floor
  • Ninth Floor
  • Tenth Floor
  • Eleventh Floor
  • Twelfth Floor
  • Thirteenth Floor
  • Fourteenth Floor
  • Fifteenth Floor
  • Sixteenth Floor
  • Seventeen Floor
  • Eighteenth Floor
  • Nineteenth Floor
  • Twentieth Floor

• Room Number

Asset Details : Removed Equipment

• Photograph if Required.

  Media

• Removal Date

  Date

• Barcode Number

• Appliance / Asset Type

  Indooor

  Outdoor

• Manufacturer:

• Model Type:

• Serial Number:

• Additional Location or Equipment Infomation:

Asset Details: Installed / Verifying Equipment

• Photograph If Required.

  Media

• Installation Date:

  Date

• Barcode Number:

• Appliance / Asset Type

  Indooor

  Outdoor

• Manufacturer:

• Refrigerant Type:

  Select R12 R134 R134a R170 R22 R290 R404a R407c R407d/R508 R409 R409a R410a R413a R422d R600a

  • R12
  • R134
  • R134a
  • R170
  • R22
  • R290
  • R404a
  • R407c
  • R407d/R508
  • R409
  • R409a
  • R410a
  • R413a
  • R422d
  • R600a

• Weight KG

• Model Number:

• Serial Number:

• Additional Location or Equipment Information

Engineers Details

• Comments:

• Signature

  Sign