• Document No.

  • Audit Title

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

Summery: Below is the information needed before calling the CBIS Desktop/ IT bridge line at 4-4431


  • Clients Full Name

  • Request or Phone # or Pager


  • Problem Description

  • Application Information

  • Screenshot / Photo

Location Information

  • Room#

  • Room Type

Clinical Engineering

  • Integrated

  • Patient TV issue

  • Nurse Call

  • Anesthesia Device

Computer / R2 Information

  • Computer Name

  • IP Address

  • Device Tag

  • Device Type

Printer Information

  • Printer Name

  • Printer Type

  • Device Asset Tag


  • Phone Type

  • Phone Number

  • Model Number (non Red Phone)

  • Network Jack#

  • Fax/MFD: Location

  • Other: Device Type, Location, Jack

SDE Ticket Information

  • Ticket Type

  • Urgency

  • Impact

  • SDE Group Assigned To

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.