Title Page

  • Audit Title

  • Department

  • Location / Storage area

  • Conducted on

  • Prepared by

  • Personnel

Make

Asset / Reference number

Action Plan / Issue Management

  • Date and time of issue report

  • Report received by :

  • Employee Id

  • Email

  • Contact number

  • Reported to Manager / Supervisor / Charge Nurse

  • Reported to Biomed

  • For replacement

  • For repair

  • To order new Parts

  • For evaluation

  • Temporary replacement / Back up

  • With biomed

  • To condemn

Resolved issue

  • Was the issue resolved?

  • Repaired / Refurbished

  • Replaced / New

  • Partial repair

  • Temporary Back up Replacement

  • Attach photo as needed

Sign to complete once issue resolved

  • Complete

  • Employee ID

  • Sign here

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