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Inspection - Service Report Form

Inspection

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Wambalo Shipoli
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43 views1 page

Inspection - Service Report Form

Inspection

Uploaded by

Wambalo Shipoli
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Plot 12, Acacia Avenue, Kololo

P.O Box 35220, Kampala, Uganda


Tel: +256 392177174 / +256 789 566714
Toll Free: 0800 111 222
WhatsApp: +256 704 009098
Email: [email protected]
Website: www.cityambulance.net
Emergency Medical Services | Remote Site Medical Support | Medical Supplies

Inspection/Service Report Form


Department/Location Date
Equipment Description Make/Model No Serial Number

Service/Maintenance Type
Preventive/Service Corrective Specify

No Test Description Pass (P) Comment


or Fail (F)
1 Check Physical-General Condition, Accessories, Parts
2 Inspect Wheels, Casters, Brakes and Swivel Locks
3 Check Electrical Supply and Switches, UPS/Backup if Any
4 Leak (of Gas or Liquid) and Compliance Tests of Circuits
5 Perform System Functional Check
6 Check Safety Valves, Switches
7 Observe the Mobility of Peripherals Parts, Arms
8 Check Oil and Other Liquid Levels, Filters
9 Monitor Operation of Sensors
10 Testing Operating, Warning and Failure Alarms
11 Check Software Configuration; Time, Date
12 Check Monitor, Keyboard and Touch Panel
13 Check the Electric Safety Current and Radiation Leakage
14 Measurement of Functional Accuracy
15 Check if Preventive Maintenance is Being Done Regularly
16 Confirm the general equipment functionality

Spare Parts Changed Spare Parts Needed Next Service Due

Comments/Remarks

Serviced By Acknowledged By
Name: ……………………….….…………….…….…. Name: ………………………………………………….…
Designation: ………………….……….……………… Designation: ……………….………………………….
Sign & Date: ………………….………………………. Sign & Date: ……....………………………………….
Tell: ……………….……….…………….………………. Tell: ………………………………………………………..

Inspired to S ave Life

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