ቁጥር----------------
ቀን--------------------
ለአቶ/ለወ/ሮ/ሪት --------------------------------------------------የመታወቂያ ቁጥር ------------------------
ህክ/ጤና ሳ.ኮሌጅ
የሰራተኞች ፈቃድ መጠየቂ ፎርም
1. የሚሰሩበት የስራ ክፍል --------------------------------------------
2. ፈቃድ የጠየቁበት ምክንያት--------------------------------------
3. የጠየቁት የፈቃድ ዓይነት -----------------------------------------
4. ፈቃድ የሚጠይቁበት ጊዜ ከ-----------------------------------------------እስከ ------------------------------------
የ---------------------ቀን የስራ ፈቃድ እንዲፈቀድልኝ እጠይቃለሁ፡፡
5. ፈቃድ ይዘውየሚሄዱበት ቦታ ------------------------------------ስ.ቁጥር ------------------------------------
ስም------------------------------------ ቀን------------------------------------ ፊርማ ------------------------------------
6. የፈቃድ ጠያቂው የቅርብ ኃላፊ አስተያየት ------------------------------------
ስም------------------------------------ ፊርማ------------------------------------ቀን ------------------------------------
በሰውኀብት ሥታ አመራር አጠቃቀም የሚሞላ
7.የአለዎት የዓመት ፈቃድ የ 2011 ዓ.ም ------------------------------------ቀናት
የ 2012 ዓ.ም ------------------------------------ቀናት
የ 2013 ዓ.ም ------------------------------------ቀናት
የተፈቀደ ------------------------------------ቀናት
ቀሪፈቃድ -----------------------------------ያለዎት ሲሆን
ከ------------------------2013 ዓ.ምጀምሮ እስከ ---------------2013 ዓ.ም
የ------------------------------የስራ ቀናት ፈቃድ የተሰጠዎት መሆኑን አውቀው ከ
-------------------------2013 ዓ.ም ጀምሮ በመደበኛ ሰራዎ ላይ አንዲገኙ እናሳስባለን፡፡
ግልባጭ//
ለሰውኃብት አስተዳደርና ልማት ዳይሬክተር
ለ--------------------------------------------------------------
ህክ/ጤና ሳ.ኮሌጅ
ማሳሰቢያ፡-ፈቃድዎን አንድ ቀን ቀድመው ማስጨረስ ይጠበቅበዎታል፡፡
በአራት ኮፒ ተሰርቶ ይላክ
11 Microscope stand
1
11 endoscope
2
11 Dental syringe
3
11 Jar staining schieffedecke with lid
4
11 Set diagnostic
5
11 Set extraction dental
6
11 Set laminectomy
7
11 Set haemorrhoidectomy
8
11 Set diaphragmatic hairal repair
9
12 Set abdominal perineal resection
0
12 Set pancreatoectomy and splenoectomy
1
12 Set prostatectomy
2
12 Set laparotomy
3
12 Set instrument major basic
4
12 Pulse oxi meter or patient monitor –SPO2 sensor finger
5
12 Infrared electronic thermometer
6
12 Resuscitator bag (ambo bag )
7
12 Pick up forceps with jar
8
12 Cannula –easy grip
9
13 Set –MVA
0
13 Set delivery
1
13 Blood pressure/heart rate/temperature/oxygen
2 saturation-Casmed
13 Speculum
3
13 Uterine sound
4
13 Kidney dish
5
13 Set curettage
6
13 Vaccine carrier
7
13 MVA aspirator
8
13 Tourniquet
9
14 Thermometer-Clinical, digital
0
14 Obstetric-surgical kit
1
14 Set –instrument, surgical, with Tray
2
14 Set –instrument Tubal legation
3
14 Model -uterus
4
14 set –instrument, vasectomy
5
14 Bone drill-electrical, [orthopedics]
6
14 Dish-round, stainless steel
7
14 Enema can
8
14 Flask boiling
9
15 Trolley
0
15 Glucometer
1
15 2019 Gastrointestinal imaging with CME in three tumb
2 drives
15 Set-budji
3
15 Set dilatation &curettage
4
15 Set- gallbladder &bile buct
5
15 Set –instrument, abdominal, gynaecological
6
15 Set –instrument, dressing
7
15 Set –laryngoscope
8
15 Set –removal, fingernail
9
16 Set tracheostomy tube
0
16 Timer –stop watch, analogue
1
16 Internal tread manifold oxygen gauge
2
16 dish–round stainless steel
3
16 Amber bottle
4
16 Analyzer –clinical spectrophotometer
5
16 Bowel kidney
6
16 Bowel washing ,with stand, polyethylene
7
16 Hammer –reflex
8
16 Homogenizer -electrical
9
17 Measuring cylinder-plastic
0
17 Pump –breast, Glass, manual
1
17 Retractor
2
17 Set –postpartum IUCD
3
17 Drum –sterilizer
4
17 Oxygen regulator /flow meter
5
17 Sign set
6
17 Towel
7
17 spinal needle
8
17 CAPONOGRAPH KIT
9
18 Laryngeal mask
0
18 Dilation balloons-micro-tech
1
18 200 watt convertor
2
18 Microscope heads
3
18 Set dilation and curettage
4
18 Stylization - kit
5
18 Tablets for midwifery students
6
18 Baby changing table
7
18 Stand for respirator
8
18 Electrical equipment
9
19 Operating table hydraulic
0
19 Gynecological op. table
1
19 Handicap equipment
2
19 Gynecological table examination
3
19 MT table
4
19 Toilet bucket stainless steel
5
19 Stand for clinging
6
19 Urine - bottles
7
19 Cleaning material
8
19 Dealys equipment
9
20 Stool, small
0
20 Dishwasher for instrument
1
20 walking stick
2
20 crutches
3
20 cupboard trolley for medicine
4
20 Ear examination chair
5
20 Table MTA
6
20 Toilet seat for handicap use
7
20 Walking support on wheels
8
20 Instrument table small
9
21 P.E.T personal Energy Transport
0
21 Billon dilation device micro-tech
1
21 Biopsy forceps micro-tech
2
21 Physical therapy incline supine stander
3
21 cans, non-adjustable length, aluminum
4
21 canes, wood
5
21 crutches, Aluminum, Adjustable
6
21 IN/007 again needle
7
21 matters
8
21 Cupboard X-ray
9
22 X-ray aprons
0
22 Infant bed incl mattress
1
22 Stool plastic & steel
2
22 Trolley for cleaning with 4wheel
3
22 Physiotherapy equipment
4
22 Trolley for oxygen cylinder
5
22 Arm support table
6
22 Trolley for hospital document
7
22 Ups
8
22 Endoscopy brushes-micro-tech
9
23 Grounding pads
0
23 Spare part for Gambro dialysis
1
23 Sterilizer - Hot Air
2
23 Towel clamp-ball and socket towel forceps 13cm.
3
23 Delivery Lamp- portable with replacement bulb.-KC-
4 1022
23 Trolley-Instrument
5
23 Light- Examination, Gynecological.
6
23 Optical Frame
7
23 precut lenses
8
23 Kids
9
24 scrotal model for NSV
0
24 Arm model for implant I/R
1
24 Zoe gynecological dark skin
2
24 Pelvis female model for MVA
3
24 Implant kit I/R
4
24 IUCD kit I/R
5
24 PP IUCD kit insertion
6
24 Bilateral tuba ligation/ MSL
7
24 MSV kit/ NSV equipment
8
24 Dilation evacuation
9
25 Set-Instrument, Tubal Legation
0
25 Set-Instrument, Vasectomy
1
25 Set-Surgery, Minor
2
25 Set-Traction, with 10 bow
3
25 Set vascular
4
25 Set surgery basic
5
25 statoscope
6
25 Mercurial B.P
7
25
8
25
9
26 Roof mounted operating lamp
0
26 Digora scanner for big x-ray
1
26 OPG x- ray unit ac 10
2
26 Computers for x-ray analyzing and displaying
3
26 Getting hospital steam autoclave
4
26 Twenty hemostasis clips micro-tech
5
26 Ten injection needles
6
26 Polyp snares
7
26 Hot biopsy forceps
8
26 McKesson Glucometers
9
27 Glucose strips
0
27 Alcohol pads
1
27 Lancets/ glucose check 400 lancet
2
27 Adaptor
3
27 Screen patient
4
27 Electrical stove
5
27 Dilator –lachrymal cannula
6
27 Gasket maker
7
27 Teflon
8
27 Battery
9
28 IM nail
0
28 screw
1
28 Locking bolt
2
28 Fx plate
3
28 Drill bit
4
28 Lamp
5
25 Jegl sew wire
25 Kit- first aid
25 Fuse
25 Autoclave gasket
25
25
25
25
25
25
25
25
25
25
