Scribd
Upload
7 views1 page

History File Form

The document outlines the equipment history for a health center in Kolfe Keraniyo Sub city, including details such as model, serial number, manufacturer information, local agent, purchase date, and condition upon receipt. It also includes sections for service and technical support, installation dates, validation status, and additional service contract information. This structured format is intended for tracking and managing medical equipment effectively.

Uploaded by

Worede A.
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
7 views1 page

History File Form

The document outlines the equipment history for a health center in Kolfe Keraniyo Sub city, including details such as model, serial number, manufacturer information, local agent, purchase date, and condition upon receipt. It also includes sections for service and technical support, installation dates, validation status, and additional service contract information. This structured format is intended for tracking and managing medical equipment effectively.

Uploaded by

Worede A.
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
You are on page 1/ 1

Kolfe Keraniyo Sub city Woreda 03 Health Center

Equipment History
Model: __________________________
Equipment Name _____________________ Serial Number: ____________________

Manufacturer Information
Name:_____________________ Origin Country: ____________________
Address: -
Telephone #: ___________________
E-Mail: _______________________ Specific Location: __________________
P.O.Box: ______________________

Local Agent Purchased Date:


Name: ______________________________
Address: - Purchased By:
Telephone #: _________________
Condition when received:
E-Mail: ______________________
P.O.Box: _____________________
New __ Used __ Reconditioned __
Service and technical support Installation Date:
Name: ______________________________ Validation/ Verification Done: Yes __ No__
Address: - Date of Validation: ________________
Telephone #: __________________
E-Mail: ______________________
P.O.Box: _____________________ Date of Service:___________________
Status: ____________________
Removal Date: ______________

Additional Information

Service Contract Information: Available ____ Not Available ____

Vendor Installation record: Available ____ Not Available ____

You might also like