Biomedical Technician Service Request

EXTERNAL SERVICES REQUEST

Biomedical Technician
Instructions:

Please provide the following information. If you have any questions or concerns regarding your request, you may contact Mr. Gabriel Sierra at gabriel.sierra@uccaribe.edu
Contact Person Details
Name*

First NameLast Name
Email*
Phone Number*

Phone NumberExt.
Department*
Service Request
Type of Service*
Equipment Name*
Equipment Property Number*
Location*
# Room
Description of Problem*
Has the supervisor in that area been notified of the maintenance or repair need?*

YesNo
Should be Empty:

EXTERNAL SERVICES REQUEST