SULTAN AHMAD SHAH MEDICAL CENTRE @IIUM COMPLAINT FORM

SULTAN AHMAD SHAH MEDICAL CENTRE @IIUM COMPLAINT FORM

Sultan Ahmad Shah Medical Centre @IIUM, Jalan Sultan Ahmad Shah, Bandar Indera Mahkota, 25200 Kuantan, Pahang Darul Makmur.

Tel: 09-591 2500

SASMEC-ENG-F009 VER: 01 REV: 02 EFFECTIVE DATE: 08 JULY 2022

FIELD (Please Tick)

Furniture Linen Gas Waste

A. COMPLAINT REPORT

Reference No. : Contact/Ext. No. :

Date/Time : Location :

Name :

Staff No. :

Detail Complaint

No Asset No Room No Room Name Description

B. ACTION BY ENGINEERING:

REMARKS:

STAMP & INITIAL/DATE

SULTAN AHMAD SHAH MEDICAL CENTRE @IIUM COMPLAINT FORM

Sultan Ahmad Shah Medical Centre @IIUM, Jalan Sultan Ahmad Shah, Bandar Indera Mahkota, 25200 Kuantan, Pahang Darul Makmur.

Tel: 09-591 2500

SASMEC-ENG-F009 VER: 01 REV: 02 EFFECTIVE DATE: 08 JULY 2022

C. JOB DONE (BY APSB/CONTRACTOR/VENDOR) D. JOBS VERIFIED BY USERS Name:

STAMP & INITIAL/DATE

Name:

STAMP & INITIAL / DATE

E. DEPARTMENT OF FACILITY & ENGINEERING Acknowledgement & Record:

Signature : Stamp :

Name :

Staff No :

Date / Time :