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Work Order Number Barcode Ticket no. City Name ---Select one--- Alluri Sita Ramaraju Anakapalli Ananthpur Annamaya Bapatla Chittoor East Godavari Eluru Guntur Kakinada Konaseema Krishna Kurnool Nandyal Nellore NTR Palnadu Parvatipuram Manyam Prakasam Sri Balaji Sri Satya Sai Srikakulam Vishakhapatnam Vizianagaram West Godavari YSR Kadapa Facility Type Facility Name Device Group ---Select one--- Analyser Automated DNA/ RAN Extraction Autopsy Blood Bank Cardiology Casualty Cath Lab CFC CSSD Dental Dermatology Dialysis Dressing Room EEG Room EMG Room Endoscopy Room ENT EYE OP General ICU Injection Room Lab Labour Room Micro Biology Mortuary Neurology NICU OP OPD Opthalmology Orthodontics OT Pathology Pharmacology Physio Psychology Pulmonology Radiology RO Plant SNCU Sterile Room Urology Device Group Class ---Select one--- NON CRITICAL CRITICAL Status ---Select one--- New Working Not Working- Minor Repair Not Working- Major Repair Damaged Already Condemned Physical Damage Condemned District ---Select one--- Alluri Sita Ramaraju Anakapalli Ananthpur Annamaya Bapatla Chittoor East Godavari Eluru Guntur Kakinada Konaseema Krishna Kurnool Nandyal Nellore NTR Palnadu Parvatipuram Manyam Prakasam Sri Balaji Sri Satya Sai Srikakulam Vishakhapatnam Vizianagaram West Godavari YSR Kadapa

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