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FIELD SERVICE REPORT
Facility FHO Women’s Pavilion Date 2-27-18
Address 601 E Rollins St. Technician Anthony Voight
City/State Orlando FL PO# 3434166
Facility Contact/Supervisor Darrell Huckaby Department Engineering
Phone# 352-613-0549 Fax# Email Darrell.Huckaby@flhosp.org
Equipment Description 2017 Discrepancy Repairs
Equipment Manufacturer(s)
Model #/ Part # /Ser #
Equipment Location (s) All
Description of work performed Discrepancy Repairs from 2017 Annual Med Gas Inspection: #’s 1, 2 & 3.
Parts Used:
Hours: Qt. 2864 Per Diem: Mileage: Rate:
Comments & Recommendations
Signature of Service Technician Anthony Voight
Signature of Responsible Facility Authority
Corporate Office ∙ 4518 Clements Rd. Lakeland Florida 33811 Phone: 863-646-7555 ∙ Fax 863-646-2999
“Medical Gas Pipeline Equipment Service, Sales & Verifications”
www.medgaspro.org
