设备维修申请单范本

设备维修申请单范本申请人信息：部门：__________________________姓名：__________________________联系电话：_______________________设备信息：设备名称：_____________________设备型号：_____________________设备编号：_____________________使用地点：_____________________购买日期：_____________________保修期限：_____________________故障现象及描述：________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________维修需求：1.____________________________________________________________________________2.____________________________________________________________________________3.____________________________________________________________________________申请人签名：_______________________日期：____年____月____日部门负责人审批：是否同意维修：是□否□审批意见：____________________________负责人签名：_________________________日期：____年____月____日维修部门接单：接单人员：___________________________日期：____年____月____日预计维修完成时间：__________________维修情况记录：1.维修原因：_______________________________________________________________2.更换部件：_______________________________________________________________3.维修费用：__________________（大写）：__________________________________4.维修人员：____________________日期：____年____月____日5.维修结果：□已修复□无法修复需要更换新设备申请人确认：维修结果是否满意：是□否□确认意见：____________________________申请人签名：_________________________日期：____年____月____日备注：_______________________________________________________________________________________________________________________________________________________________