設備維修申請單范本申請人信息：部門：__________________________姓名：__________________________聯系電話：_______________________設備信息：設備名稱：_____________________設備型號：_____________________設備編號：_____________________使用地點：_____________________購買日期：_____________________保修期限：_____________________故障現象及描述：________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________維修需求：1.____________________________________________________________________________2.____________________________________________________________________________3.____________________________________________________________________________申請人簽名：_______________________日期：____年____月____日部門負責人審批：是否同意維修：是□否□審批意見：____________________________負責人簽名：_________________________日期：____年____月____日維修部門接單：接單人員：___________________________日期：____年____月____日預計維修完成時間：__________________維修情況記錄：1.維修原因：_______________________________________________________________2.更換部件：_______________________________________________________________3.維修費用：__________________（大寫）：__________________________________4.維修人員：____________________日期：____年____月____日5.維修結果：□已修復□無法修復需要更換新設備申請人確認：維修結果是否滿意：是□否□確認意見：____________________________申請人簽名：_________________________日期：____年____月____日備注：_______________________________________________________________________________________________________________________________________________________________