ANNEX B

LIST OF EQUIPMENT/INSTRUMENT
Name of Health Facility: SMMC PAANAKAN
Address of Health Facility: #47 P. Alcantara St. Brgy. VII-B San Pablo City, Laguna
Brand Name &
Model

Serial No.

Bandage Scissor(s)
Bench
Cabinet
Calculator
Chair
Clinical Weighing
Scale
Delivery Set
Delivery Table
Desk
Electric Fan/Wall Fan
Emergency Light
Examining Table
Fire Extinguisher
Foot Stool
Gooseneck/Examining
Lamp
Hemostatic/Kelly
Forceps
Instrument Cabinet
Instrument Table
IV Stand
Kidney Basin
Needle Holder
Oxygen

Quantity

Date of Purchase

2
1
1
2
6
2 (1 adult; 1 pedia)
2
1
1
4
1
1
1
2
2
6
1
1
3
3
3
3

Use additional sheets when necessary.

Prepared by: _ _________________________________________________________

Form-HF-LTO-A
Revision:02
5

12/11/2014
Page 2 of

ANNEX B
LIST OF EQUIPMENT/INSTRUMENT
Name of Health Facility: SMMC PAANAKAN
Address of Health Facility: #47 P. Alcantara St. Brgy. VII-B San Pablo City, Laguna
Brand Name &
Model

Serial No.

Pail
Pair (s) of slippers
Suction bulb
Refrigerator
Sphygmomanometer
Sterile plastic
umbilical cord clamp
Stethoscope
Suction apparatus
Surgical scissors
Stool
Tape measure
Thermometer
Thumb forceps
Tissue forceps (with
teeth)
Transport vehicle or
MOA with service
provider
Typewriter
Computer
Vaginal speculum
Wall clock with second
hand
Bag valve mask

Quantity

Date of Purchase

1
2
6
1
3

3
1
3
1
2
3
3
3
1

1
1
2
2
2 (1 pedia; 1 adult)

Use additional sheets when necessary.

Prepared by: _ _________________________________________________________

Form-HF-LTO-A
Revision:02
5

12/11/2014
Page 2 of