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Facility Name:
Address 1:
Address 2:
City:
State:
Alabama
Alaska
Arizona
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California
Colorado
Connecticut
DC, Washington
Delaware
Florida
Georgia
Hawaii
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OTHER
Pennsylvania
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South Carolina
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Tennessee
Texas
Utah
Vermont
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Washington
West Virginia
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Zip Code:
Contact Name:
Contact Phone:
Contact E-mail:
Date of Service:
Service Engineer:
- Select One -
Don't Know
Bill Spanoghe
Curtis Flipse
David Martinez
Joel Fluck
John Black
Kelly Brooks
Mike McNamara
Mike McNamara
Richard Goldman
Type of system on which Echoserve FSE performed service:
Manufacturer:
- Select Manufacturer -
Aloka
B-K Medical
Biosound
GE
Hitachi
Medison
Mindray
Philips
Siemens
Sonosite
Toshiba
System Model:
- Select Model-
Emergency [system down] or scheduled [preventative maintenance] service:
Emergency [system down]
Scheduled [preventative maintenance]
Did Echoserve call to confirm appointment within 2 hours of service request (may not be a service engineer; could be a dispatcher)?
Yes
No
Did the Service Engineer arrive on time?
Yes
No
Did the Service Engineer project a professional image (was he/she dressed appropriately; did they act professionally; etc.)?
Yes
No
Did the Service Engineer appear to be knowledgeable about the system and/or problem(s)?
Yes
No
Did the Service Engineer arrive with the right parts to repair the system?
Yes
No
Did the Service Engineer resolve all issues within the scheduled time period?
Yes
No
Did the Service Engineer provide a complete Service Report describing the issues and repair activity?
Yes
No
Did the Service Engineer provide accurate information on estimated repair costs?
Yes
No
The system is now repaired and is functioning properly.
Yes
No
What is your overall grade for this service action?
Bad
Poor
Average
Good
Excellent
Any Additional Comments?
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