Page 10 - Med Plaza and Cancer Center

MEDICAL GAS MASTER ALARM INSPECTION DOCUMENT

Facility Florida Hospital Orlando-Med Plaza Inspector Anthony Voight
Contractor/ Facility Contact Darrell Huckaby Date 12-12-17
Infusion and Observation Medaes Multi Signal Black Face
Alarm Location #1 Center, Nurses Station Manuf & Model# GP-L-5CC-04-MA-Z01/02
Area Maintenance Shop Medaes Multi Signal Black Face
Alarm Location #2 Basement Manuf & Model# GP-L-5CC-04-MAZ03/04

TEST
VISUAL AUDIBLE SWITCH
ALARM CONDITION SET POINT #1 #2 #1 #2 #1 #2 COMMENTS
O2 LINE PRESSURE HIGH 60 PSI P P P P P P
O2 LINE PRESSURE LOW 40 PSI P P P P P P
N2O LINE PRESSURE HIGH 60 PSI P P P P P P
N2O LINE PRESSURE LOW 40 PSI P P P P P P
N2O RESERVE IN USE P P P P P P
N2 LINE PRESSURE HIGH 200 PSI P P P P P P
N2 LINE PRESSURE LOW 130 PSI P P P P P P
N2 BANK #1 IN RESERVE P F P P P P #2 No Visual
N2 BANK #2 IN RESERVE P F P P P P #2 No Visual
CO2 LINE PRESSURE HIGH P P P P P P
CO2 LINE PRESSURE LOW P P P P P P
CO2 RESERVE IN USE P F P P P P #2 lights stay on
MED AIR LINE PRESSURE HIGH 60 PSI P P P P P P
MED AIR LINE PRESSURE LOW 40 PSI P P P P P P
MED AIR DEW POINT HIGH P P P P P P
MED AIR LAG COMP IN USE P P P P P P
MED AIR CO HIGH P P P P P P
MED VAC LINE PRESSURE LOW 12” P P P P P P
MED VAC LAG ALARM P P P P P P

IS MASTER ALARM INSTALLED IN A LOCATION TO ENSURE CONTINUOUS OBSERVATION Pass
IS AN ADDITIONAL PANEL INSTALLED IN THE PRINCIPLE WORKING AREA OF THE MAINTENANCE DEPARTMENT Pass
IS THE ALARM ELECTRICAL SOURCE ON EMERGENCY POWER Pass

CODE DEFICIENCIES NOTED:

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