Page 100 - Med Plaza and Cancer Center

ZONE VALVE/ AREA ALARM / OUTLET PERFORMANCE/GAS CONCENTRATION AND PURITY INSPECTION DOCUMENT

Facility Florida Hospital Orlando-Med Plaza Inspector Joseph Voight
City/State Orlando, FL Date 11-17-17 Page 1 of 4
Contractor n/a Facility Contact Darrell Huckaby

Area Served Stage 2 & 3 Recovery and Pre-OP Floor/Bldg 4 Floor Med Plaza
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Zone Valve Location for this Area In OR Area ZVB Manufacturer Medaes

FL Hosp. Tag # MA/O2/VA-P-5PC-04-B-Z-W-12
Location IAW NFPA 99 Pass Labeled Pass Gauges Pass Leak Test Pass
Test Gauge O2 51 AIR 50 VAC 25
Pressure vs.
ZVB Gauge 52 50 25

Valve Size ½” ½” 1”
Comments:

Gas/Pipeline Purity Oxygen Medical Air Comments
Hydrocarbons <1 PPM <1 PPM
Dew Point -46 23
Carbon Monoxide <1 PPM <1 PPM
Carbon Dioxide <1 PPM 370 PPM
Gas Concentration 99.9%O2 21.0%O2
Particulates <1 <1

Odor/Discoloration None None
Test Location Stage 2 Bed 3D Stage 2 Bed 3D

Area Alarm Panel Location for this Area Nurse Station

Location IAW NFPA 99 Pass Labeled Pass Gauges Pass Leak Test Pass
Area Alarm Panel Manufacture Data Medaes (GP-L-5PC-04-3G-Z12)
GAUGE LOW HIGH TEST
GAS/VAC PSI ALARM ALARM VISUAL AUDIBLE SWITCH SENSOR COMMENTS PASS/FAIL
OXY 50 40 60 P P P PS PASS
AIR 49 40 60 P P P PS PASS
VAC 23 12 - P P P PS PASS
PS= Patient Side SS= Source Side NW= Not Working CNT= Could Not Test NA = Not Applicable NP = Not Present

Corporate Office ∙ 4518 Clements Rd. Lakeland Florida 33811 Phone: 863-646-7555 ∙ Fax 863-646-2999
“Medical Gas Pipeline Equipment Service, Sales & Verifications”
©Daniel Voight 2009