Page 12 - Med Plaza and Cancer Center

MEDICAL AIR SYSTEM ANNUAL INSPECTION FORM

Facility Florida Hospital Orlando-Med Plaza Technician Anthony Voight
City/State Orlando, FL Date 12-12-17

System Inspected Med Air System Floor/Bldg Med Plaza Basement Mech.
Manufacturer Beacon Medaes Equipment ID # CM-H-5CC-GR-0-F-0A1
Compressor Configuration Duplex Recip. Motor HP 7.5HP

Hours Comp #1 5206 Comp #2 6259

Is Medical Air System located IAW NFPA 99 (Dedicated Mechanical Equipment Room, Adequately Ventilated, with Required
YES Utilities, Minimum 1-HR Fire Rated)
YES Is Medical Air System Fed from Emergency Power (Essential Electrical System)
Do the Medical Air Compressors meet the requirements of NFPA 99 (Elimination of oil anywhere in the compressor,
YES separation of the oil containing section by seal(s) with atmospheric vents
Is the Medical Air System connected ONLY to the Medical Air Distribution System and used ONLY in the application of Human
YES Respiration, and calibration of Medical Devices for Human Respiration

YES Does the Medical Air System consist of at least (2) Two Compressors
YES Is the Medical Air Intake & Discharge connected to the Piping by Flexible Connectors
YES Is the Medical Air Intake located IAW NFPA 99
YES Is there a Discharge Isolation Valve, Check Valve and Pressure Relief Valve for each Compressor

YES Is there at least Duplex After Coolers w/Condensate Drain Traps for the System
Is the Medical Air Receiver Corrosion Resistant & equipped with a Pressure Relief Valve, Automatic Drain, Manual Drain, Sight
YES Glass, Pressure Indicator and Valved Bypass Arrangement
YES Is the Medical Air System equipped with at least Duplex Dryers Desiccant x Refrigerant

YES Is the Medical Air System Equipped with at least Duplex Final Line Regulators with Pressure Indicators
YES Is the Medical Air System Equipped with at Least Duplex Final Line Filters with Continuous Visual Indicator
YES Can the Medical Air Compressors, Dryers, Filters & Regulators be Isolated for Service without shutting down the system

YES Is the Medical Air System Equipped with a ¼” Sample Port Valve and Source Shut Off Valve
YES Is the Medical Air System Equipped with a Dew Point & Co Monitor
YES Are the Local Alarms Required by NFPA 99 Present, Functioning and connected to the Master Alarms as required
Comments:

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