Page 18 - Med Plaza and Cancer Center

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

Facility Florida Hospital Orlando-Med Plaza Inspector Steve Gourley
City/State Orlando, FL Date 11-30-17 Page 1 of 2
Contractor n/a Facility Contact Darrell Huckaby

Area Served 1.5T MRI Floor/Bldg 1 Floor Med Plaza
st

Zone Valve Location for this Area Wall across from 1.5 T MRI ZVB Manufacturer Chemetron

FL Hosp. Tag # O2 #000000234086 AIR #000000234084 VAC #000000234085
Location IAW NFPA 99 Pass Labeled Pass Gauges Fail Leak Test Pass
Test Gauge O2 52 AIR 49 VAC -25
Pressure vs.
ZVB Gauge 54 54 -27

Valve Size 1/2 1/2 3/4
Comments: MED AIR gauge on ZVB reads high

Gas/Pipeline Purity Oxygen Med 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 1.5T MRI 1.5T MRI

Area Alarm Panel Location for this Area Corridor wall next to ZVB

Location IAW NFPA 99 Pass Labeled Pass Gauges Pass Leak Test Pass
Area Alarm Panel Manufacture Data Amico Alert #000000222694
GAUGE LOW HIGH TEST
GAS/VAC PSI ALARM ALARM VISUAL AUDIBLE SWITCH SENSOR COMMENTS PASS/FAIL
OXY 52 40 60 P P P PS PASS
AIR 49 40 60 P P P PS PASS
VAC 26 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

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