Page 22 - 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 12-4-17 Page 1 of 2
Contractor n/a Facility Contact Darrell Huckaby

Area Served CYSTO 2 Floor/Bldg 1 Floor Med Plaza
st

Zone Valve Location for this Area Outside CYSTO ZVB Manufacturer Hill-Rom

FL Hosp. Tag # No FL Hosp #
Location IAW NFPA 99 Pass Labeled Pass Gauges Pass Leak Test Pass
Test Gauge O2 52 AIR 49 VAC 25 N2O 53 N2 173 WAGD 25
Pressure vs.
ZVB Gauge 52 50 25 52 175 25

Valve Size 3/4 3/4 1 3/4 1/2 3/4
Comments: No ZVB #s

Gas/Pipeline Purity Oxygen Med Air N2O Comments
Hydrocarbons <1 PPM <1 PPM <1 PPM
Dew Point -46 23 -27
Carbon Monoxide <1 PPM <1 PPM <1PPM
Carbon Dioxide <1 PPM 370 PPM <1 PPM
Gas Concentration 99.9%O2 21.0 (%O2) 99.9%N2O

Particulates >1 <1 <1
Odor/Discoloration None None None
Test Location CYSTO 2 CYSTO 2 CYSTO 2

Area Alarm Panel Location for this Area Across from decontamination room
Location IAW NFPA 99 Pass Labeled Pass Gauges Pass Leak Test Pass
Area Alarm Panel Manufacture Data Hill rom Med Plus (GP-L-5PS-01-6G-001)
GAUGE LOW HIGH TEST
GAS/VAC PSI ALARM ALARM VISUAL AUDIBLE SWITCH SENSOR COMMENTS PASS/FAIL
OXY 51 40 60 P P P SS PASS
AIR 50 40 60 P P P SS PASS
VAC 25 12 - P P P SS PASS
N2O 53 40 60 P P P SS PASS
N2 170 140 200 P P P SS PASS
WAGD 24 12 - P P P SS PASS
PS= Patient Side SS= Source Side NW= Not Working CNT= Could Not Test NA = Not Applicable NP = Not Present
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©Daniel Voight 2009