Page 36 - 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 OR 4 Floor/Bldg 1 Floor Med Plaza
st

Zone Valve Location for this Area Outside OR4 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 22 N2O 53 N2 175 WAGD 22
Pressure vs.
ZVB Gauge 51 50 22 51 179 22

Valve Size 3/4 3/4 1 3/4 1/2 3/4
Comments:

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 OR4 OR4 OR4

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 170 130 200 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