Page 38 - 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 PACU Beds 1-5 Floor/Bldg 1 Floor Med Plaza
st

Zone Valve Location for this Area Inside area served ZVB Manufacturer Hill-Rom

FL Hosp. Tag # O2/MA/VA-P-5PS-01-B-Z-W-03 #000000227013
Location IAW NFPA 99 Pass Labeled Fails Gauges Pass Leak Test Pass
Test Gauge O2 52 AIR 49 VAC 25
Pressure vs.
ZVB Gauge 53 50 25

Valve Size 3/4 3/4 11/4
Comments: Tags on piping in ZVB read Pre-OP/Discharge Beds 1-5, Should read PACU Beds 1 thru 5

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 PACU 4 PACU 4

Area Alarm Panel Location for this Area In PACU nurses station

Location IAW NFPA 99 Pass Labeled Pass Gauges Pass Leak Test Pass
Area Alarm Panel Manufacture Data Hill-Rom (GP-L-5PS-01-3G-003)
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 50 40 60 P P P PS PASS
VAC 20 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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