Page 96 - 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 3
Contractor n/a Facility Contact Darrell Huckaby

Area Served Stage 1 Recovery Floor/Bldg 4 Floor Med Plaza
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Zone Valve Location for this Area In OR Area ZVB Manufacturer Medaes

FL Hosp. Tag # O2/MA/VA-P-5PC-04-B-Z-W-10
Location IAW NFPA 99 Pass Labeled Pass Gauges Pass Leak Test Pass
Test Gauge O2 51 AIR 50 VAC 24
Pressure vs.
ZVB Gauge 50 48 24

Valve Size 1/2 1/2 1
Comments:

Gas/Pipeline Purity Oxygen Medical 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 Stage 1 Bed 1 Stage 1 Bed 1

Area Alarm Panel Location for this Area Nurse Station

Location IAW NFPA 99 Pass Labeled Pass Gauges Pass Leak Test Pass
Area Alarm Panel Manufacture Data Medaes (GP-L-5PC-04-3G-Z10)
GAUGE LOW HIGH TEST
GAS/VAC PSI ALARM ALARM VISUAL AUDIBLE SWITCH SENSOR COMMENTS PASS/FAIL
OXY 50 40 60 P P P PS Alarmed at 32 FAIL
AIR 51 40 60 P P P PS Alarmed at 30 FAIL
VAC 25 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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