Page 10 - Select Specialty

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

Facility Select Specialty Hospital-Orlando Inspector Seth Stephens
City/State Orlando, FL Date 11-17-17 Page 1 of 2
Contractor n/a Facility Contact Darrell Huckaby

Area Served Rooms 8601-8604 Floor/Bldg 1 Floor
st

Zone Valve Location for this Area Wall by front entrance ZVB Manufacturer Chemetron

FL Hosp. Tag # MA/O2/VA-P-1LR-01-B-Z-W-01
Location IAW NFPA 99 Pass Labeled Pass Gauges Pass Leak Test Pass
Test Gauge O2 54 AIR 47 VAC 22
Pressure vs.
ZVB Gauge 53 49 22

Valve Size ½’’ ½’’ 1’’
Comments: *NOTE: ZVB/ALARM NEEDS FH STYLE TAGS ON THE OUTSIDE OF THE WINDOW.

Gas/Pipeline Purity Oxygen Med Air Comments
Hydrocarbons <1 PPM <1 PPM NOTE: RAISE PRESSURE FOR MEDICAL AIR (AT 47 NOW SHOULD
Dew Point -12 23 BE 50 OR ABOVE).
Carbon Monoxide <1 PPM <1 PPM
Carbon Dioxide <1 PPM 410 PPM
Gas Concentration 99%O2 21.5(%O2)
Particulates <1 <1

Odor/Discoloration None None
Test Location 8603 8603

Area Alarm Panel Location for this Area Nurses station

Location IAW NFPA 99 Pass Labeled Pass Gauges Pass Leak Test Pass
Area Alarm Panel Manufacture Data Amico Alert (double) GP-L-1LR-01-6G-003
GAUGE LOW HIGH TEST
GAS/VAC PSI ALARM ALARM VISUAL AUDIBLE SWITCH SENSOR COMMENTS PASS/FAIL
OXY 54 40 60 P P P PS PASS
AIR 48 40 60 P P P PS PASS
VAC 22 12 N/A P P P PS PASS
PS= Patient Side SS= Source Side NW= Not Working CNT= Could Not Test NA = Not Applicable NP = Not Present

Corporate Office ∙ 4518 Clements Rd. Lakeland Florida 33811 Phone: 863-646-7555 ∙ Fax 863-646-2999
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©Daniel Voight 2009