Page 6 - Select Specialty

MEDICAL AIR SYSTEM INSPECTION FORM

Facility Select Specialty Hospital-Orlando Technician Anthony Voight
City/State Orlando, FL Date 12-12-17

System Inspected Med Air System Floor/Bldg Basement
Manufacturer Beacon Medaes Equipment ID # CM-H-ICR-GR-0-F-1A1/1B1
Model# LPS-7D-SD80-DAY-003 Serial # 65448

Compressor Configuration Duplex Stack scroll Motor HP 7.5HP
Hours Comp# 1 16,546 Comp# 2 16,331 Comp# 3 - Comp# 4 -

Is Medical Air System located IAW NFPA 99 (Dedicated Mechanical Equipment Room, Adequately Ventilated, with Required
PASS Utilities, Minimum 1-HR Fire Rated)
PASS Is Medical Air System Fed from Emergency Power (Essential Electrical System)
Do the Medical Air Compressors meet the requirements of NFPA 99 (Elimination of oil anywhere in the compressor,
PASS separation of the oil containing section by seal(s) with atmospheric vents
Is the Medical Air System connected ONLY to the Medical Air Distribution System and used ONLY in the application of Human
PASS Respiration, and calibration of Medical Devices for Human Respiration

PASS Does the Medical Air System consist of at least (2) Two Compressors
PASS Is the Medical Air Intake & Discharge connected to the Piping by Flexible Connectors
PASS Is the Medical Air Intake located IAW NFPA 99
PASS Is there an Discharge Isolation Valve, Check Valve and Pressure Relief Valve for each Compressor

PASS Is there at least Duplex After Coolers w/Condensate Drain Traps for the System
Is the Medical Air Receiver Corrosion Resistant & equipped with a Pressure Relief Valve, Automatic Drain, Manual Drain, Sight
PASS Glass, Pressure Indicator and Valved Bypass Arrangement

PASS Is the Medical Air System equipped with at least Duplex Dryers Desiccant x Refrigerant
PASS Is the Medical Air System Equipped with at least Duplex Final Line Regulators with Pressure Indicators
PASS Is the Medical Air System Equipped with at Least Duplex Final Line Filters with Continuous Visual Indicator
PASS Can the Medical Air Compressors, Dryers, Filters & Regulators be Isolated for Service without shutting down the system

PASS Is the Medical Air System Equipped with a ¼” Sample Port Valve and Source Shut Off Valve
PASS Is the Medical Air System Equipped with a Dew Point & Co Monitor

PASS Are the Local Alarms Required by NFPA 99 Present, Functioning and connected to the Master Alarms as required
Comments:

Corporate Office ∙ 4518 Clements Rd. Lakeland Florida 33811 Phone: 863-646-7555 ∙ Fax 863-646-2999
“Medical Gas Pipeline Equipment Service, Sales & Verifications”
www.medgaspro.org