Page 8 - Select Specialty

EMERGENCY OXYGEN SUPPLY CONNECTION (EOSC) ANNUAL INSPECTION FORM

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

System Inspected EOSC Building Select Specialty
Location Next to Oxygen Farm Manufacturer

Is the EOSC located IAW NFPA 99 (Located on exterior of Building being served in a location accessible by emergency supply
Y vehicles always in all weather conditions, connected to the main line immediately downstream of the main shutoff valve)
Y Does the EOSC provide physical protection to prevent unauthorized tampering
Y Does the EOSC have a Manual Shutoff Valve to isolate the EOSC when not in use
Does the EOSC have Two Check Valves, one downstream of the EOSC and one downstream of the Main Line shutoff valve,
CNT with both check valves upstream from the Tee connection for the two pipelines
Does the EOSC have a Pressure Relief Valve sized to protect the downstream piping system and related equipment from
Y exposure to pressures more than 50% higher than normal line pressure
Does the EOSC provide valves necessary to allow connection of an emergency supply of oxygen and isolation of the piping to
Y the normal source of supply
N Does the EOSC have a minimum of 3 feet of clearance around the EOSC for connection of a temporary auxiliary source
Is the EOSC in Good/Serviceable Condition (Clean for Oxygen Service- free of Dirt/Debris/insects/rodents, Free of
N Leaks/Pressure Tight)
Is the EOSC Properly Labeled- “Emergency Oxygen Supply Connection”, Area Served, Caution to not open the valve except in
Y an emergency
Comments: 3 Ft. clearance rule does not apply, as this system was “Grandfathered”

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