Page 16 - Womens Pavilion

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

Facility Florida Hospital Orlando Inspector Steve Gourley
City/State Orlando, Fl. Date 12-5-17 Page 1 of 2
Contractor n/a Facility Contact Darrell Huckaby

Triage Exam 1 Thru 8, Ultrasound and
Area Served Triage Assessment Floor/Bldg Ground Floor Womens

Zone Valve Location for this Area Next to soiled holding ZVB Manufacturer Beacon
FL Hosp. Tag # O2 #000000171998, AIR #000000171996, VAC #000000171997
Location IAW NFPA 99 Pass Labeled Pass Gauges Pass Leak Test Pass
Test Gauge O2 54 AIR 49 VAC 22
Pressure vs.
ZVB Gauge 50 50 22
Valve Size ¾” ¾" 1 ½”
Comments: *

Gas/Pipeline Purity Oxygen Med Air Comments
Hydrocarbons <1 PPM <1 PPM
Dew Point -44F 5F
Carbon Monoxide <1 PPM <1 PPM
Carbon Dioxide 0 PPM 120 PPM

Gas Concentration 99%O2 21.8(%O2)
Particulates <1 <1
Odor/Discoloration none none
Test Location Exam 3 Exam 3

Area Alarm Panel Location for this Area Near nurses station
Location IAW NFPA 99 Pass Labeled Pass Gauges Pass Leak Test Pass
Area Alarm Panel Manufacture Data Beacon Total Alert 2 ADV# 000000222138
GAUGE LOW HIGH TEST
GAS/VAC PSI ALARM ALARM VISUAL AUDIBLE SWITCH SENSOR COMMENTS PASS/FAIL
OXY 53 40 60 P P P PS PASS
AIR 49 40 60 P P P PS PASS
VAC 21 12 NA 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
“Medical Gas Pipeline Equipment Service, Sales & Verifications”
©Daniel Voight 2009