Page 30 - Womens Pavilion
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ZONE VALVE/ AREA ALARM / OUTLET PERFORMANCE/GAS CONCENTRATION AND PURITY INSPECTION DOCUMENT

           Facility    Florida Hosp. Orlando – Women’s Center  Inspector  Anthony Voight
           City/State   Orlando, FL                           Date       11-29-17        Page       1 of 5

           Contractor  n/a                                    Facility Contact   Darrell Huckaby
                                                                           rd
          Area Served   LDR Rooms 7-14 (3907-3914)            Floor/Bldg   3  Floor

           Zone Valve Location for this Area   Corridor wall across from Rm 3908   ZVB Manufacturer   Beacon

          FL Hosp. Tag #       O2 000000222014 AIR 000000222016 VAC 000000222015
          Location IAW NFPA 99   Pass          Labeled    Pass      Gauges   Pass       Leak Test   Pass
           Test Gauge   O2    52   AIR    49   VAC    21
           Pressure vs.
           ZVB Gauge          53          47          21

          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                None          None

         Odor/Discoloration          None          None
         Test Location              LDR 8         LDR 8

         Area Alarm Panel Location for this Area         Nurses station across from Rm 3904

         Location IAW NFPA 99       Pass                 Labeled    Pass   Gauges     Pass     Leak Test   Pass
         Area Alarm Panel Manufacture Data         Beacon Total Alert 2 ADV# 000000222140
                     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       48       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
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