Page 58 - Womens Pavilion

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 4

Contractor n/a Facility Contact Darrell Huckaby
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Area Served NICU 4939-4942, 4921-4923 Floor/Bldg 4 Floor

Zone Valve Location for this Area Next to Clean Supply ZVB Manufacturer Beacon

FL Hosp. Tag # O2-000000311186 AIR-000000311187 VAC-000000311189
Location IAW NFPA 99 Pass Labeled Pass Gauges Pass Leak Test Pass
Test Gauge O2 53 AIR 50 VAC 20
Pressure vs.
ZVB Gauge 53 49 20

Valve Size ¾” ¾” 1 ¼”
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 4922 4922

Area Alarm Panel Location for this Area Next to Clean Supply Room

Location IAW NFPA 99 Pass Labeled Pass Gauges Pass Leak Test Pass
Area Alarm Panel Manufacture Data Beacon Total Alert Infinity ADV# 000000311184
GAUGE LOW HIGH TEST
GAS/VAC PSI ALARM ALARM VISUAL AUDIBLE SWITCH SENSOR COMMENTS PASS/FAIL
OXY 53 40 60 P P P SS PASS
AIR 50 40 60 P P P SS PASS
VAC 21 12 NA P P P SS 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