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- Q702--Medical Gas Inspection and Certification
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- 36C24126Q0061
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This document contains a Medical Gas Zone Inspection & Performance Verification report for the White River Junction VA Medical Center. The report details comprehensive testing of medical gas systems across multiple floors and zones, including oxygen, medical air, vacuum, nitrous oxide, WAGD (Waste Anesthetic Gas Disposal), nitrogen, and carbon dioxide gas services. The inspections were conducted on Building 31, covering inpatient wards on floors 1 and G (ground), with specific focus on rooms ranging from 101-129, 132-137, and G-71 to G-86.
The documentation systematically verifies each zone's gas outlet and inlet performance, including static pressure, flow rates, dynamic pressure, and assay percentages. Each zone uses a Beacon Medaes Total Alert Infinity monitoring system, with area alarms and zone valves checked for compliance with NFPA 99 standards. The reports consistently show that all tested outlets and inlets met the required performance metrics, with no significant issues identified. The inspection dates range from 1/2/25 to 4/30/24, indicating a proactive approach to medical gas system maintenance and verification at the VA medical facility.
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Text version
31 1
31 1
31 1
31 1
31 1
31 1
General Notes:
1-6 Ceiling
Overhead Nurses Station
Future Tie In Main Pipelines To ICU Service X X X
1-5 Rest Room
Adjacent to Nurses Station Inpatient
Ward Future Zone Service X X X Yes
1-4 Medication Room 164 Main Pipelines Service X
Inspection & Performance Verification Critical Control Valve
10/17/24
1-2 Ceiling
Overhead Adjacent to
Future Zone Service X X X Yes
1-3
X X
Designation
Date:
Building: Floor: Room / Area: Carbon Dioxide
Valve Identification / Location Meets
NFPA 99:
YesX X X
YesFuture Tie In Main Pipelines Service
Ceiling Overhead
Adjacent to Future Zone Future
Yes
Yes
Location: White River VA Medical Center
Ceiling Overhead Room 137
Med Air Vacuum N2O WAGD Nitrogen Area of Control: Valve
Type:
Gas Service
Valve ID: Oxygen
1-1 X X X
Attachment 2
D W
D W D W D W D W D W D W D W D W D W D W D W D W D W D W D W D W D W D W D W D W D W D W D W D W D W
Note 1
Note 2
Symbol Key: N/T = Not Tested, N/A = Not Applicable, N/V = Not Verified, Y = Yes, N = No, W = Wall, B = Boom/Column, C = Ceiling, P = Pedestal, O = Other, D = DISS, Q = Quick Connect, C = Chemetron, G = Geo
Findings:
General Notes:
These outlets were checked for proper static pressure, performance, and/or concentration levels only.
49 20.9% Yes 124 Inpatient Ward O None 51 100 50 124 Inpatient Ward A None 50 100
99.8% Yes
124 Inpatient Ward V N/A 20 85 18 N/A Yes 123 Inpatient Ward O None 51 100 50 99.8% Yes
18 N/A Yes 123 Inpatient Ward A None 50 100 49 123 Inpatient Ward V N/A 20 85
20.9% Yes
122 Inpatient Ward O None 51 100 50 99.8% Yes 122 Inpatient Ward A None 50 100 49 20.9% Yes
50 99.8% Yes 122 Inpatient Ward V N/A 20 85 18 121 Inpatient Ward O None 51 100
N/A Yes
121 Inpatient Ward A None 50 100 49 20.9% Yes 121 Inpatient Ward V N/A 20 85 18 N/A Yes
49 20.9% Yes 120 Inpatient Ward O None 51 100 50 120 Inpatient Ward A None 50 100
99.8% Yes
120 Inpatient Ward V N/A 20 85 18 N/A Yes 119 Inpatient Ward O None 51 100 50 99.8% Yes
18 N/A Yes 119 Inpatient Ward A None 50 100 49 119 Inpatient Ward V N/A 20 85
20.9% Yes
118 Inpatient Ward O None 51 100 50 99.8% Yes 118 Inpatient Ward A None 50 100 49 20.9% Yes
50 99.8% Yes 118 Inpatient Ward V N/A 20 85 18 117 Inpatient Ward O None 51 100
N/A Yes
117 Inpatient Ward A None 50 100 49 20.9% Yes 117 Inpatient Ward V N/A 20 85 18 N/A Yes
49 20.9% Yes 116 Inpatient Ward O None 51 100 50 116 Inpatient Ward A None 50 100
99.8% Yes
La tc h
La tc h
FG
I T ab le
2.
1-
Le ak s in
Us e Le ak s
No t
In U se Tr an si en t
Fl ow
Odor Test
(None or
OD)
Room Number: Room Information: Gas
Service
C on ne ct io n
Ty pe
Lo ca tio n of
O ut le t /
In le t
A rt ic ul at in g A ss em bl ie s
116 Inpatient Ward V N/A 20 85 18 N/A Yes
Static Pressure Flow Dynamic
Pressure Assay Meets
NFPA
99:(psi or inHg) (LPM) (psi or inHg) (%)
Notes:
Station Outlets & Inlets Notes: Notes: Notes:
Meets
NFPA 99:
Meets
NFPA 99:
Notes: Notes: Notes:
Meets
NFPA 99:
Meets
NFPA 99:
Meets
NFPA 99:
Meets NFPA 99: Yes Meets
NFPA 99: Yes Meets NFPA 99: Yes
Notes:
60 40 60 40 12 50 50 20
Manufacturer: Beacon Medaes Model / Type: Total Alert Infinity Gas Service, Alarm Set Points & Area Alarm Pressure (psi or inHg)
Oxygen Med Air Vacuum Nitrous Oxide WAGD Nitrogen Carbon Dioxide Other
Notes:
Area Alarms Alarm ID: 1-1
Area Monitored: Inpatient Ward 116-129 Location: Adjacent to Room 129
Notes: Notes: Notes:Notes: Notes: Notes: Notes:
Meets
NFPA 99:
Meets NFPA 99: Yes Meets
NFPA 99: Yes Meets NFPA 99: Yes Meets
NFPA 99:
50 50 20 Meets
NFPA 99:
Meets
NFPA 99:
Meets
NFPA 99:
Zone Valves Zone ID: 1-1
Area of Control: Inpatient Ward 116-129 Location: Adjacent to room 129
Gas Service & Zone Valve Gauge Pressure (psi or inHg) Oxygen Med Air Vacuum Nitrous Oxide WAGD Nitrogen Carbon Dioxide Other
Medical Gas Zone Inspection & Performance Verification
Location: White River Junction VA Building: 31 Floor: 1 Department: Inpatient Ward Date: 1/2/25
D W D W D W D W D W D W D W D W D W D W D W D W D W D W D W D W D W D W D W
Note 1
Note 2
Symbol Key: N/T = Not Tested, N/A = Not Applicable, N/V = Not Verified, Y = Yes, N = No, W = Wall, B = Boom/Column, C = Ceiling, P = Pedestal, O = Other, D = DISS, Q = Quick Connect, C = Chemetron, G = Geo
Findings:
General Notes:
These outlets were checked for proper static pressure, performance, and/or concentration levels only.
Yes 129 Inpatient Ward O None 51 100 50 99.8% Yes
N/A Yes 129 Inpatient Ward A None 50 100 49 20.9%
50 99.8% Yes 129 Inpatient Ward V N/A 20 85 18 128 Inpatient Ward O None 51 100
Yes 128 Inpatient Ward A None 50 100 49 20.9% Yes
99.8% Yes 128 Inpatient Ward V N/A 20 85 18 N/A
49 20.9% Yes 127 Inpatient Ward O None 51 100 50 127 Inpatient Ward A None 50 100
Yes 127 Inpatient Ward V N/A 20 85 18 N/A Yes
20.9% Yes 127 Inpatient Ward O None 51 100 50 99.8%
18 N/A Yes 127 Inpatient Ward A None 50 100 49 127 Inpatient Ward V N/A 20 85
Yes 126 Inpatient Ward O None 51 100 50 99.8% Yes
N/A Yes 126 Inpatient Ward A None 50 100 49 20.9%
50 99.8% Yes 126 Inpatient Ward V N/A 20 85 18 126 Inpatient Ward O None 51 100
Yes 126 Inpatient Ward A None 50 100 49 20.9% Yes
99.8% Yes 126 Inpatient Ward V N/A 20 85 18 N/A
49 20.9% Yes 125 Inpatient Ward O None 51 100 50 125 Inpatient Ward A None 50 100 125 Inpatient Ward V N/A 20 85 18 N/A Yes
Static Pressure Flow Dynamic
Pressure Assay Meets
NFPA
99:(psi or inHg) (LPM) (psi or inHg) (%)
La tc h
La tc h
FG
I T
Le ak
Le ak s
No t
In U se Tr an si en t
Fl ow
Odor Test
(None or
OD)
Room Number: Room Information: Gas
Service
C on ne ct io n
Ty pe
Lo ca tio le t /
In le t
A rt ic ul at in g A ss em bl ie s
Notes: Notes:
Station Outlets & Inlets Notes: Notes: Notes:
Meets
NFPA 99:
Meets
NFPA 99:
Notes: Notes: Notes:
Meets
NFPA 99:
Meets
NFPA 99:
Meets
NFPA 99:
Meets NFPA 99: Yes Meets
NFPA 99: Yes Meets NFPA 99: Yes
50 50 20
Nitrogen Carbon Dioxide Other 60 40 60 40 12
Manufacturer: Beacon Medaes Model / Type: Total Alert Infinity Gas Service, Alarm Set Points & Area Alarm Pressure (psi or inHg)
Oxygen Med Air Vacuum Nitrous Oxide WAGD
Notes:
Area Alarms Alarm ID: 1-1
Area Monitored: Inpatient Ward 116-129 Location: Adjacent to Room 129
Notes: Notes: Notes:
Meets
NFPA 99:
Notes: Notes: Notes: Notes:
Meets
NFPA 99:
Meets
NFPA 99:
Meets
NFPA 99:
Meets NFPA 99: Yes Meets
NFPA 99: Yes Meets NFPA 99: Yes Meets
NFPA 99:
50 50 20
Gas Service & Zone Valve Gauge Pressure (psi or inHg) Oxygen Med Air Vacuum Nitrous Oxide WAGD Nitrogen Carbon Dioxide Other
Inpatient Ward Date: 1/2/25
Zone Valves Zone ID: 1-1
Area of Control: Inpatient Ward 116-129 Location: Adjacent to room 129
Medical Gas Zone Inspection & Performance Verification
Location: White River Junction VA Building: 31 Floor: 1 Department:
D W D W D W D W D W D W D W D W D W D W D W D W D W D W D W D W D W D W D W
Note 1
Note 2
135 Inpatient O N/A 51 100 50 99.8% Yes
Yes 135 Inpatient A None 50 100 49 20.9% Yes
Symbol Key: N/T = Not Tested, N/A = Not Applicable, N/V = Not Verified, Y = Yes, N = No, W = Wall, B = Boom/Column, C = Ceiling, P = Pedestal, O = Other, D = DISS, Q = Quick Connect, C = Chemetron, G = Geo
Findings:
General Notes:
These outlets were checked for proper static pressure, performance, and/or concentration levels only.
Zone Valves Zone ID: 1-2
Area of Control: Inpatient Ward 132-137 Location: Adjacent to Room 135
Medical Gas Zone Inspection & Performance Verification
1/2/25Date:Inpatient Ward Department:1Floor:31Building:Location: White River Junction VA
Gas Service & Zone Valve Gauge Pressure (psi or inHg) Oxygen Med Air Vacuum Nitrous Oxide WAGD Nitrogen Carbon Dioxide Other
Meets
NFPA 99:
Meets NFPA 99: Yes Meets
NFPA 99: Yes Meets NFPA 99: Yes Meets
NFPA 99:
51 50 20 Meets
NFPA 99:
Meets
NFPA 99:
Meets
NFPA 99:
Area Alarms Alarm ID: 1-2
Area Monitored: Inpatient Ward Rooms 132-137 Location: Adjacent to Nurse Station
Notes: Notes: Notes: Notes:Notes: Notes: Notes: Notes:
40 60 40
Manufacturer: Beacon Medaes Model / Type: Total Alert Infinity Gas Service, Alarm Set Points & Area Alarm Pressure (psi or inHg)
Oxygen Med Air Vacuum Nitrous Oxide WAGD Nitrogen Carbon Dioxide Other
50 50 19
Notes: Notes: Notes: Notes:
Yes Meets NFPA 99: Yes Meets
NFPA 99: Yes Meets
NFPA 99:
Meets
NFPA 99:
Meets
NFPA 99:
Meets
NFPA 99:
Meets
NFPA 99:
Meets
NFPA 99:
Notes: Notes: Notes:Notes:
(psi or inHg) (%)
Meets
NFPA
99:
Station Outlets & Inlets AssayDynamic
PressureFlowStatic Pressure
Odor Test
(LPM)(None or
OD)
(psi or inHg)
V
99.8% Yes
20.9% Yes 133 Inpatient N/A 20 85 18 N/A Yes
132 Inpatient A None 50 100 49
133 Inpatient O None
Room Number:
Tr an si en t Fl ow
Le ak s No t In
U se
La tc h
La tc h
A rt ic ul at in g A ss em bl ie s
50100None
Room Information:
Inpatient
Lo ca tio le t /
In le t
Le ak
FG
I T
C on ne ct io n
Ty pe
Gas Service
O
134 Inpatient None 50 100 49 20.9% Yes 99.8% YesO134 Inpatient None 51 100 50
135 Inpatient None 20 85 18 N/A Yes
134 Inpatient N/A 20 85 18 N/A Yes 135 Inpatient V None 20 85 18 N/A
135 Inpatient N/A 51 100 50 99.8% Yes 135 Inpatient None 50 100 49 20.9% Yes
136 Inpatient None 50 100 49 20.9% Yes
137 Inpatient None 51 100 50 99.8% Yes 136 Inpatient N/A 20 85 18 N/A Yes
137 Inpatient N/A 20 85 18 N/A Yes 137 Inpatient None 50 100 49 20.9% Yes
100 50 133 Inpatient None 50 100 49A
20.9% Yes 132 Inpatient V N/A 20 85 18 N/A Yes
99.8% Yes
A V
V A O
136 Inpatient O None 51 100 50 99.8% Yes A V O A V
D W D W D W D W D W D W D W D W D W D W D W D W D W D W D W D W D W D W D W D W D W D W D W D W D W D W D W D W111 Inpatient V N/A 20 85 18 N/A Yes
111 Inpatient A None 50 100 49 20.9% Yes 111 Inpatient O None 51 100 50 99.8% Yes 109 Inpatient V N/A 20 85 18 N/A Yes 109 Inpatient A None 50 100 49 20.9% Yes 109 Inpatient O None 51 100 50 99.8% Yes
99.8% Yes
A V
V A O
107 Inpatient O None 51 100 50 99.8% Yes A V O A V
20.9% Yes 101 Inpatient Bed 1 V N/A 20 85 18 N/A Yes
100 50 103 Inpatient None 50 100 49A
107 Inpatient N/A 20 85 18 N/A Yes
108 Inpatient N/A 20 85 18 N/A Yes 108 Inpatient None 50 100 49 20.9% Yes
107 Inpatient None 50 100 49 20.9% Yes
108 Inpatient None 51 100 50 99.8% Yes
106 Inpatient N/A 51 100 50 99.8% Yes 106 Inpatient None 50 100 49 20.9% Yes 106 Inpatient None 20 85 18 N/A Yes
104 Inpatient N/A 20 85 18 N/A Yes 105 Inpatient V None 20 85 18 N/A
104 Inpatient None 50 100 49 20.9% Yes 99.8% YesO104 Inpatient None 51 100 50
Room Number:
Tr an si en t Fl ow
Le ak s No t In
U se
La tc h
La tc h
A rt ic ul at in g A ss em bl ie s
50100None
Room Information:
Inpatient Bed 1
Lo ca tio le t /
In le t
Le ak
FG
I T
C on ne ct io n
Ty pe
Gas Service
O
V
99.8% Yes
20.9% Yes 103 Inpatient N/A 20 85 18 N/A Yes
101 Inpatient Bed 1 A None 50 100 49
103 Inpatient O None
Notes: Notes: Notes:Notes:
(psi or inHg) (%)
Meets
NFPA
99:
Station Outlets & Inlets AssayDynamic
PressureFlowStatic Pressure
Odor Test
(LPM)(None or
OD)
(psi or inHg)
Notes: Notes: Notes: Notes:
Yes Meets NFPA 99: Yes Meets
NFPA 99: Yes Meets
NFPA 99:
Meets
NFPA 99:
Meets
NFPA 99:
Meets
NFPA 99:
Meets
NFPA 99:
Meets
NFPA 99:
50 50 19 40 60 40
Manufacturer: Beacon Medaes Model / Type: Total Alert Infinity Gas Service, Alarm Set Points & Area Alarm Pressure (psi or inHg)
Oxygen Med Air Vacuum Nitrous Oxide WAGD Nitrogen Carbon Dioxide Other
Area Alarms Alarm ID: 1-2
Area Monitored: Inpatient Ward Rooms 101 - 114 & 143 Location: Fall Nurses Station
Notes: Notes: Notes: Notes:Notes: Notes: Notes: Notes:
Meets
NFPA 99:
Meets NFPA 99: Yes Meets
NFPA 99: Yes Meets NFPA 99: Yes Meets
NFPA 99:
51 50 20 Meets
NFPA 99:
Meets
NFPA 99:
Meets
NFPA 99:
Gas Service & Zone Valve Gauge Pressure (psi or inHg) Oxygen Med Air Vacuum Nitrous Oxide WAGD Nitrogen Carbon Dioxide Other
Zone Valves Zone ID: 1-2
Area of Control: Inpatient Ward Rooms 101 - 114 & 143 Location: Adjacent to Room 101
Medical Gas Zone Inspection & Performance Verification
9/24/25Date:Inpatient Fall Ward Department:1Floor:31Building:Location: White River Junction VA
Yes 105 Inpatient A None 50 100 49 20.9% Yes 105 Inpatient O N/A 51 100 50 99.8% Yes
101 Inpatient Bed 2 O None 51 100 50 99.8% Yes 101 Inpatient Bed 2 A None 50 100 49 20.9% Yes 101 Inpatient Bed 2 V N/A 20 85 18 N/A Yes
Room Number:
Tr an si en t Fl ow
Le ak s No t In
U se
La tc h
La tc h
A rt ic ul at in g A ss em bl ie s
Room Information:
Lo ca tio le t /
In le t
Le ak
FG
I T
C on ne ct io n
Ty pe
Gas Service (psi or inHg) (%)
Meets
NFPA
99:
Station Outlets & Inlets AssayDynamic
PressureFlowStatic Pressure
Odor Test
(LPM)(None or
OD)
(psi or inHg)
D W D W D W D W D W D W D W D W D W D W D W D W D W D W D W D W D W D W D W D W D W D W
Note 1
Note 2
112 Inpatient Bed 1 V N/A 20 85 18 N/A Yes 112 Inpatient Bed 1 A None 50 100 49 20.9% Yes 112 Inpatient Bed 1 O None 51 100 50 99.8% Yes
O A
143 Inpatient Bed 1 N/A 20 85 18 N/A YesV 143 Inpatient Bed 1 None 50 100 49 20.9% YesA 143 Inpatient Bed 1 None 51 100 50 99.8% YesO
114 Inpatient None 51 100 50 99.8% YesO 114 Inpatient None 50 100 49 20.9% YesA 114 Inpatient None 51 100 50 99.8% YesO
113 Inpatient Bed 1 N/A 20 85 18 N/A YesV 113 Inpatient Bed 1 None 50 100 49 20.9% Yes 113 Inpatient Bed 1 None 51 100 50 99.8% Yes
Symbol Key: N/T = Not Tested, N/A = Not Applicable, N/V = Not Verified, Y = Yes, N = No, W = Wall, B = Boom/Column, C = Ceiling, P = Pedestal, O = Other, D = DISS, Q = Quick Connect, C = Chemetron, G = Geo
Findings:
General Notes:
These outlets were checked for proper static pressure, performance, and/or concentration levels only.
112 Inpatient Bed 2 O None 51 100 50 99.8% Yes 112 Inpatient Bed 2 A None 50 100 49 20.9% Yes 112 Inpatient Bed 2 V N/A 20 85 18 N/A Yes
113 Inpatient Bed 2 O None 51 100 50 99.8% Yes 113 Inpatient Bed 2 A None 50 100 49 20.9% Yes 113 Inpatient Bed 2 V N/A 20 85 18 N/A Yes
114 Inpatient A None 50 100 49 20.9% Yes
143 Inpatient Bed 2 O None 51 100 50 99.8% Yes 143 Inpatient Bed 2 A None 50 100 49 20.9% Yes 143 Inpatient Bed 2 V N/A 20 85 18 N/A Yes
D W D W D W D W D W D W D W D W D W D W D W D W D W D W D W D W D W D W D W D W D W D W
Note 1
Note 2
Symbol Key: N/T = Not Tested, N/A = Not Applicable, N/V = Not Verified, Y = Yes, N = No, W = Wall, B = Boom/Column, C = Ceiling, P = Pedestal, O = Other, D = DISS, Q = Quick Connect, C = Chemetron, G = Geo
Findings:
General Notes:
These outlets were checked for proper static pressure, performance, and/or concentration levels only.
Zone Valves Zone ID: G-1
Area of Control: Inpatient Ward Rooms G71, 78, 83, 84, 85, 86 Location: Across from G-72 Reception B
Medical Gas Zone Inspection & Performance Verification
4/30/24Date:Inpatient Ward Department:G Floor:31Building:Location: White River Junction VA
Gas Service & Zone Valve Gauge Pressure (psi or inHg) Oxygen Med Air Vacuum Nitrous Oxide WAGD Nitrogen Carbon Dioxide Other
Meets
NFPA 99:
Meets NFPA 99: Yes Meets
NFPA 99: Yes Meets NFPA 99: Yes Meets
NFPA 99:
50 50 19 Meets
NFPA 99:
Meets
NFPA 99:
Meets
NFPA 99:
Area Alarms Alarm ID: G-1
Area Monitored: Inpatient Ward Rooms G71, 78, 83, 84, 85, 86 Location: Nurse Station Inpatient Ward
Notes: Notes: Notes: Notes:Notes: Notes: Notes: Notes:
40 60 40
Manufacturer: BeaconMedaes Model / Type: TotalAlert Infinity Gas Service, Alarm Set Points & Area Alarm Pressure (psi or inHg)
Oxygen Med Air Vacuum Nitrous Oxide WAGD Nitrogen Carbon Dioxide Other
50 50 19
Notes: Notes: Notes: Notes:
Yes Meets NFPA 99: Yes Meets
NFPA 99: Yes Meets
NFPA 99:
Meets
NFPA 99:
Meets
NFPA 99:
Meets
NFPA 99:
Meets
NFPA 99:
Meets
NFPA 99:
Notes: Notes: Notes:Notes:
(psi or inHg) (%)
Meets
NFPA
99:
Station Outlets & Inlets AssayDynamic
PressureFlowStatic Pressure
Odor Test
(LPM)(None or
OD)
(psi or inHg)
V
99.8% Yes
20.9% Yes G-78 Patient Isolation N/A 19 85 16 N/A Yes
G-71 Patient Isolation A None 50 100 48
G-78 Patient Isolation O None
Room Number:
G-71
Tr an si en t Fl ow
Le ak s No t In
U se
La tc h
A rt ic ul at in g A ss em bl ie s
49100None
Room Information:
Patient Isolation
Lo ca tio le t /
In le t
Le ak
La be l
C on ne ct io n
Ty pe
Gas Service
O
G-83 Patient Room None 50 100 48 20.9% Yes 99.8% YesOG-83 Patient Room None 50 100 49
G-83 Patient Room None 50 100 49 99.8% Yes G-83 Patient Room N/A 19 85 16 N/A Yes
G-83 Patient Room None
19 85 16 N/A Yes G-83 Patient Room 50 100 48 20.9% Yes
N/A
G-83 Patient Room None 50 100 48 20.9% Yes
G-84 Patient Room None 50 100 49 99.8% Yes G-83 Patient Room N/A 19 85 16 N/A Yes
G-84 Patient Room N/A 19 85 16 N/A Yes G-84 Patient Room None 50 100 48 20.9% Yes
G-84 Patient Room None 50 100 48 20.9% Yes G-84 Patient Room None 50 100 49 99.8% Yes
G-84 Patient Room N/A 19 85 16 N/A YesV G-84 Patient Room None 50 100 49 99.8% YesO G-84 Patient Room None 50 100 48 20.9% YesA G-84 Patient Room N/A 19 85 16 N/A YesV
100 49 G-78 Patient Isolation None 50 100 48A
20.9% Yes G-71 Patient Isolation V N/A 19 85 16 N/A Yes
99.8% Yes
A V O A V
G-83 Patient Room O None 50 100 49 99.8% Yes A V O A V O A
D W D W D W D W D W D W D W D W D W D W D W D W D W D W D W D W
Note 1
Note 2
G-85 Patient Room A None 50 100 48 20.9% Yes G-85 Patient Room O None 50 100 49 99.8% Yes G-85 Patient Room V N/A 19 85 16 N/A Yes G-85 Patient Room A None 50 100 48 20.9% Yes G-85 Patient Room O None 50 100 49 99.8% Yes
Medical Gas Zone Inspection & Performance Verification
Location: White River Junction VA Building: 31 Floor: G Department: Inpatient Ward Date: 4/30/24
Zone Valves Zone ID: G-1
Area of Control: Inpatient Ward Rooms G71, 78, 83, 84, 85, 86 Location: Across from G-72 Reception B
Gas Service & Zone Valve Gauge Pressure (psi or inHg) Oxygen Med Air Vacuum Nitrous Oxide WAGD Nitrogen Carbon Dioxide Other
Meets
NFPA 99:
Meets NFPA 99: Yes Meets
NFPA 99: Yes Meets NFPA 99: Yes Meets
NFPA 99:
50 50 19 Meets
NFPA 99:
Meets
NFPA 99:
Meets
NFPA 99:
Notes:
Area Alarms Alarm ID: G-1
Area Monitored: Inpatient Ward Rooms G71, 78, 83, 84, 85, 86 Location: Nurse Station Inpatient Ward
Notes: Notes: Notes:Notes: Notes: Notes: Notes:
Manufacturer: BeaconMedaes Model / Type: TotalAlert Infinity Gas Service, Alarm Set Points & Area Alarm Pressure (psi or inHg)
Oxygen Med Air Vacuum Nitrous Oxide WAGD Nitrogen Carbon Dioxide Other 60 40 60 40 12
50 50 19 Meets
NFPA 99:
Meets
NFPA 99:
Notes: Notes: Notes:
Meets
NFPA 99:
Meets
NFPA 99:
Meets
NFPA 99:
Meets NFPA 99: Yes Meets
NFPA 99: Yes Meets NFPA 99: Yes
Notes: Notes:
Station Outlets & Inlets Notes: Notes: Notes:
Static Pressure Flow Dynamic
Pressure Assay Meets
NFPA
99:(psi or inHg) (LPM) (psi or inHg) (%)
G-85 Patient Room V N/A 19 85 16 N/A Yes
La tc h
La be l
Le ak
Le ak s
No t
In U se Tr an si en t
Fl ow
Odor Test
(None or
OD)
Room Number: Room Information: Gas
Service
C on ne ct io n
Ty pe
Lo ca tio le t /
In le t
A rt ic ul at in g A ss em bl ie s
49 99.8% Yes G-85 Patient Room A None 50 100 48 G-85 Patient Room O None 50 100
20.9% Yes G-85 Patient Room V N/A 19 85 16 N/A Yes G-86 Patient Room O None 50 100 49 99.8% Yes
48 20.9% Yes G-86 Patient Room V N/A 19 85 16 G-86 Patient Room A None 50 100
N/A Yes G-86 Patient Room O None 50 100 49 99.8% Yes G-86 Patient Room A None 50 100 48 20.9% Yes
16 N/A Yes G-86 Patient Room O None 50 100 49 G-86 Patient Room V N/A 19 85
99.8% Yes G-86 Patient Room A None 50 100 48 20.9% Yes G-86 Patient Room V N/A 19 85 16 N/A Yes
Symbol Key: N/T = Not Tested, N/A = Not Applicable, N/V = Not Verified, Y = Yes, N = No, W = Wall, B = Boom/Column, C = Ceiling, P = Pedestal, O = Other, D = DISS, Q = Quick Connect, C = Chemetron, G = Geo
Findings:
General Notes:
These outlets were checked for proper static pressure, performance, and/or concentration levels only.
File details come from the government source that posted it. Updated .