Attachment 0005B_Med Gas Annual Inspection 2024.pdf

PREPARED BY: BRAYDEN SEGER

JULY 15TH-18TH, 2024

BIRMINGHAM VAMC

MEDICAL GAS

ANNUAL

INSPECTION

700 19TH STREET SOUTH

BIRMINGHAM, AL 35233

ITEMS TESTED/INSPECTED

OXYGEN MEDICAL AIR

MEDICAL

VACUUM

NITROUS

OXIDE

NITROGEN

CARBON

DIOXIDE

COMP AIR WAGD

SOURCE EQUIPMENT P P P P P

MASTER ALARMS P P P P P

ZONE VALVES P P P P P P P

ZONE VERIFICATION P P P P P P P

CROSS CONNECTION P P P P P P P

AREA ALARMS P P P P P

PATIENT OUTLETS P P P P P P P

PARTICLE ANALYSIS P P P P

PURITY ANALYSIS P P P P

MGI MEDICAL GAS VERIFIER: BRAYDEN SEGER

SIGNATURE:

DATE: 7/15/2024

MEDICAL GAS ANNUAL TESTING ANALYSIS

MEDICAL GAS TYPE

SCOPE OF

TESTING/VERIFICATION

NFPA 99 2024 Compliant Medical Gas Annual Inspection for a Category 1 Medical Facility. Includes testing of all medical gas source equipment, medical gas zone valves, medical gas master alarm panels, medical gas area alarm panels, medical gas control panels, medical gas flexible terminals and medical gas terminals and medical gas labeling.

ADDITIONAL COMMENTS

EXECUTIVE SUMMARY

SIGNALS

PASSED

SIGNALS

FAILED

EXECUTIVE OVERALL SUMMARY-SOURCE

SOURCE EQUIPMENT

GAS TYPE SOURCE TYPE TOTAL COUNT TOTAL PASSED TOTAL FAILED

MEDICAL AIR RECIPROCATING 1 1 0

OXYGEN BULK OXYGEN 1 1 0

CLAWVACUUM 1 1 0

NITROUS OXIDE GAS X GAS MANIFOLD 1 0 1

NITROGEN GAS X GAS MANIFOLD 1 0 1

2 2 0

SOURCE EQUIPMENT MASTER ALARMS

EQUIPMENT

EQUIPMENT MAKE &

MODEL

ALARM PANEL

COUNT

ALARM SIGNAL

COUNT

TOTAL 7 5 2

MASTER ALARM PANEL ALARMS

MASTER ALARM PANEL AMICO ALERT 1 20 20 0

MASTER ALARM PANEL AMICO ALERT 1 20 20

TOTALS 2 40 40 0

PASSED FAILED PASSED FAILED

PATIENT OUTLET TERMINALS

EXECUTIVE OVERALL SUMMARY-PIPELINE

ZONE VALVES AREA ALARMS

TOTAL VALVES TOTAL ALARMS

66 65 1 42 42 0

MISSING VALVES MISSING ALARMS

0 0

OXYGEN 378 369 9 0

GAS TYPE TOTAL COUNT TOTAL PASSED TOTAL FAILED TOTAL UNAVALIBLE

MEDICAL AIR 255 250 5 0

VACUUM 423 411 12 0

NITROGEN 25 25 0 0

NITROUS OXIDE 21 21 0 0

WAGD 22 22 0 0

PERCENTAGE 97.7% 2.3% 0.0%

TOTAL 1152 1126 26 0

TOTAL PERCENTAGE OF

OUTLETS TESTED

100.0%

TOTAL OUTLET

FAILURES

TOTAL OUTLETS

REPAIRED

26 0

COMPRESSED AIR 28 28 0 0

MGI TECHNICIAN: BRAYDEN SEGER

1 SPECIFIC OUTLET REPAIRED BY REPAIR DATE

RIGHT VACUUM

2 SPECIFIC OUTLET REPAIRED BY REPAIR DATE

MEDICAL AIR

3 SPECIFIC OUTLET REPAIRED BY REPAIR DATE

RIGHT OXYGEN

4 SPECIFIC OUTLET REPAIRED BY REPAIR DATE

OXYGEN

5 SPECIFIC OUTLET REPAIRED BY REPAIR DATE

OXYGEN

6 SPECIFIC OUTLET REPAIRED BY REPAIR DATE

RIGHT SIDE RIGHT OXYGEN

7 SPECIFIC OUTLET REPAIRED BY REPAIR DATE

LEFT SIDE MEDICAL AIR

8 SPECIFIC OUTLET REPAIRED BY REPAIR DATE

LEFT SIDE BOTTOM RIGHT VACUUM

9 SPECIFIC OUTLET REPAIRED BY REPAIR DATE

LEFT SIDE BOTTOM LEFT VACUUM

10 SPECIFIC OUTLET REPAIRED BY REPAIR DATE

RIGHT SIDE RIGHT OXYGEN

11 SPECIFIC OUTLET REPAIRED BY REPAIR DATE

RIGHT SIDE BOTTOM LEFT VACUUM

12 SPECIFIC OUTLET REPAIRED BY REPAIR DATE

RIGHT SIDE BOTTOM RIGHT VACUUM

13 SPECIFIC OUTLET REPAIRED BY REPAIR DATE

RIGHT SIDE LEFT OXYGEN

14 SPECIFIC OUTLET REPAIRED BY REPAIR DATE

LEFT SIDE MEDICAL AIR

15 SPECIFIC OUTLET REPAIRED BY REPAIR DATE

LEFT SIDE BOTTOM RIGHT VACUUM

16 SPECIFIC OUTLET REPAIRED BY REPAIR DATE

RIGHT SIDE BOTTOM LEFT VACUUM

17 SPECIFIC OUTLET REPAIRED BY REPAIR DATE

RIGHT SIDE BOTTOM LEFT VACUUM

18 SPECIFIC OUTLET REPAIRED BY REPAIR DATE

LEFT SIDE BOTTOM RIGHT VACUUM

19 SPECIFIC OUTLET REPAIRED BY REPAIR DATE

LEFT SIDE LEFT OXYGEN

20 SPECIFIC OUTLET REPAIRED BY REPAIR DATE

OXYGEN

21 SPECIFIC OUTLET REPAIRED BY REPAIR DATE

2ND VACUUM

22 SPECIFIC OUTLET REPAIRED BY REPAIR DATE

1ST MEDICAL AIR

23 SPECIFIC OUTLET REPAIRED BY REPAIR DATE

2ND VACUUM

24 SPECIFIC OUTLET REPAIRED BY REPAIR DATE

LEFT OXYGEN

25 SPECIFIC OUTLET REPAIRED BY REPAIR DATE

3RD VACUUM

26 SPECIFIC OUTLET REPAIRED BY REPAIR DATE

2ND MEDICAL AIR

ROOM OUTLET SPECS ISSUE

6455 BEACON - DC - CH OUTLET DAMAGED

ROOM OUTLET SPECS ISSUE

6454 BEACON - DC - CH OUTLET DAMAGED

ROOM OUTLET SPECS ISSUE

6454 BEACON - DC - CH LEAKS W/ ADAPTER INSERTED

ROOM OUTLET SPECS ISSUE

6449 BEACON - DC - CH OUTLET DAMAGED

ROOM OUTLET SPECS ISSUE

6449 BEACON - DC - CH OUTLET DAMAGED

4111 ALLIED - 500 - CH LEAKS W/ ADAPTER INSERTED

ROOM OUTLET SPECS

ROOM OUTLET SPECS ISSUE

4336 BED C BEACON - DC - CH OUTLET DAMAGED

ROOM OUTLET SPECS ISSUE

4336 BED B BEACON - DC - CH OUTLET DAMAGED

ISSUE

4206 ALLIED - 500 - CH LEAKS W/ AND W/OUT ADAPTER INSERTED

ROOM OUTLET SPECS ISSUE

ROOM OUTLET SPECS ISSUE

4110 ALLIED - 500 - CH OUTLET DAMAGED

ROOM OUTLET SPECS ISSUE

OUTLET ISSUES BIRMINGHAM VAMC

ROOM OUTLET SPECS ISSUE

3106 PROCEDURE 6

WALL

ALLIED - 500 - CH LEAKS W/OUT ADAPTER INSERTED

4207 ALLIED - 500 - CH LEAKS W/ AND W/OUT ADAPTER INSERTED

ROOM OUTLET SPECS ISSUE

4329 BEACON - DC - CH OUTLET DAMAGED

ROOM OUTLET SPECS ISSUE

4333 BEACON - DC - CH OUTLET DAMAGED

ROOM OUTLET SPECS ISSUE

4333 BEACON - DC - CH OUTLET DAMAGED

ROOM OUTLET SPECS ISSUE

4334 BEACON - DC - CH OUTLET DAMAGED

ROOM OUTLET SPECS ISSUE

4334 BEACON - DC - CH OUTLET DAMAGED

ROOM OUTLET SPECS ISSUE

6447 BEACON - DC - CH OUTLET DAMAGED

ROOM OUTLET SPECS

END OF OUTLET ISSUES

4334 BEACON - DC - CH OUTLET DAMAGED

ROOM OUTLET SPECS ISSUE

ROOM OUTLET SPECS ISSUE

4336 BED B BEACON - DC - CH OUTLET DAMAGED

ROOM OUTLET SPECS ISSUE

4336 BED B BEACON - DC - CH OUTLET DAMAGED

ISSUE

4336 BED D BEACON - DC - CH OUTLET DAMAGED

ROOM OUTLET SPECS ISSUE

ISSUE

4336 BED D BEACON - DC - CH

ROOM OUTLET SPECS

LEAKS W/OUT ADAPTER INSERTED

ROOM OUTLET SPECS

ISSUE

STORAGE 6317 ALLIED - 500 - CH LEAKS W/ AND W/OUT ADAPTER INSERTED

ROOM OUTLET SPECS ISSUE

4336 BED A BEACON - DC - CH OUTLET DAMAGED

4334 BEACON - DC - CH OUTLET DAMAGED

BIRMINGHAM VAMC

CORRECTED

CORRECTED

CORRECTED

NOTE: CORRECTIVE ACTIONS ARE COMPONENTS OF THE MEDICAL GAS SYSTEM THAT DO NOT MEET THE NFPA 99 2024 CODE AND SHOULD BE UPGRADED OR REPAIRED TO MEET THE

NFPA 99 2024 CODE.

4435 OR-1

THE MEDICAL AIR ZONE VALVE GAUGE READING

DOES NOT FALL IN THE MIDDLE THIRD OF THE

GAUGE.

The scale range of positive pressure analog indicators shall be such that the normal operating pressure is within the middle third of the total range.

(NFPA 99 2024 5.1.8.1.3)

CORRECTIVE

ACTION

INSTALL A 0-100 PSI GAUGE.

CORRECTIVE

ACTION

UPDATE THE LABELS ON THE AREA ALARMS. SEE INDIVIDUAL AREA ALARM PAGES FOR SPECIFIC AREA ALARMS THAT NEED UPDATED.

AREA ISSUE

CORRECTIVE ACTIONS

AREA ISSUE NFPA 99 2024 CODE

ZONE VALVES

MULTIPLE ZONE VALVES NEED LABELING UPDATED

TO REFLECT THE ROOMS THE SERVE.

Zone valves shall be labeled in accordance with

5.1.11.2. (NFPA 99 2024 5.1.4.1.3)

CORRECTIVE

ACTION

UPDATE THE LABELS ON THE ZONE VALVES. SEE INDIVIDUAL ZONE VALVE PAGES FOR SPECIFIC ZONE VALVES THAT NEED UPDATED.

NFPA 99 2024 CODE

AREA ISSUE NFPA 99 2024 CODE

AREA ALARMS

MULTIPLE AREA ALARMS NEED LABELING UPDATED

TO REFLECT THE ROOMS THEY MONITOR.

Area alarm systems used for medical gas and vacuum systems shall include the following:

(NFPA 99 2024 5.1.9.1)

(7) Labeling of each alarm panel for its area of surveillance.

NOTE: THESE ARE COMPONENTS OF THE MEDICAL GAS SYSTEM THAT DO NOT MEET THE 2024 NFPA 99 CODE, HOWEVER THEY ARE PERMITTED TO

REMAIN IN USE UNTIL THE AREA(S) ARE UPGRADED OR RENOVATED DUE TO THE ABOVE NOT AFFECTING PATIENT CARE.

END OF FUTURE CORRECTIONS

INSTALL MECHANICAL VENTILATION TO GET THE APPROPRIATE AIR FLOW.

FUTURE CORRECTIONS

AREA ISSUE NFPA 99 2024 CODE

NITROUS OXIDE / NITROGEN MANIFOLD

ROOM

THERE IS NO VENTILATION TO CIRCULATE AIR FLOW.

Indoor storage or manifold areas and storage or manifold buildings for medical gases and cryogenic fluids shall be provided with natural ventilation or mechanical exhaust ventilation in accordance with

9.3.6.5.1 through 9.3.6.8.

(NFPA 99 2024 9.3.6.5)

FUTURE

CORRECTION

MEDICAL GAS MASTER

ALARM ANALYSIS

MASTER ALARM CODE REQUIREMENTS

Master alarm panels for medical gas and vacuum systems shall each include the following signals: (NFPA

99 2024 5.1.9.2.4)

(1) Alarm indication when, or just before, changeover occurs in a medical gas system that is supplied by a manifold or other alternating-type bulk system that has as a part of its normal operation a changeover from one portion of the operating supply to another.

(2) Alarm indication for a bulk cryogenic liquid system when the main supply reaches an average day’s supply, indicating low contents.

(3) Alarm indication when, or just before, the changeover to the reserve supply occurs in a medical gas system that consists of one or more units that continuously supply the piping system while another unit remains as the reserve supply and operates only in the case of an emergency.

(4) Alarm indication for cylinder reserve pressure low when the content of a cylinder reserve header is reduced below one average day’s supply.

(5) For bulk cryogenic liquid systems, an alarm when or at a predetermined set point before the reserve supply contents fall to one day’s average supply, indicating reserve low.

(6) Where a cryogenic liquid storage unit is used as a reserve for a bulk supply system, an alarm indication when the gas pressure available in the reserve unit is below that required for the medical gas system to function.

(7) Alarm indication when the pressure in the main line of each separate medical gas system increases 20 percent or decreases 20 percent from the normal operating pressure.

(8) Alarm indication when the medical–surgical vacuum pressure in the main line of each vacuum system drops.

(9) Alarm indication(s) from the local alarm panel(s) as described in 5.1.9.5.2 to indicate when one or more of the conditions being monitored at a site is in alarm.

(10) Medical air dew point high alarm from each compressor site to indicate when the line pressure dew point is greated than +2°C (+35°F)

(11) WAGD low alarm when the WAGD vacuum level or flow is below effective operating limits.

(12) An instrument air dew point high alarm from each compressor site to indicate when the line pressure dew point is greater than −30°C (−22°F).

(13) Alarm indication if the primary or reserve production stops on a proportioning system.

BIRMINGHAM VAMC MGI TECHNICIAN: BRAYDEN SEGER

BIRMINGHAM, AL 35233 TESTING DATE: 7/15/2024

VISUAL

STATUS

AUDIBLE

STATUS

LABELED

CORRECTLY

COMMENTS

P P P

P P P

P P P

P P P

P P P

P P P

P P P

P P P

P P P

P P P

P P P

P P P

P P P

P P P

P P P

P P P

P P P

P P P

P P P

P P P

ALARM MAKE AND MODEL: CALL CENTER

COMMENTS

MEDICAL AIR COMP. HIGH TEMP. SHUTDOWN PASS

OXYGEN LINE PRESSURE HIGH PASS

OXYGEN LINE PRESSURE LOW PASS

MEDICAL AIR LAG COMPRESSOR IN USE PASS

OXYGEN SECONDARY LIQUID SUPPLY IN USE PASS

OXYGEN SECONDARY LIQUID LEVEL LOW PASS

OXYGEN SECONDARY LIQUID LOW HEAD PRESSURE PASS

MASTER ALARM ANALYSIS

MASTER ALARM SIGNALS PASS/FAIL

OXYGEN PRIMARY LIQUID LEVEL LOW PASS

MEDICAL AIR HIGH DEW POINT PASS

MEDICAL AIR CO HIGH PASS

MEDICAL AIR LINE PRESSURE HIGH PASS

MEDICAL AIR LINE PRESSURE LOW PASS

NITROGEN LINE PRESSURE LOW PASS

NITROGEN RESERVE IN USE PASS

NITROGEN LINE PRESSURE HIGH PASS

NITROUS OXIDE RESERVE IN USE PASS

MEDICAL VACUUM PUMPS MAINT. REQUIRED PASS

MEDICAL VACUUM LINE PRESSURE LOW PASS

NITROUS OXIDE LINE PRESSURE HIGH PASS

NITROUS OXIDE LINE PRESSURE LOW PASS

AMICO ALERT LOCATION:

PER NFPA 99 2024 WHERE IS THE MASTER ALARM LOCATED OF THE FOLLOWING LOCATIONS LOCATION

(1) One master alarm panel shall be located in the office or work space of the on-site individual responsible for the maintenance of the medical gas and vacuum piping systems.

(2) In order to ensure continuous surveillance of the medical gas and vacuum systems while the facility is in operation, the second master alarm panel shall be located in an area of continuous observation (e.g., the telephone switchboard, security office, or other continuously staffed location).

PASS/FAIL

PASS

BIRMINGHAM VAMC MGI TECHNICIAN: BRAYDEN SEGER

BIRMINGHAM, AL 35233 TESTING DATE: 7/15/2024

VISUAL

STATUS

AUDIBLE

STATUS

LABELED

CORRECTLY

COMMENTS

P P P

P P P

P P P

P P P

P P P

P P P

P P P

P P P

P P P

P P P

P P P

P P P

P P P

P P P

P P P

P P P

P P P

P P P

P P P

P P P

ALARM MAKE AND MODEL: EMERGENCY DEPARTMENT

COMMENTSPER NFPA 99 2024 WHERE IS THE MASTER ALARM LOCATED OF THE FOLLOWING LOCATIONS LOCATION

(1) One master alarm panel shall be located in the office or work space of the on-site individual responsible for the maintenance of the medical gas and vacuum piping systems.

(2) In order to ensure continuous surveillance of the medical gas and vacuum systems while the facility is in operation, the second master alarm panel shall be located in an area of continuous observation (e.g., the telephone switchboard, security office, or other continuously staffed location).

PASS/FAIL

PASS

AMICO ALERT LOCATION:

NITROUS OXIDE RESERVE IN USE PASS

NITROUS OXIDE LINE PRESSURE HIGH PASS

NITROUS OXIDE LINE PRESSURE LOW PASS

NITROGEN RESERVE IN USE PASS

NITROGEN LINE PRESSURE HIGH PASS

NITROGEN LINE PRESSURE LOW PASS

MEDICAL AIR LINE PRESSURE LOW PASS

MEDICAL VACUUM PUMPS MAINT. REQUIRED PASS

MEDICAL VACUUM LINE PRESSURE LOW PASS

MEDICAL AIR HIGH DEW POINT PASS

MEDICAL AIR CO HIGH PASS

MEDICAL AIR LINE PRESSURE HIGH PASS

OXYGEN LINE PRESSURE LOW PASS

MEDICAL AIR LAG COMPRESSOR IN USE PASS

MEDICAL AIR COMP. HIGH TEMP. SHUTDOWN PASS

OXYGEN SECONDARY LIQUID LEVEL LOW PASS

OXYGEN SECONDARY LIQUID LOW HEAD PRESSURE PASS

OXYGEN LINE PRESSURE HIGH PASS

OXYGEN SECONDARY LIQUID SUPPLY IN USE PASS

MASTER ALARM ANALYSIS

MASTER ALARM SIGNALS PASS/FAIL

OXYGEN PRIMARY LIQUID LEVEL LOW PASS

MEDICAL GAS AREA

ALARM ANALYSIS

(2) *Critical Care Areas

AREA ALARM CODE REQUIREMENTS

(1) Separate visual indicators for each condition monitored, except as permitted in 5.1.9.5.2 for local alarms that are displayed on master alarm panels.

(2) Visual indicators that remain in alarm until the situation that has caused the alarm is resolved.

(3) Cancelable audible indication of each alarm condition that produces a sound with a minimum level of

80 dBA at 0.92m (3 ft)

(4) Means to visually indicate a lamp or LED failure

Area alarm systems used for medical gas and vacuum systems shall include the following:

(NFPA 99 2024 5.1.9.1)

(2)*Anesthetizing locations where moderate sedation, deep sedation, or general anesthesia is administered shall have the sensors installed either on the source side of any of the individual room zone valve box assemblies or on the patient or use side of each of the individual zone valve box assemblies.

(5) Visual and audible indication that the communication with an alarm-initiating devices is disconnected.

(6) Labeling of each indicator, indication the condition monitored.

(7) Labeling of each alarm panel for its area of surveillance.

(8) Reinitiating of the audible signal if another alarm condition occurs while the audible alarm is silenced.

(9) Power for master, area alarms, sensors, and switches from the life safety branch of the emergency electrical system as described in Chapter 6.

Area Alarms. Area alarm panels shall be provided to monitor all medical gas, medical–surgical vacuum, and piped WAGD systems supplying the following: (NFPA 99 2024 5.1.9.4)

(1) Anesthetizing locations where moderate sedation, deep sedation, or general anesthesia is administered.

Area alarm panels for medical gas systems shall indicate if the pressure in the lines in the area being monitored increases or decreases by 20 percent from the normal line pressure. (NFPA 99 2024 5.1.9.4.2)

Area alarm panels for medical–surgical vacuum systems shall indicate if the vacuum in the area drops to or below 300 mm (12 in.) gauge HgV. (NFPA 99 2024 5.1.9.4.3)

Alarm sensors for area alarms shall be located as follows: (NFPA 99 2024 5.1.9.4.4)

(1)*Critical care areas shall have the alarm sensors installed on the patient or use side of each individual zone valve box assemblies.

GAS MONITORED

PRESSURE

READING

LABELING

CORRECT

HIGH

ALARM

SETPOINT

LOW ALARM

SETPOINT

VISUAL

ALARM

FUNCTION

AUDIBLE

ALARM

FUNCTION

MAINLINE

OR ZONE

SENSOR

PASS FAIL

OXYGEN 53 PSI PASS 60 PSI 40 PSI PASS PASS ZONE P

VACUUM 20" HG PASS N/A 12" HG PASS PASS ZONE P

FLOOR: G ALARM LOCATION:

AREA ALARM ANALYSIS

GROUND FLOOR

OUTSIDE G109R ALARM MAKE AND MODEL: AMICO ALERT

END OF GROUND FLOOR AREA ALARM ANALYSIS

AREA MONITORED: COMMENTS

G109R, G109M, G109N, G109L

GAS MONITORED

PRESSURE

READING

LABELING

CORRECT

HIGH

ALARM

SETPOINT

LOW ALARM

SETPOINT

VISUAL

ALARM

FUNCTION

AUDIBLE

ALARM

FUNCTION

MAINLINE

OR ZONE

SENSOR

PASS FAIL

OXYGEN 54 PSI PASS 60 PSI 40 PSI PASS PASS ZONE P

MED AIR 50 PSI PASS 60 PSI 40 PSI PASS PASS ZONE P

VACUUM 21" HG PASS N/A 12" HG PASS PASS ZONE P

FLOOR: 1ST ALARM LOCATION:

GAS MONITORED

PRESSURE

READING

LABELING

CORRECT

HIGH

ALARM

SETPOINT

LOW ALARM

SETPOINT

VISUAL

ALARM

FUNCTION

AUDIBLE

ALARM

FUNCTION

MAINLINE

OR ZONE

SENSOR

PASS FAIL

OXYGEN 53 PSI PASS 60 PSI 40 PSI PASS PASS ZONE P

MED AIR 47 PSI PASS 60 PSI 40 PSI PASS PASS ZONE P

VACUUM 17" HG PASS N/A 12" HG PASS PASS ZONE P

FLOOR: 1ST ALARM LOCATION:

GAS MONITORED

PRESSURE

READING

LABELING

CORRECT

HIGH

ALARM

SETPOINT

LOW ALARM

SETPOINT

VISUAL

ALARM

FUNCTION

AUDIBLE

ALARM

FUNCTION

MAINLINE

OR ZONE

SENSOR

PASS FAIL

OXYGEN 53 PSI PASS 60 PSI 40 PSI PASS PASS ZONE P

VACUUM 21" HG PASS N/A 12" HG PASS PASS ZONE P

FLOOR: 1ST ALARM LOCATION:

GAS MONITORED

PRESSURE

READING

LABELING

CORRECT

HIGH

ALARM

SETPOINT

LOW ALARM

SETPOINT

VISUAL

ALARM

FUNCTION

AUDIBLE

ALARM

FUNCTION

MAINLINE

OR ZONE

SENSOR

PASS FAIL

OXYGEN 55 PSI PASS 60 PSI 40 PSI PASS PASS ZONE P

MED AIR 47 PSI PASS 60 PSI 40 PSI PASS PASS ZONE P

VACUUM 20" HG PASS N/A 12" HG PASS PASS ZONE P

FLOOR: 1ST ALARM LOCATION:

GAS MONITORED

PRESSURE

READING

LABELING

CORRECT

HIGH

ALARM

SETPOINT

LOW ALARM

SETPOINT

VISUAL

ALARM

FUNCTION

AUDIBLE

ALARM

FUNCTION

MAINLINE

OR ZONE

SENSOR

PASS FAIL

OXYGEN 54 PSI PASS 60 PSI 40 PSI PASS PASS ZONE P

MED AIR 48 PSI PASS 60 PSI 40 PSI PASS PASS ZONE P

VACUUM 19" HG PASS N/A 12" HG PASS PASS ZONE P

FLOOR: 1ST ALARM LOCATION:

GAS MONITORED

PRESSURE

READING

LABELING

CORRECT

HIGH

ALARM

SETPOINT

LOW ALARM

SETPOINT

VISUAL

ALARM

FUNCTION

AUDIBLE

ALARM

FUNCTION

MAINLINE

OR ZONE

SENSOR

PASS FAIL

OXYGEN 54 PSI PASS 60 PSI 40 PSI PASS PASS ZONE P

N2O 48 PSI PASS 60 PSI 40 PSI PASS PASS ZONE P

VACUUM 22" HG PASS N/A 12" HG PASS PASS ZONE P

FLOOR: 1ST ALARM LOCATION:

GAS MONITORED

PRESSURE

READING

LABELING

CORRECT

HIGH

ALARM

SETPOINT

LOW ALARM

SETPOINT

VISUAL

ALARM

FUNCTION

AUDIBLE

ALARM

FUNCTION

MAINLINE

OR ZONE

SENSOR

PASS FAIL

OXYGEN 54 PSI PASS 60 PSI 40 PSI PASS PASS ZONE P

VACUUM 21" HG PASS N/A 12" HG PASS PASS ZONE P

FLOOR: 1ST ALARM LOCATION:

DENTAL CHECK IN ALARM MAKE AND MODEL: AMICO ALERT

AREA MONITORED: COMMENTS

DENTAL ROOMS 1615, 1616,

1620, 1621, 1622, 1623, 1624, 1626, 1627, 1628, 1629

DENTAL CHECK IN ALARM MAKE AND MODEL: AMICO ALERT

DENTAL ROOMS 1610, 1611,

1612, 1613, 1614

NURSES STATION ALARM MAKE AND MODEL: CHEMETRON DIGITAL ALARM 2

AREA MONITORED: COMMENTS

DIALYSIS BAYS 1, 2, 3, 4, 5, 6, 7,

8, 9, 10, EXAM, TREATMENT,

EQUIPMENT REPROCESSING

OUTSIDE DIALYSIS TREATMENT ROOM ALARM MAKE AND MODEL: POWEREX MED TOUCH

AREA MONITORED: COMMENTS

AREA MONITORED: COMMENTS

ACROSS 1435L ALARM MAKE AND MODEL: CHEMETRON DIGITAL ALARM 2

AREA MONITORED: COMMENTS

END OF 1ST FLOOR AREA ALARM ANALYSIS

AREA ALARM ANALYSIS

1ST FLOOR

AREA MONITORED: COMMENTS

ER ROOMS 1435K, 1435L,

1435M, 1435P, 1435O

OLD ER ROOMS 14, 15, 16, 17,

ER NURSES STATION ALARM MAKE AND MODEL: CHEMETRON DIGITAL ALARM 2

AREA MONITORED: COMMENTS

ER ROOM 1435I

ONCOLOGY NURSES STATION ALARM MAKE AND MODEL: AMICO ALERT

ONCOLOGY BAYS 1, 2, 3, 4, 5, 6,

7, 8, 9, 10

AREA ALARM NEEDS

LABELED TO REFLECT

ROOMS SERVED

GAS MONITORED

PRESSURE

READING

LABELING

CORRECT

HIGH

ALARM

SETPOINT

LOW ALARM

SETPOINT

VISUAL

ALARM

FUNCTION

AUDIBLE

ALARM

FUNCTION

MAINLINE

OR ZONE

SENSOR

PASS FAIL

OXYGEN 55 PSI PASS 60 PSI 40 PSI PASS PASS ZONE P

VACUUM 22" HG PASS N/A 12" HG PASS PASS ZONE P

FLOOR: 2ND ALARM LOCATION:

GAS MONITORED

PRESSURE

READING

LABELING

CORRECT

HIGH

ALARM

SETPOINT

LOW ALARM

SETPOINT

VISUAL

ALARM

FUNCTION

AUDIBLE

ALARM

FUNCTION

MAINLINE

OR ZONE

SENSOR

PASS FAIL

OXYGEN 55 PSI PASS 60 PSI 40 PSI PASS PASS ZONE P

VACUUM 19" HG PASS N/A 12" HG PASS PASS ZONE P

FLOOR: 2ND ALARM LOCATION:

GAS MONITORED

PRESSURE

READING

LABELING

CORRECT

HIGH

ALARM

SETPOINT

LOW ALARM

SETPOINT

VISUAL

ALARM

FUNCTION

AUDIBLE

ALARM

FUNCTION

MAINLINE

OR ZONE

SENSOR

PASS FAIL

OXYGEN 56 PSI PASS 60 PSI 40 PSI PASS PASS ZONE P

VACUUM 22" HG PASS N/A 12" HG PASS PASS ZONE P

FLOOR: 2ND ALARM LOCATION:

GAS MONITORED

PRESSURE

READING

LABELING

CORRECT

HIGH

ALARM

SETPOINT

LOW ALARM

SETPOINT

VISUAL

ALARM

FUNCTION

AUDIBLE

ALARM

FUNCTION

MAINLINE

OR ZONE

SENSOR

PASS FAIL

OXYGEN 54 PSI PASS 60 PSI 40 PSI PASS PASS ZONE P

MED AIR N/A PASS 60 PSI 40 PSI PASS PASS ZONE P

VACUUM 18" HG PASS N/A 12" HG PASS PASS ZONE P

FLOOR: 2ND ALARM LOCATION:

GAS MONITORED

PRESSURE

READING

LABELING

CORRECT

HIGH

ALARM

SETPOINT

LOW ALARM

SETPOINT

VISUAL

ALARM

FUNCTION

AUDIBLE

ALARM

FUNCTION

MAINLINE

OR ZONE

SENSOR

PASS FAIL

OXYGEN 56 PSI PASS 60 PSI 40 PSI PASS PASS ZONE P

VACUUM 20" HG PASS N/A 12" HG PASS PASS ZONE P

FLOOR: 2ND ALARM LOCATION:

GAS MONITORED

PRESSURE

READING

LABELING

CORRECT

HIGH

ALARM

SETPOINT

LOW ALARM

SETPOINT

VISUAL

ALARM

FUNCTION

AUDIBLE

ALARM

FUNCTION

MAINLINE

OR ZONE

SENSOR

PASS FAIL

OXYGEN 55 PSI PASS 60 PSI 40 PSI PASS PASS ZONE P

FLOOR: 2ND ALARM LOCATION:

GAS MONITORED

PRESSURE

READING

LABELING

CORRECT

HIGH

ALARM

SETPOINT

LOW ALARM

SETPOINT

VISUAL

ALARM

FUNCTION

AUDIBLE

ALARM

FUNCTION

MAINLINE

OR ZONE

SENSOR

PASS FAIL

OXYGEN 55 PSI PASS 60 PSI 40 PSI PASS PASS ZONE P

VACUUM 19" HG PASS N/A 12" HG PASS PASS ZONE P

FLOOR: 2ND ALARM LOCATION:

GAS MONITORED

PRESSURE

READING

LABELING

CORRECT

HIGH

ALARM

SETPOINT

LOW ALARM

SETPOINT

VISUAL

ALARM

FUNCTION

AUDIBLE

ALARM

FUNCTION

MAINLINE

OR ZONE

SENSOR

PASS FAIL

OXYGEN 53 PSI PASS 60 PSI 40 PSI PASS PASS ZONE P

VACUUM 21" HG PASS N/A 12" HG PASS PASS ZONE P

FLOOR: 2ND ALARM LOCATION:

END OF 2ND FLOOR AREA ALARM ANALYSIS

AREA MONITORED: COMMENTS

2367 X-RAY 6, 2365 X-RAY 4

ALARM MAKE AND MODEL: AMICO

ALARM MAKE AND MODEL: AMICO ALERT

AREA MONITORED: COMMENTS

2603A, 2603B, 2606, 2607, 2608, 2611, 2612, 2613, 2615, 2616, 2617, 2618

AREA ALARM NEEDS

LABELED TO REFLECT

ROOMS SERVED

DENTAL CHECK IN

AREA MONITORED: COMMENTS

OUTSIDE 2343

AREA MONITORED: COMMENTS

NOT IN USE

ACROSS 2345 ALARM MAKE AND MODEL: CHEMETRON MODULAR

AREA MONITORED: COMMENTS

MRI 2115D, 2115

OUTSIDE 2370 ALARM MAKE AND MODEL: AMICO ALERT

INSIDE MRI SUITE ALARM MAKE AND MODEL: AMICO ALERT

AREA MONITORED: COMMENTS

OUTSIDE 2121 ALARM MAKE AND MODEL: AMICO ALERT

ROOM 2121, 2116, MRI

HOLDING

AREA MONITORED: COMMENTS

CT 2123

OUTSIDE 2123 ALARM MAKE AND MODEL: AMICO ALERT

OUTSIDE 2125 ALARM MAKE AND MODEL: AMICO ALERT

AREA ALARM ANALYSIS

2ND FLOOR

AREA MONITORED: COMMENTS

CT/GANTY 2125

GAS MONITORED

PRESSURE

READING

LABELING

CORRECT

HIGH

ALARM

SETPOINT

LOW ALARM

SETPOINT

VISUAL

ALARM

FUNCTION

AUDIBLE

ALARM

FUNCTION

MAINLINE

OR ZONE

SENSOR

PASS FAIL

OXYGEN 54 PSI PASS 60 PSI 40 PSI PASS PASS ZONE P

MED AIR 48 PSI PASS 60 PSI 40 PSI PASS PASS ZONE P

VACUUM 19" HG PASS N/A 12" HG PASS PASS ZONE P

FLOOR: 3RD ALARM LOCATION:

GAS MONITORED

PRESSURE

READING

LABELING

CORRECT

HIGH

ALARM

SETPOINT

LOW ALARM

SETPOINT

VISUAL

ALARM

FUNCTION

AUDIBLE

ALARM

FUNCTION

MAINLINE

OR ZONE

SENSOR

PASS FAIL

OXYGEN 54 PSI PASS 60 PSI 40 PSI PASS PASS ZONE P

MED AIR 48 PSI PASS 60 PSI 40 PSI PASS PASS ZONE P

VACUUM 20" HG PASS N/A 12" HG PASS PASS ZONE P

FLOOR: 3RD ALARM LOCATION:

GAS MONITORED

PRESSURE

READING

LABELING

CORRECT

HIGH

ALARM

SETPOINT

LOW ALARM

SETPOINT

VISUAL

ALARM

FUNCTION

AUDIBLE

ALARM

FUNCTION

MAINLINE

OR ZONE

SENSOR

PASS FAIL

OXYGEN 55 PSI PASS 60 PSI 40 PSI PASS PASS ZONE P

MED AIR 48 PSI PASS 60 PSI 40 PSI PASS PASS ZONE P

VACUUM 21" HG PASS N/A 12" HG PASS PASS ZONE P

FLOOR: 3RD ALARM LOCATION:

GAS MONITORED

PRESSURE

READING

LABELING

CORRECT

HIGH

ALARM

SETPOINT

LOW ALARM

SETPOINT

VISUAL

ALARM

FUNCTION

AUDIBLE

ALARM

FUNCTION

MAINLINE

OR ZONE

SENSOR

PASS FAIL

OXYGEN 54 PSI PASS 60 PSI 40 PSI PASS PASS ZONE P

MED AIR 48 PSI PASS 60 PSI 40 PSI PASS PASS ZONE P

VACUUM 19" HG PASS N/A 12" HG PASS PASS ZONE P

FLOOR: 3RD ALARM LOCATION:

GAS MONITORED

PRESSURE

READING

LABELING

CORRECT

HIGH

ALARM

SETPOINT

LOW ALARM

SETPOINT

VISUAL

ALARM

FUNCTION

AUDIBLE

ALARM

FUNCTION

MAINLINE

OR ZONE

SENSOR

PASS FAIL

OXYGEN 53 PSI PASS 60 PSI 40 PSI PASS PASS ZONE P

MED AIR 48 PSI PASS 60 PSI 40 PSI PASS PASS ZONE P

VACUUM 22" HG PASS N/A 12" HG PASS PASS ZONE P

FLOOR: 3RD ALARM LOCATION:

GAS MONITORED

PRESSURE

READING

LABELING

CORRECT

HIGH

ALARM

SETPOINT

LOW ALARM

SETPOINT

VISUAL

ALARM

FUNCTION

AUDIBLE

ALARM

FUNCTION

MAINLINE

OR ZONE

SENSOR

PASS FAIL

OXYGEN 55 PSI PASS 60 PSI 40 PSI PASS PASS ZONE P

MED AIR 47 PSI PASS 60 PSI 40 PSI PASS PASS ZONE P

VACUUM 19" HG PASS N/A 12" HG PASS PASS ZONE P

FLOOR: 3RD ALARM LOCATION:

AREA MONITORED: COMMENTS

3A WING ROOMS 3106,

3104, 3102, 3101

ACROSS 3102 ALARM MAKE AND MODEL: AMICO ALERT

AREA MONITORED: COMMENTS

3501, 3502, 3503, 3504, 3505, 3506, 3507, 3508, 3509, 3510, 3511, 3512, AMBULATORY NURSES STATION ALARM MAKE AND MODEL: AMICO ALERT

AMBULATORY NURSES STATION ALARM MAKE AND MODEL: AMICO ALERT

AREA MONITORED: COMMENTS

AREA ALARM ANALYSIS

3RD FLOOR

AREA MONITORED: COMMENTS

SPECIAL PROCEDURE 3528

OUTSIDE 3811 ALARM MAKE AND MODEL: AMICO ALERT

AREA MONITORED: COMMENTS

OUTSIDE 3810 ALARM MAKE AND MODEL: AMICO ALERT

AREA MONITORED: COMMENTS

OUTSIDE 3809 ALARM MAKE AND MODEL: AMICO ALERT

AREA ALARM ANALYSIS

3RD FLOOR

GAS MONITORED

PRESSURE

READING

LABELING

CORRECT

HIGH

ALARM

SETPOINT

LOW ALARM

SETPOINT

VISUAL

ALARM

FUNCTION

AUDIBLE

ALARM

FUNCTION

MAINLINE

OR ZONE

SENSOR

PASS FAIL

OXYGEN 54 PSI PASS 60 PSI 40 PSI PASS PASS ZONE P

MED AIR 46 PSI PASS 60 PSI 40 PSI PASS PASS ZONE P

VACUUM 21" HG PASS N/A 12" HG PASS PASS ZONE P

FLOOR: 3RD ALARM LOCATION:

GAS MONITORED

PRESSURE

READING

LABELING

CORRECT

HIGH

ALARM

SETPOINT

LOW ALARM

SETPOINT

VISUAL

ALARM

FUNCTION

AUDIBLE

ALARM

FUNCTION

MAINLINE

OR ZONE

SENSOR

PASS FAIL

OXYGEN 54 PSI PASS 60 PSI 40 PSI PASS PASS ZONE P

MED AIR 48 PSI PASS 60 PSI 40 PSI PASS PASS ZONE P

VACUUM 21" HG PASS N/A 12" HG PASS PASS ZONE P

FLOOR: 3RD ALARM LOCATION:

GAS MONITORED

PRESSURE

READING

LABELING

CORRECT

HIGH

ALARM

SETPOINT

LOW ALARM

SETPOINT

VISUAL

ALARM

FUNCTION

AUDIBLE

ALARM

FUNCTION

MAINLINE

OR ZONE

SENSOR

PASS FAIL

OXYGEN 53 PSI PASS 60 PSI 40 PSI PASS PASS ZONE P

MED AIR 48 PSI PASS 60 PSI 40 PSI PASS PASS ZONE P

VACUUM 19" HG PASS N/A 12" HG PASS PASS ZONE P

FLOOR: 3RD ALARM LOCATION:

GAS MONITORED

PRESSURE

READING

LABELING

CORRECT

HIGH

ALARM

SETPOINT

LOW ALARM

SETPOINT

VISUAL

ALARM

FUNCTION

AUDIBLE

ALARM

FUNCTION

MAINLINE

OR ZONE

SENSOR

PASS FAIL

OXYGEN 53 PSI PASS 60 PSI 40 PSI PASS PASS ZONE P

MED AIR 49 PSI PASS 60 PSI 40 PSI PASS PASS ZONE P

VACUUM 22" HG PASS N/A 12" HG PASS PASS ZONE P

FLOOR: 3RD ALARM LOCATION:

GAS MONITORED

PRESSURE

READING

LABELING

CORRECT

HIGH

ALARM

SETPOINT

LOW ALARM

SETPOINT

VISUAL

ALARM

FUNCTION

AUDIBLE

ALARM

FUNCTION

MAINLINE

OR ZONE

SENSOR

PASS FAIL

OXYGEN 55 PSI PASS 60 PSI 40 PSI PASS PASS ZONE P

MED AIR 50 PSI PASS 60 PSI 40 PSI PASS PASS ZONE P

VACUUM 19" HG PASS N/A 12" HG PASS PASS ZONE P

FLOOR: 3RD ALARM LOCATION:

GAS MONITORED

PRESSURE

READING

LABELING

CORRECT

HIGH

ALARM

SETPOINT

LOW ALARM

SETPOINT

VISUAL

ALARM

FUNCTION

AUDIBLE

ALARM

FUNCTION

MAINLINE

OR ZONE

SENSOR

PASS FAIL

OXYGEN 54 PSI PASS 60 PSI 40 PSI PASS PASS ZONE P

MED AIR 49 PSI PASS 60 PSI 40 PSI PASS PASS ZONE P

VACUUM 21" HG PASS N/A 12" HG PASS PASS ZONE P

FLOOR: 3RD ALARM LOCATION:

END OF 3RD FLOOR AREA ALARM ANALYSIS

OUTSIDE 3808 ALARM MAKE AND MODEL: AMICO ALERT

AREA MONITORED: COMMENTS

3114 PROCEDURE ROOM 1

AREA MONITORED: COMMENTS

3117 PROCEDURE ROOM 2,

3116 SCOPE CLEAN

OUTSIDE 3117 ALARM MAKE AND MODEL:

AREA MONITORED: COMMENTS

OUTSIDE 3114 ALARM MAKE AND MODEL: AMICO ALERT

AMICO ALERT

AREA MONITORED: COMMENTS

3119 PROCEDURE ROOM 3,

3120 SCOPE REPROCESSING

OUTSIDE 3119 ALARM MAKE AND MODEL: AMICO ALERT

AREA MONITORED: COMMENTS

3121 PROCEDURE ROOM 4

OUTSIDE 3121 ALARM MAKE AND MODEL: AMICO ALERT

AREA MONITORED: COMMENTS

3122 PROCEDURE ROOM 5

OUTSIDE 3122 ALARM MAKE AND MODEL: AMICO ALERT

GAS MONITORED

PRESSURE

READING

LABELING

CORRECT

HIGH

ALARM

SETPOINT

LOW ALARM

SETPOINT

VISUAL

ALARM

FUNCTION

AUDIBLE

ALARM

FUNCTION

MAINLINE

OR ZONE

SENSOR

PASS FAIL

OXYGEN 55 PSI PASS 60 PSI 40 PSI PASS PASS ZONE P

MED AIR 48 PSI PASS 60 PSI 40 PSI PASS PASS ZONE P

VACUUM 22" HG PASS N/A 12" HG PASS PASS ZONE P

FLOOR: 4TH ALARM LOCATION:

GAS MONITORED

PRESSURE

READING

LABELING

CORRECT

HIGH

ALARM

SETPOINT

LOW ALARM

SETPOINT

VISUAL

ALARM

FUNCTION

AUDIBLE

ALARM

FUNCTION

MAINLINE

OR ZONE

SENSOR

PASS FAIL

OXYGEN 54 PSI PASS 60 PSI 40 PSI PASS PASS ZONE P

MED AIR 47 PSI PASS 60 PSI 40 PSI PASS PASS ZONE P

VACUUM 20" HG PASS N/A 12" HG PASS PASS ZONE P

FLOOR: 4TH ALARM LOCATION:

GAS MONITORED

PRESSURE

READING

LABELING

CORRECT

HIGH

ALARM

SETPOINT

LOW ALARM

SETPOINT

VISUAL

ALARM

FUNCTION

AUDIBLE

ALARM

FUNCTION

MAINLINE

OR ZONE

SENSOR

PASS FAIL

OXYGEN 52 PSI PASS 60 PSI 40 PSI PASS PASS ZONE P

MED AIR 49 PSI PASS 60 PSI 40 PSI PASS PASS ZONE P

VACUUM 20" HG PASS N/A 12" HG PASS PASS ZONE P

FLOOR: 4TH ALARM LOCATION:

GAS MONITORED

PRESSURE

READING

LABELING

CORRECT

HIGH

ALARM

SETPOINT

LOW ALARM

SETPOINT

VISUAL

ALARM

FUNCTION

AUDIBLE

ALARM

FUNCTION

MAINLINE

OR ZONE

SENSOR

PASS FAIL

OXYGEN 52 PSI PASS 60 PSI 40 PSI PASS PASS ZONE P

MED AIR 48 PSI PASS 60 PSI 40 PSI PASS PASS ZONE P

VACUUM 21" HG PASS N/A 12" HG PASS PASS ZONE P

FLOOR: 4TH ALARM LOCATION:

GAS MONITORED

PRESSURE

READING

LABELING

CORRECT

HIGH

ALARM

SETPOINT

LOW ALARM

SETPOINT

VISUAL

ALARM

FUNCTION

AUDIBLE

ALARM

FUNCTION

MAINLINE

OR ZONE

SENSOR

PASS FAIL

OXYGEN 53 PSI PASS 60 PSI 40 PSI PASS PASS MAINLINE P

MED AIR 48 PSI PASS 60 PSI 40 PSI PASS PASS MAINLINE P

VACUUM 18" HG PASS N/A 12" HG PASS PASS MAINLINE P

N2O 49 PSI PASS 60 PSI 40 PSI PASS PASS MAINLINE P

N2 147 PSI PASS 195 PSI 140 PSI PASS PASS MAINLINE P

FLOOR: 4TH ALARM LOCATION:

PACU NURSES STATION ALARM MAKE AND MODEL: CHEMETRON MODULAR

END OF 4TH FLOOR AREA ALARM ANALYSIS

SICU NURSES STATION ALARM MAKE AND MODEL: AMICO ALERT

AREA MONITORED: COMMENTS

PACU BAYS 1, 2, 3, 4, 5, 6,

ISOLATION

AREA MONITORED: COMMENTS

OR'S 1, 2, 3, 4, 5, 6, 7, 8, 9,

10, 11

ACROSS PRE-OP

ALARM NEEDS LABELED

TO REFLECT ROOMS

SERVED

4B NURSES STATION ALARM MAKE AND MODEL: AMICO ALERT

AREA MONITORED: COMMENTS

ALARM MAKE AND MODEL: AMICO ALERT

AREA ALARM ANALYSIS

4TH FLOOR

AREA MONITORED: COMMENTS

4A WING ROOMS 4102,

4103, 4104, 4110, 4111, 4112, 4113, 4119, 4120, 4121, 4122, 4123, 4124, 4127, 4128

ALARM NEEDS LABELED

TO REFLECT ROOMS

SERVED

SICU ROOMS 4329, 4330,

4331, 4332, 4333, 4334, 4335, 4336

ALARM NEEDS LABELED

TO REFLECT ROOMS

SERVED

4A NURSES STATION ALARM MAKE AND MODEL: CHEMETRON DIGITAL ALARM 2

AREA MONITORED: COMMENTS

4B WING ROOMS 4202,

4203, 4206, 4207, 4208, 4210, 4211, 4217, 4218, 4219, 4220, 4226, 4227, GAS MONITORED

PRESSURE

READING

LABELING

CORRECT

HIGH

ALARM

SETPOINT

LOW ALARM

SETPOINT

VISUAL

ALARM

FUNCTION

AUDIBLE

ALARM

FUNCTION

MAINLINE

OR ZONE

SENSOR

PASS FAIL

OXYGEN 52 PSI PASS 60 PSI 40 PSI PASS PASS ZONE P

MED AIR 48 PSI PASS 60 PSI 40 PSI PASS PASS ZONE P

VACUUM 21" HG PASS N/A 12" HG PASS PASS ZONE P

FLOOR: 5TH ALARM LOCATION:

GAS MONITORED

PRESSURE

READING

LABELING

CORRECT

HIGH

ALARM

SETPOINT

LOW ALARM

SETPOINT

VISUAL

ALARM

FUNCTION

AUDIBLE

ALARM

FUNCTION

MAINLINE

OR ZONE

SENSOR

PASS FAIL

OXYGEN N/A N/A N/A N/A N/A N/A N/A

MED AIR N/A N/A N/A N/A N/A N/A N/A

VACUUM N/A N/A N/A N/A N/A N/A N/A

FLOOR: N/A ALARM LOCATION:

GAS MONITORED

PRESSURE

READING

LABELING

CORRECT

HIGH

ALARM

SETPOINT

LOW ALARM

SETPOINT

VISUAL

ALARM

FUNCTION

AUDIBLE

ALARM

FUNCTION

MAINLINE

OR ZONE

SENSOR

PASS FAIL

OXYGEN 50 PSI PASS 60 PSI 40 PSI PASS PASS ZONE

MED AIR 50 PSI PASS 60 PSI 40 PSI PASS PASS ZONE

VACUUM 20" HG PASS N/A 12" HG PASS PASS ZONE

FLOOR: 5TH ALARM LOCATION:

AREA MONITORED: COMMENTS

END OF 5TH FLOOR AREA ALARM ANALYSIS

NOT IN USE

ALARM NO LONGER IN

USE

ACROSS 5312 ALARM MAKE AND MODEL: CHEMETRON MODULAR

AREA MONITORED: COMMENTS

B-WING

UNIT IS UNDER

CONSTRUCTION

B-WING ALARM MAKE AND MODEL: N/A

5A NURSES STATION ALARM MAKE AND MODEL: AMICO ALERT

AREA ALARM ANALYSIS

5TH FLOOR

AREA MONITORED: COMMENTS

A-WING ROOMS 5102,

5103, 5104, 5110, 5111, 5112, 5113, 5119, 5120, 5121, 5122, 5123, 5124, ALARM NEEDS LABELED

TO REFLECT ROOMS

SERVED

GAS MONITORED

PRESSURE

READING

LABELING

CORRECT

HIGH

ALARM

SETPOINT

LOW ALARM

SETPOINT

VISUAL

ALARM

FUNCTION

AUDIBLE

ALARM

FUNCTION

MAINLINE

OR ZONE

SENSOR

PASS FAIL

OXYGEN 54 PSI PASS 60 PSI 40 PSI PASS PASS ZONE P

MED AIR 50 PSI PASS 60 PSI 40 PSI PASS PASS ZONE P

VACUUM 20" HG PASS N/A 12" HG PASS PASS ZONE P

FLOOR: 6TH ALARM LOCATION:

GAS MONITORED

PRESSURE

READING

LABELING

CORRECT

HIGH

ALARM

SETPOINT

LOW ALARM

SETPOINT

VISUAL

ALARM

FUNCTION

AUDIBLE

ALARM

FUNCTION

MAINLINE

OR ZONE

SENSOR

PASS FAIL

OXYGEN 54 PSI PASS 60 PSI 40 PSI PASS PASS ZONE P

MED AIR 49 PSI PASS 60 PSI 40 PSI PASS PASS ZONE P

VACUUM 22" HG PASS N/A 12" HG PASS PASS ZONE P

FLOOR: 6TH ALARM LOCATION:

GAS MONITORED

PRESSURE

READING

LABELING

CORRECT

HIGH

ALARM

SETPOINT

LOW ALARM

SETPOINT

VISUAL

ALARM

FUNCTION

AUDIBLE

ALARM

FUNCTION

MAINLINE

OR ZONE

SENSOR

PASS FAIL

OXYGEN 54 PSI PASS 60 PSI 40 PSI PASS PASS ZONE P

MED AIR 49 PSI PASS 60 PSI 40 PSI PASS PASS ZONE P

VACUUM 21" HG PASS N/A 12" HG PASS PASS ZONE P

FLOOR: 6TH ALARM LOCATION:

GAS MONITORED

PRESSURE

READING

LABELING

CORRECT

HIGH

ALARM

SETPOINT

LOW ALARM

SETPOINT

VISUAL

ALARM

FUNCTION

AUDIBLE

ALARM

FUNCTION

MAINLINE

OR ZONE

SENSOR

PASS FAIL

OXYGEN 52 PSI PASS 60 PSI 40 PSI PASS PASS ZONE P

MED AIR 47 PSI PASS 60 PSI 40 PSI PASS PASS ZONE P

VACUUM 17" HG PASS N/A 12" HG PASS PASS ZONE P

FLOOR: 6TH ALARM LOCATION:

GAS MONITORED

PRESSURE

READING

LABELING

CORRECT

HIGH

ALARM

SETPOINT

LOW ALARM

SETPOINT

VISUAL

ALARM

FUNCTION

AUDIBLE

ALARM

FUNCTION

MAINLINE

OR ZONE

SENSOR

PASS FAIL

OXYGEN 54 PSI PASS 60 PSI 40 PSI PASS PASS ZONE P

MED AIR 46 PSI PASS 60 PSI 40 PSI PASS PASS ZONE P

VACUUM 21" HG PASS N/A 12" HG PASS PASS ZONE P

FLOOR: 6TH ALARM LOCATION:

6B WING ROOMS 6204,

6206, 6207, 6208, 6210, 6211, 6217, 6218, 6219, 6220, 6226, 6227, 6228

ALARM NEEDS LABELED

TO REFLECT ROOMS

SERVED

6B NURSES STATION ALARM MAKE AND MODEL: AMICO ALERT

ALARM NEEDS LABELED

TO REFLECT ROOMS

SERVED

6A NURSES STATION ALARM MAKE AND MODEL: AMICO ALERT

AREA MONITORED: COMMENTS

END OF 6TH FLOOR AREA ALARM ANALYSIS

AREA MONITORED: COMMENTS

CCU 6407, 6408, 6409, 6410,

6411, 6414, 6415, 6416

ALARM NEEDS LABELED

TO REFLECT ROOMS

SERVED

AREA MONITORED: COMMENTS

CATH LAB 6430, 6432, CATH

LAB HOLDING, GXT, ECHO

1, ECHO EXAM

ALARM NEEDS LABELED

TO REFLECT ROOMS

SERVED

ACROSS 6424 ALARM MAKE AND MODEL: CHEMETRON MODULAR

AREA MONITORED:

AREA MONITORED: COMMENTS

6A WING ROOMS 6105,

6111, 6114, 6116, 6119, 6124, 6125, 6128, 6130, 6132, 6133, 6136

MICU NURSES STATION ALARM MAKE AND MODEL: CHEMETRON MODULAR

AREA ALARM ANALYSIS

6TH FLOOR

COMMENTS

MICU ROOMS 6447, 6448,

6449, 6450, 6451, 6453, 6454, 6455, 6456, 6459

ALARM NEEDS LABELED

TO REFLECT ROOMS

SERVED

CCU NURSES STATION ALARM MAKE AND MODEL: CHEMETRON MODULAR

GAS MONITORED

PRESSURE

READING

LABELING

CORRECT

HIGH

ALARM

SETPOINT

LOW ALARM

SETPOINT

VISUAL

ALARM

FUNCTION

AUDIBLE

ALARM

FUNCTION

MAINLINE

OR ZONE

SENSOR

PASS FAIL

OXYGEN 54 PSI PASS 60 PSI 40 PSI PASS PASS MAINLINE P

VACUUM 20" HG PASS N/A 12" HG PASS PASS MAINLINE P

FLOOR: 7TH ALARM LOCATION:

END OF 7TH FLOOR AREA ALARM ANALYSIS

AREA ALARM ANALYSIS

7TH FLOOR

AREA MONITORED: COMMENTS

SLEEP LAB 7119, 7120, 7121,

7123, 7124, 7125

ACROSS 7118 ALARM MAKE AND MODEL: AMICO ALERT

MEDICAL GAS

ZONE VALVE ANALYSIS

Zone valves shall be readily operable from a standing position in the corridor on the same floor they serve. (NFPA 99 2024 5.1.4.6.1)

ZONE VALVE CODE REQUIREMENTS

Zone Valves. All station outlets/inlets shall be supplied through a zone valve as follows:

(NFPA 99 2024 5.1.4.6.1)

(2) The zone valves shall serve only outlets/inlets located on that same story.

(3) The zone valve shall not be located in a room with station outlets/inlets that it controls.

(1) The zone valve shall be placed such that a wall intervenes between the valve and outlets/inlets that it controls.

Zone valves shall be labeled in accordance with 5.1.11.2. (NFPA 99 2024 5.1.4.1.3)

Zone valves shall be so arranged that shutting off the supply of medical gas or vacuum to one zone will not affect the supply of medical gas or vacuum to another zone or the rest of the system.

(NFPA 99 2024 5.1.4.6.3)

A pressure/vacuum indicator shall be provided on the station outlet/inlet side of each zone valve.

(NFPA 99 2024 5.1.4.6.4)

Zone valve boxes shall not be installed behind normally open or normally closed doors or otherwise hidden from plain view. (NFPA 99 2024 5.1.4.6.1)

Zone valve boxes shall not be located in closed or locked rooms, areas, or closets. (NFPA 99 2024 5.1.4.6.1)

Zone valves shall be so arranged that shutting off the supply of gas to any one operating room or anesthetizing location will not affect the others. (NFPA 99 2024 5.1.4.6.3)

Zone valve boxes shall be installed where they are visible and accessible at all times.

(NFPA 99 2024 5.1.4.6.1 )

GAS

GAUGE

READING

GAS LABELED

CORRECTLY

ZONE LABELED

CORRECTLY

VALVE SIZE &

TYPE

PROPER

LOCATION

LEAKAGE PASS FAIL

OXYGEN 54 PSI PASS PASS 1/2" BALL PASS PASS P

VACUUM 22" HG PASS PASS 3/4" BALL PASS PASS P

FLOOR: G VALVE LOCATION:

END OF GROUND FLOOR ZONE VALVE ANALYSIS

OUTSIDE G109R VALVE MANUFACTURER: AMICO

ZONE VALVE ANALYSIS

GROUND FLOOR

AREA SERVED: COMMENTS

G109R, G109M, G109N, G109L

GAS

GAUGE

READING

GAS LABELED

CORRECTLY

ZONE LABELED

CORRECTLY

VALVE SIZE &

TYPE

PROPER

LOCATION

LEAKAGE PASS FAIL

OXYGEN 56 PSI PASS PASS 3/4" BALL PASS PASS P

MED AIR 50 PSI PASS PASS 1/2" BALL PASS PASS P

VACUUM 21" HG PASS PASS 1-1/2" BALL PASS PASS P

FLOOR: 1ST VALVE LOCATION:

GAS

GAUGE

READING

GAS LABELED

CORRECTLY

ZONE LABELED

CORRECTLY

VALVE SIZE &

TYPE

PROPER

LOCATION

LEAKAGE PASS FAIL

OXYGEN 54 PSI PASS PASS 1/2" BALL PASS PASS P

MED AIR 59 PSI PASS PASS 1/2" BALL PASS PASS P

VACUUM 20" HG PASS PASS 3/4" BALL PASS PASS P

FLOOR: 1ST VALVE LOCATION:

GAS

GAUGE

READING

GAS LABELED

CORRECTLY

ZONE LABELED

CORRECTLY

VALVE SIZE &

TYPE

PROPER

LOCATION

LEAKAGE PASS FAIL

OXYGEN 55 PSI PASS PASS 3/4" BALL PASS PASS P

VACUUM 22" HG PASS PASS 1" BALL PASS PASS P

FLOOR: 1ST VALVE LOCATION:

GAS

GAUGE

READING

GAS LABELED

CORRECTLY

ZONE LABELED

CORRECTLY

VALVE SIZE &

TYPE

PROPER

LOCATION

LEAKAGE PASS FAIL

OXYGEN 55 PSI PASS PASS 3/4" BALL PASS PASS P

MED AIR 49 PSI PASS PASS 3/4" BALL PASS PASS P

VACUUM 20" HG PASS PASS 1-1/4" BALL PASS PASS P

FLOOR: 1ST VALVE LOCATION:

GAS

GAUGE

READING

GAS LABELED

CORRECTLY

ZONE LABELED

CORRECTLY

VALVE SIZE &

TYPE

PROPER

LOCATION

LEAKAGE PASS FAIL

OXYGEN 55 PSI PASS PASS 3/4" BALL PASS PASS P

MED AIR 48 PSI PASS PASS 3/4" BALL PASS PASS P

VACUUM 22" HG PASS PASS 1-1/4" BALL PASS PASS P

FLOOR: 1ST VALVE LOCATION:

GAS

GAUGE

READING

GAS LABELED

CORRECTLY

ZONE LABELED

CORRECTLY

VALVE SIZE &

TYPE

PROPER

LOCATION

LEAKAGE PASS FAIL

N2O 49 PSI PASS PASS 1/2" BALL PASS PASS P

FLOOR: 1ST VALVE LOCATION:

NURSES STATION VALVE MANUFACTURER: CHEMETRON

AREA SERVED: COMMENTS

DIALYSIS BAYS 1, 2, 3, 4, 5, 6, 7, 8, 9, 10,

EXAM, TREATMENT, EQUIPMENT

REPROCESSING

OUTSIDE DIALYSIS VALVE MANUFACTURER: POWEREX

AREA SERVED: COMMENTS

OLD ER ROOMS 14, 15, 16, 17, 18

ZONE NOT IN USE

ZONE NEEDS HANDLES

INSTALLED OR

DEPRESSURIZED

ER NURSES STATION VALVE MANUFACTURER: CHEMETRON

AREA SERVED: COMMENTS

ER ROOM 1435I

MEDICAL AIR GAUGE IS

NOT ACCURATE

ACROSS 1435L VALVE MANUFACTURER: CHEMETRON

AREA SERVED: COMMENTS

ZONE VALVE ANALYSIS

1ST FLOOR

AREA SERVED: COMMENTS

ER ROOMS 1435K, 1435L, 1435M, 1435P,

1435O

ONCOLOGY BAYS 1, 2, 3, 4, 5, 6, 7, 8, 9,

DENTAL ROOMS 1610, 1611, 1612, 1613

AREA SERVED:

ZONE VALVE NEEDS

LABELED TO REFLECT

ROOM NUMBERS

SERVED

OUTSIDE DENTAL CLINIC VALVE MANUFACTURER: AMICO

OUTSIDE ONCOLOGY VALVE MANUFACTURER: AMICO

COMMENTS

ZONE VALVE ANALYSIS

1ST FLOOR

GAS

GAUGE

READING

GAS LABELED

CORRECTLY

ZONE LABELED

CORRECTLY

VALVE SIZE &

TYPE

PROPER

LOCATION

LEAKAGE PASS FAIL

OXYGEN 54 PSI PASS PASS 1/2" BALL PASS PASS P

COMP AIR 4 PSI PASS PASS 1/2" BALL PASS PASS P

VACUUM 20" HG PASS PASS 1" BALL PASS PASS P

FLOOR: 1ST VALVE LOCATION:

GAS

GAUGE

READING

GAS LABELED

CORRECTLY

ZONE LABELED

CORRECTLY

VALVE SIZE &

TYPE

PROPER

LOCATION

LEAKAGE PASS FAIL

OXYGEN 54 PSI PASS PASS 1/2" BALL PASS PASS P

COMP AIR 7 PSI PASS PASS 1/2" BALL PASS PASS P

VACUUM 21" HG PASS PASS 1-1/4" BALL PASS PASS P

FLOOR: 1ST VALVE LOCATION:

COMMENTS

END OF 1ST FLOOR ZONE VALVE ANALYSIS

AREA SERVED: COMMENTS

ACROSS 1616 VALVE MANUFACTURER: AMICO

AMICO

DENTAL ROOMS 1615, 1616, 1620, 1621,

1622, 1623, 1624, 1626, 1627, 1628, 1629

DENTAL ROOMS 1610, 1611, 1612, 1613,

ACROSS 1613 VALVE MANUFACTURER:

AREA SERVED:

GAS

GAUGE

READING

GAS LABELED

CORRECTLY

ZONE LABELED

CORRECTLY

VALVE SIZE &

TYPE

PROPER

LOCATION

LEAKAGE PASS FAIL

OXYGEN 54 PSI PASS PASS 1/2" BALL PASS PASS P

MED AIR N/A PASS PASS 1/2" BALL PASS PASS P

VACUUM 21" HG PASS PASS 3/4" BALL PASS PASS P

FLOOR: 2ND VALVE LOCATION:

GAS

GAUGE

READING

GAS LABELED

CORRECTLY

ZONE LABELED

CORRECTLY

VALVE SIZE &

TYPE

PROPER

LOCATION

LEAKAGE PASS FAIL

OXYGEN 56 PSI PASS PASS 1/2" BALL PASS PASS P

VACUUM 22" HG PASS PASS 3/4" BALL PASS PASS P

FLOOR: 2ND VALVE LOCATION:

GAS

GAUGE

READING

GAS LABELED

CORRECTLY

ZONE LABELED

CORRECTLY

VALVE SIZE &

TYPE

PROPER

LOCATION

LEAKAGE PASS FAIL

OXYGEN 54 PSI PASS PASS 3/4" BALL PASS PASS P

VACUUM 21" HG PASS PASS 3/4" BALL PASS PASS P

FLOOR: 2ND VALVE LOCATION:

GAS

GAUGE

READING

GAS LABELED

CORRECTLY

ZONE LABELED

CORRECTLY

VALVE SIZE &

TYPE

PROPER

LOCATION

LEAKAGE PASS FAIL

OXYGEN 58 PSI PASS PASS 1/2" BALL PASS PASS P

MED AIR N/A PASS PASS 1/2" BALL PASS PASS P

VACUUM 21" HG PASS PASS 3/4" BALL PASS PASS P

FLOOR: 2ND VALVE LOCATION:

GAS

GAUGE

READING

GAS LABELED

CORRECTLY

ZONE LABELED

CORRECTLY

VALVE SIZE &

TYPE

PROPER

LOCATION

LEAKAGE PASS FAIL

OXYGEN 56 PSI PASS PASS 1/2" BALL PASS PASS P

VACUUM 19" HG PASS PASS 3/4" BALL PASS PASS P

FLOOR: 2ND VALVE LOCATION:

GAS

GAUGE

READING

GAS LABELED

CORRECTLY

ZONE LABELED

CORRECTLY

VALVE SIZE &

TYPE

PROPER

LOCATION

LEAKAGE PASS FAIL

OXYGEN 54 PSI PASS PASS 1/2" BALL PASS PASS P

FLOOR: 2ND VALVE LOCATION:

GAS

GAUGE

READING

GAS LABELED

CORRECTLY

ZONE LABELED

CORRECTLY

VALVE SIZE &

TYPE

PROPER

LOCATION

LEAKAGE PASS FAIL

OXYGEN N/A PASS PASS 1/2" BALL PASS PASS P

FLOOR: 2ND VALVE LOCATION:

AREA SERVED: COMMENTS

MRI 2115D, 2115 MEDICAL AIR NOT IN USE

INSIDE MRI SUITE VALVE MANUFACTURER: AMICO

OUTSIDE RADIOLOGY CHECK IN VALVE MANUFACTURER: AMICO

2367 X-RAY 6, 2365 X-RAY 4

ZONE VALVE ANALYSIS

2ND FLOOR

AREA SERVED: COMMENTS

CT/GANTY2125 MEDICAL AIR NOT IN USE

OUTSIDE 2125 VALVE MANUFACTURER: AMICO

2116, 2121, MRI HOLDING

AREA SERVED: COMMENTS

OUTSIDE 2121 VALVE MANUFACTURER: POWEREX

AREA SERVED: COMMENTS

CT 2123

AREA SERVED: COMMENTS

OUTSIDE 2123 VALVE MANUFACTURER: AMICO

OUTSIDE 2370 VALVE MANUFACTURER: AMICO

AREA SERVED: COMMENTS

2340A, 2341

AREA SERVED: COMMENTS

NOT IN USE

ACROSS 2345 VALVE MANUFACTURER: CHEMETRON

ZONE VALVE ANALYSIS

2ND FLOOR

GAS

GAUGE

READING

GAS LABELED

CORRECTLY

ZONE LABELED

CORRECTLY

VALVE SIZE &

TYPE

PROPER

LOCATION

LEAKAGE PASS FAIL

OXYGEN 54 PSI PASS PASS 1/2" BALL PASS PASS P

VACUUM 21" HG PASS PASS 3/4" BALL PASS PASS P

FLOOR: 2ND VALVE LOCATION:

GAS

GAUGE

READING

GAS LABELED

CORRECTLY

ZONE LABELED

CORRECTLY

VALVE SIZE &

TYPE

PROPER

LOCATION

LEAKAGE PASS FAIL

OXYGEN 55 PSI PASS PASS 1/2" BALL PASS PASS P

VACUUM 21" HG PASS PASS 3/4" BALL PASS PASS P

FLOOR: 2ND VALVE LOCATION:

GAS

GAUGE

READING

GAS LABELED

CORRECTLY

ZONE LABELED

CORRECTLY

VALVE SIZE &

TYPE

PROPER

LOCATION

LEAKAGE PASS FAIL

OXYGEN 0 PSI PASS PASS 1/2" BALL PASS PASS P

FLOOR: 2ND VALVE LOCATION:

GAS

GAUGE

READING

GAS LABELED

CORRECTLY

ZONE LABELED

CORRECTLY

VALVE SIZE &

TYPE

PROPER

LOCATION

LEAKAGE PASS FAIL

OXYGEN 55 PSI PASS PASS 1" BALL PASS PASS P

COMP AIR 6 PSI PASS PASS 1" BALL PASS PASS P

VACUUM 22" HG PASS PASS 1-1/2" BALL PASS PASS P

FLOOR: 2ND VALVE LOCATION:

GAS

GAUGE

READING

GAS LABELED

CORRECTLY

ZONE LABELED

CORRECTLY

VALVE SIZE &

TYPE

PROPER

LOCATION

LEAKAGE PASS FAIL

COMP AIR 6 PSI PASS PASS 1" BALL PASS PASS P

FLOOR: 2ND VALVE LOCATION:

AREA SERVED: COMMENTS

ACROSS 2615 VALVE MANUFACTURER: AMICO

ACROSS 2352A VALVE MANUFACTURER: POWEREX

AREA SERVED: COMMENTS

2344, 2345, 2345B, 2346

AREA SERVED: COMMENTS

OUTSIDE 2343 VALVE MANUFACTURER: AMICO

AREA SERVED: COMMENTS

VALVE MANUFACTURER:

END OF 2ND FLOOR ZONE VALVE ANALYSIS

OUTSIDE 2345

NOT IN USE

AMICO

2603A, 2603B, 2606, 2607, 2608, 2611, 2612, 2613, 2615, 2616, 2617, 2618

ZONE VALVE NEEDS

LABELED TO REFLECT

ROOMS SERVED

AREA SERVED: COMMENTS

UNKNOWN

ZONE VALVE IS FOR HOSE

BARB OUTLET CONNECTION

ACROSS 2615 VALVE MANUFACTURER: AMICO

GAS

GAUGE

READING

GAS LABELED

CORRECTLY

ZONE LABELED

CORRECTLY

VALVE SIZE &

TYPE

PROPER

LOCATION

LEAKAGE PASS FAIL

OXYGEN 56 PSI PASS PASS 3/4" BALL PASS PASS P

MED AIR 48 PSI PASS PASS 3/4" BALL PASS PASS P

VACUUM 19" HG PASS PASS 1-1/4" BALL PASS PASS P

FLOOR: 3RD VALVE LOCATION:

GAS

GAUGE

READING

GAS LABELED

CORRECTLY

ZONE LABELED

CORRECTLY

VALVE SIZE &

TYPE

PROPER

LOCATION

LEAKAGE PASS FAIL

OXYGEN 54 PSI PASS PASS 1/2" BALL PASS PASS P

MED AIR 48 PSI PASS PASS 1/2" BALL PASS PASS P

VACUUM 19" HG PASS PASS 1-1/4" BALL PASS PASS P

FLOOR: 3RD VALVE LOCATION:

GAS

GAUGE

READING

GAS LABELED

CORRECTLY

ZONE LABELED

CORRECTLY

VALVE SIZE &

TYPE

PROPER

LOCATION

LEAKAGE PASS FAIL

OXYGEN 56 PSI PASS PASS 3/4" BALL PASS PASS P

MED AIR 50 PSI PASS PASS 3/4" BALL PASS PASS P

VACUUM 22" HG PASS PASS 1-1/2" BALL PASS PASS P

FLOOR: 3RD VALVE LOCATION:

GAS

GAUGE

READING

GAS LABELED

CORRECTLY

ZONE LABELED

CORRECTLY

VALVE SIZE &

TYPE

PROPER

LOCATION

LEAKAGE PASS FAIL

OXYGEN 53 PSI PASS PASS 1/2" BALL PASS PASS P

MED AIR 48 PSI PASS PASS 1/2" BALL PASS PASS P

VACUUM 22" HG PASS PASS 3/4" BALL PASS PASS P

FLOOR: 3RD VALVE LOCATION:

GAS

GAUGE

READING

GAS LABELED

CORRECTLY

ZONE LABELED

CORRECTLY

VALVE SIZE &

TYPE

PROPER

LOCATION

LEAKAGE PASS FAIL

OXYGEN 55 PSI PASS PASS 1/2" BALL PASS PASS P

MED AIR 50 PSI PASS PASS 1/2" BALL PASS PASS P

VACUUM 20" HG PASS PASS 3/4" BALL PASS PASS P

FLOOR: 3RD VALVE LOCATION:

GAS

GAUGE

READING

GAS LABELED

CORRECTLY

ZONE LABELED

CORRECTLY

VALVE SIZE &

TYPE

PROPER

LOCATION

LEAKAGE PASS FAIL

OXYGEN 54 PSI PASS PASS 1/2" BALL PASS PASS P

MED AIR 48 PSI PASS PASS 1/2" BALL PASS PASS P

VACUUM 22" HG PASS PASS 3/4" BALL PASS PASS P

FLOOR: 3RD VALVE LOCATION:

AREA SERVED: COMMENTS

3A WING ROOMS 3106, 3104, 3102, 3101

ZONE VALVE NEEDS

LABELED TO REFLECT

ROOMS SERVED.

ACROSS 3102 VALVE MANUFACTURER: CHEMETRON

AREA SERVED: COMMENTS

ZONE VALVE ANALYSIS

3RD FLOOR

AREA SERVED: COMMENTS

3501, 3502, 3503, 3504, 3505, 3506, 3507, 3508, 3509, 3510, 3511, 3512, 3513

OUTSIDE AMBULATORY UNIT VALVE MANUFACTURER: AMICO

AREA SERVED: COMMENTS

SPECIAL PROCEDURE 3528

OUTSIDE ROOM 3528 VALVE MANUFACTURER: AMICO

OUTSIDE 3810 VALVE MANUFACTURER: AMICO

OUTSIDE 3811 VALVE MANUFACTURER: AMICO

AREA SERVED: COMMENTS

AREA SERVED: COMMENTS

OUTSIDE 3809 VALVE MANUFACTURER: AMICO

ZONE VALVE ANALYSIS

3RD FLOOR

GAS

GAUGE

READING

GAS LABELED

CORRECTLY

ZONE LABELED

CORRECTLY

VALVE SIZE &

TYPE

PROPER

LOCATION

LEAKAGE PASS FAIL

OXYGEN 56 PSI PASS PASS 3/4" BALL PASS PASS P

MED AIR 49 PSI PASS PASS 3/4" BALL PASS PASS P

VACUUM 21" HG PASS PASS 1" BALL PASS PASS P

FLOOR: 3RD VALVE LOCATION:

GAS

GAUGE

READING

GAS LABELED

CORRECTLY

ZONE LABELED

CORRECTLY

VALVE SIZE &

TYPE

PROPER

LOCATION

LEAKAGE PASS FAIL

VACUUM 21" HG PASS PASS 1" BALL PASS PASS P

FLOOR: 3RD VALVE LOCATION:

GAS

GAUGE

READING

GAS LABELED

CORRECTLY

ZONE LABELED

CORRECTLY

VALVE SIZE &

TYPE

PROPER

LOCATION

LEAKAGE PASS FAIL

OXYGEN 54 PSI PASS PASS 3/4" BALL PASS PASS P

MED AIR 49 PSI PASS PASS 3/4" BALL PASS PASS P

VACUUM 20" HG PASS PASS 3/4" BALL PASS PASS P

FLOOR: 3RD VALVE LOCATION:

GAS

GAUGE

READING

GAS LABELED

CORRECTLY

ZONE LABELED

CORRECTLY

VALVE SIZE &

TYPE

PROPER

LOCATION

LEAKAGE PASS FAIL

OXYGEN 55 PSI PASS PASS 3/4" BALL PASS PASS P

MED AIR 49 PSI PASS PASS 3/4" BALL PASS PASS P

VACUUM 21" HG PASS PASS 3/4" BALL PASS PASS P

FLOOR: 3RD VALVE LOCATION:

GAS

GAUGE

READING

GAS LABELED

CORRECTLY

ZONE LABELED

CORRECTLY

VALVE SIZE &

TYPE

PROPER

LOCATION

LEAKAGE PASS FAIL

OXYGEN 56 PSI PASS PASS 3/4" BALL PASS PASS P

MED AIR 50 PSI PASS PASS 3/4" BALL PASS PASS P

VACUUM 22" HG PASS PASS 3/4" BALL PASS PASS P

FLOOR: 3RD VALVE LOCATION:

AREA SERVED: COMMENTS

AREA SERVED: COMMENTS

ENT 3207, 3208, 3209, 3212, 3222, 3223,

3224, 3225, 3226, 3227

OUTSIDE 3231 VALVE MANUFACTURER: POWEREX

3119 PROCEDURE ROOM 3, 3120 SCOPE

REPROCESSING

SCOPE ROOM NEEDS

ADDED TO THE ZONE

VALVE LABEL

OUTSIDE 3119 VALVE MANUFACTURER: AMICO

OUTSIDE 3808 VALVE MANUFACTURER: AMICO

AREA SERVED: COMMENTS

3114 PROCEDURE ROOM 1

OUTSIDE OF 3114 VALVE MANUFACTURER: AMICO

AREA SERVED: COMMENTS

3117 PROCEDURE ROOM 2, 3116 SCOPE

CLEAN

SCOPE ROOM NEEDS

ADDED TO THE ZONE

VALVE LABEL

OUTSIDE 3117 VALVE MANUFACTURER: AMICO

ZONE VALVE ANALYSIS

3RD FLOOR

GAS

GAUGE

READING

GAS LABELED

CORRECTLY

ZONE LABELED

CORRECTLY

VALVE SIZE &

TYPE

PROPER

LOCATION

LEAKAGE PASS FAIL

OXYGEN 54 PSI PASS PASS 3/4" BALL PASS PASS P

MED AIR 49 PSI PASS PASS 3/4" BALL PASS PASS P

VACUUM 22" HG PASS PASS 3/4" BALL PASS PASS P

FLOOR: 3RD VALVE LOCATION:

GAS

GAUGE

READING

GAS LABELED

CORRECTLY

ZONE LABELED

CORRECTLY

VALVE SIZE &

TYPE

PROPER

LOCATION

LEAKAGE PASS FAIL

OXYGEN 54 PSI PASS PASS 3/4" BALL PASS PASS P

MED AIR 48 PSI PASS PASS 3/4" BALL PASS PASS P

VACUUM 19" HG PASS PASS 3/4" BALL PASS PASS P

FLOOR: 3RD VALVE LOCATION:

END OF 3RD FLOOR ZONE VALVE ANALYSIS

AREA SERVED: COMMENTS

OUTSIDE 3121 VALVE MANUFACTURER: AMICO

3121 PROCEDURE ROOM 4

3122 PROCEDURE ROOM 5

OUTSIDE 3122 VALVE MANUFACTURER: AMICO

GAS

GAUGE

READING

GAS LABELED

CORRECTLY

ZONE LABELED

CORRECTLY

VALVE SIZE &

TYPE

PROPER

LOCATION

LEAKAGE PASS FAIL

OXYGEN 56 PSI PASS PASS 1" BALL PASS PASS P

MED AIR 50 PSI PASS PASS 1" BALL PASS PASS P

VACUUM 22" HG PASS PASS 1-1/2" BALL PASS PASS P

FLOOR: 4TH VALVE LOCATION:

GAS

GAUGE

READING

GAS LABELED

CORRECTLY

ZONE LABELED

CORRECTLY

VALVE SIZE &

TYPE

PROPER

LOCATION

LEAKAGE PASS FAIL

OXYGEN 54 PSI PASS PASS 1" BALL PASS PASS P

MED AIR 49 PSI PASS PASS 1" BALL PASS PASS P

VACUUM 21" HG PASS PASS 1-1/2" BALL PASS PASS P

FLOOR: 4TH VALVE LOCATION:

GAS

GAUGE

READING

GAS LABELED

CORRECTLY

ZONE LABELED

CORRECTLY

VALVE SIZE &

TYPE

PROPER

LOCATION

LEAKAGE PASS FAIL

OXYGEN 53 PSI PASS PASS 3/4" BALL PASS PASS P

MED AIR 48 PSI PASS PASS 3/4" BALL PASS PASS P

VACUUM 21" HG PASS PASS 2" BALL PASS PASS P

FLOOR: 4TH VALVE LOCATION:

GAS

GAUGE

READING

GAS LABELED

CORRECTLY

ZONE LABELED

CORRECTLY

VALVE SIZE &

TYPE

PROPER

LOCATION

LEAKAGE PASS FAIL

OXYGEN 75 PSI PASS PASS 1/2" BALL PASS PASS P

MED AIR 50 PSI PASS PASS 1/2" BALL PASS PASS P

VACUUM 22" HG PASS PASS 1" BALL PASS PASS P

FLOOR: 4TH VALVE LOCATION:

GAS

GAUGE

READING

GAS LABELED

CORRECTLY

ZONE LABELED

CORRECTLY

VALVE SIZE &

TYPE

PROPER

LOCATION

LEAKAGE PASS FAIL

OXYGEN 56 PSI PASS PASS 3/4" BALL PASS PASS P

MED AIR 48 PSI PASS PASS 3/4" BALL PASS PASS P

N2O 50 PSI PASS PASS 1/2" BALL PASS PASS P

VACUUM 22" HG PASS PASS 2" BALL PASS PASS P

FLOOR: 4TH VALVE LOCATION:

AREA SERVED: COMMENTS

SICU ROOMS 4329, 4330, 4331, 4332,

4333, 4334, 4335, 4336

ZONE VALVE NEEDS

LABELED TO REFLECT

ROOMS SERVED

SICU HALLWAY VALVE MANUFACTURER: CHEMETRON

AREA SERVED: COMMENTS

PRE-OP

OXYGEN GAUGE IS NOT

ACCURATE

OUTSIDE PRE-OP VALVE MANUFACTURER: CHEMETRON

AREA SERVED: COMMENTS

PACU BAYS 1, 2, 3, 4, 5, 6, ISOLATION N2O NOT IN USE

ACROSS OR-2 VALVE MANUFACTURER: CHEMETRON

ZONE VALVE ANALYSIS

4TH FLOOR

AREA SERVED: COMMENTS

4A WING ROOMS 4102, 4103, 4104,

4110, 4111, 4112, 4113, 4119, 4120, 4121, 4122, 4123, 4124, 4127, 4128

ZONE VALVE NEEDS

LABELED TO REFLECT

ROOMS SERVED

4A NURSES STATION VALVE MANUFACTURER: CHEMETRON

AREA SERVED: COMMENTS

4B WING ROOMS 4202, 4203, 4206,

4207, 4208, 4210, 4211, 4217, 4218, 4219, 4220, 4226, 4227, 4228

ZONE VALVE NEEDS

LABELED TO REFLECT

4B NURSES STATION VALVE MANUFACTURER: AMICO

ZONE VALVE ANALYSIS

4TH FLOOR

GAS

GAUGE

READING

GAS LABELED

CORRECTLY

ZONE LABELED

CORRECTLY

VALVE SIZE &

TYPE

PROPER

LOCATION

LEAKAGE PASS FAIL

OXYGEN 54 PSI PASS PASS 1/2" BALL PASS PASS P

MED AIR 48 PSI PASS PASS 1/2" BALL PASS PASS

N2O 50 PSI PASS PASS 1/2" BALL PASS PASS P

VACUUM 22" HG PASS PASS 3/4" BALL PASS PASS P

N2 150 PSI PASS PASS 1/2" BALL PASS PASS P

FLOOR: 4TH VALVE LOCATION:

GAS

GAUGE

READING

GAS LABELED

CORRECTLY

ZONE LABELED

CORRECTLY

VALVE SIZE &

TYPE

PROPER

LOCATION

LEAKAGE PASS FAIL

OXYGEN 56 PSI PASS PASS 1/2" BALL PASS PASS P

MED AIR 50 PSI PASS PASS 1/2" BALL PASS PASS P

N2O 50 PSI…