John J Pershing VA Medical Center Med Gas Annual 2025.pdf

PREPARED BY: BRAYDEN SEGER

TESTING DATES: SEPTEMBER 30TH, 2025

JOHN J PERSHING MEDICAL CENTER

MEDICAL GAS

ANNUAL

INSPECTION

1500 N WESTWOOD BLVD

POPLAR BLUFF, MO 63901

ITEMS TESTED/INSPECTED

OXYGEN MEDICAL AIR

MEDICAL

VACUUM

NITROUS

OXIDE

NITROGEN

CARBON

DIOXIDE

LAB AIR WAGD

SOURCE EQUIPMENT P P P P

MASTER ALARMS P P P P

ZONE VALVES P P P P

ZONE VERIFICATION P P P P

CROSS CONNECTION P P P P

AREA ALARMS P P P P

PATIENT OUTLETS P P P P

PARTICLE ANALYSIS P P P

PURITY ANALYSIS P P P

MGI MEDICAL GAS VERIFIER: BRAYDEN SEGER

SIGNATURE:

DATE: 9/30/2025

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

https://qrplanet.com/8lq61w

EXECUTIVE SUMMARY

SIGNALS

PASSED

SIGNALS

FAILED

LAB AIR SCROLL 1 1 0

EXECUTIVE OVERALL SUMMARY-SOURCE

SOURCE EQUIPMENT

GAS TYPE SOURCE TYPE TOTAL COUNT TOTAL PASSED TOTAL FAILED

MEDICAL AIR RECIPROCATING 2 2 0

OXYGEN BULK OXYGEN 1 1 0

2 2 0

SOURCE EQUIPMENT MASTER ALARMS

EQUIPMENT

EQUIPMENT MAKE &

MODEL

ALARM PANEL

COUNT

ALARM SIGNAL

COUNT

TOTAL 8 8 0

MASTER ALARM PANEL ALARMS

MASTER ALARM PANEL

BEACON MEDAES TOTAL

ALERT

1 23 23 0

MASTER ALARM PANEL

BEACON MEDAES TOTAL

ALERT

1 23 23

TOTALS 2 46 46 0

VACUUM LUBE VANE 2 2 0

FAILED REPAIRED FAILED REPAIRED

PASSED

PATIENT OUTLET TERMINALS

21 21

MISSING VALVES MISSING ALARMS

0 0 0 00 0

EXECUTIVE OVERALL SUMMARY-PIPELINE

ZONE VALVES AREA ALARMS

TOTAL VALVES TOTAL ALARMSTOTAL PASSED

OXYGEN 122 122 0 0

GAS TYPE TOTAL COUNT TOTAL PASSED TOTAL FAILED TOTAL UNAVAILABLE

VACUUM 116 116 0 0

DENTAL AIR 3 3 0 0

PERCENTAGE 100.0% 0.0% 0.0%

TOTAL 358 358 0 0

TOTAL PERCENTAGE OF

OUTLETS TESTED

100.0%

TOTAL OUTLET

FAILURES

TOTAL OUTLETS

REPAIRED

0 0

MEDICAL AIR 117 117 0 0

MGI TECHNICIAN: BRAYDEN SEGER

1 SPECIFIC OUTLET REPAIRED BY REPAIR DATE

NO ISSUES FOUND

END OF OUTLET ISSUES

OUTLET ISSUES JOHN J PERSHING MEDICAL CENTER

ROOM OUTLET SPECS ISSUE

JOHN J PERSHING MEDICAL CENTER

CORRECTED

END OF CORRECTIVE ACTIONS

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.

CORRECTIVE ACTIONS

AREA ISSUE NFPA 99 2024 CODE

NONE FOUND.

CORRECTIVE

ACTION

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

FUTURE CORRECTIONS

AREA ISSUE NFPA 99 2024 CODE

NONE FOUND.

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 greater 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.

JOHN J PERSHING MEDICAL CENTER MGI TECHNICIAN: BRAYDEN SEGER

POPLAR BLUFF, MO 63901 TESTING DATE: 9/30/2025

VISUAL

STATUS

AUDIBLE

STATUS

LABELED

CORRECTLY

COMMENTS

P TESTED & MAINTAINED BY BULK PROVIDER

P TESTED & MAINTAINED BY BULK PROVIDER

P TESTED & MAINTAINED BY BULK PROVIDER

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: 3RD FLOOR NURSE STATION

COMMENTS

OXYGEN LINE PRESSURE HIGH PASS

OXYGEN LINE PRESSURE LOW PASS

MEDICAL AIR COMP MAINTENANCE REQUIRED (MAIR 1) PASS

OXYGEN SECONDARY LIQUID SUPPLY IN USE N/A

OXYGEN SECONDARY LIQUID LEVEL LOW N/A

MASTER ALARM ANALYSIS

MASTER ALARM SIGNALS PASS/FAIL

OXYGEN PRIMARY LIQUID LEVEL LOW N/A

MEDICAL AIR HIGH DEW POINT (MAIR 1) PASS

MEDICAL AIR CO HIGH (MAIR 1) PASS

MEDICAL AIR LINE PRESSURE HIGH PASS

MEDICAL AIR COMP MAINTENANCE REQUIRED (MAIR 2) PASS

MEDICAL AIR HIGH DEW POINT (MAIR 2) PASS

MEDICAL AIR CO HIGH (MAIR 2) PASS

MEDICAL AIR LINE PRESSURE LOW PASS

LAB AIR HIGH DEW POINT PASS

LAB AIR COMPRESSOR SYSTEM MALFUNCTION PASS

R/D LAB AIR SERVICE ALERT PASS

LAB AIR LINE PRESSURE HIGH PASS

LAB AIR LINE PRESSURE LOW PASS

MEDICAL VACUUM LINE PRESSURE LOW PASS

MEDICAL VACUUM LAG IN USE (VAC 1) PASS

MEDICAL VACUUM HIGH TEMP SHUTDOWN (VAC 1) PASS

MEDICAL VACUUM LAG IN USE (VAC 2) PASS

MEDICAL VACUUM HIGH TEMP SHUTDOWN (VAC 2) PASS

BEACON MEDAES TOTAL 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

JOHN J PERSHING MEDICAL CENTER MGI TECHNICIAN: BRAYDEN SEGER

POPLAR BLUFF, MO 63901 TESTING DATE: 9/30/2025

VISUAL

STATUS

AUDIBLE

STATUS

LABELED

CORRECTLY

COMMENTS

P TESTED & MAINTAINED BY BULK PROVIDER

P TESTED & MAINTAINED BY BULK PROVIDER

P TESTED & MAINTAINED BY BULK PROVIDER

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: ER CHECK-IN DESK

COMMENTS

PASS/FAIL

PASS

BEACON MEDAES TOTAL 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).

R/D LAB AIR SERVICE ALERT PASS

LAB AIR LINE PRESSURE HIGH PASS

LAB AIR LINE PRESSURE LOW PASS

MEDICAL VACUUM LINE PRESSURE LOW PASS

MEDICAL VACUUM HIGH TEMP SHUTDOWN (VAC 2) PASS

MEDICAL VACUUM LAG IN USE (VAC 1) PASS

MEDICAL VACUUM HIGH TEMP SHUTDOWN (VAC 1) PASS

MEDICAL VACUUM LAG IN USE (VAC 2) PASS

LAB AIR HIGH DEW POINT PASS

LAB AIR COMPRESSOR SYSTEM MALFUNCTION PASS

MEDICAL AIR CO HIGH (MAIR 2) PASS

MEDICAL AIR LINE PRESSURE HIGH PASS

MEDICAL AIR LINE PRESSURE LOW PASS

MEDICAL AIR CO HIGH (MAIR 1) PASS

MEDICAL AIR COMP MAINTENANCE REQUIRED (MAIR 2) PASS

MEDICAL AIR HIGH DEW POINT (MAIR 2) PASS

OXYGEN LINE PRESSURE LOW PASS

MEDICAL AIR COMP MAINTENANCE REQUIRED (MAIR 1) PASS

MEDICAL AIR HIGH DEW POINT (MAIR 1) PASS

OXYGEN SECONDARY LIQUID LEVEL LOW N/A

OXYGEN LINE PRESSURE HIGH PASS

OXYGEN SECONDARY LIQUID SUPPLY IN USE N/A

MASTER ALARM ANALYSIS

MASTER ALARM SIGNALS PASS/FAIL

OXYGEN PRIMARY LIQUID LEVEL LOW N/A

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

MED AIR 55 PSI PASS 60 PSI 40 PSI PASS PASS ZONE P

FLOOR: GROUND 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 54 PSI PASS 60 PSI 40 PSI PASS PASS ZONE P

VACUUM 25" HG PASS N/A 12" HG N/A PASS ZONE P

FLOOR: GROUND ALARM LOCATION:

END OF GROUND FLOOR AREA ALARM ANALYSIS

ACROSS FROM URGENT CARE BREAK ROOM ALARM MAKE AND MODEL: BEACON MEDAES MEGA 3

OUTSIDE OF BIOMED ALARM MAKE AND MODEL: BEACON MEDAES MEGA 3

AREA MONITORED: COMMENTS

URGENT CARE: LL12, LL13, LL14,

LL15, LL16, LL17, LL25, LL38

AREA ALARM ANALYSIS

GROUND FLOOR

AREA MONITORED: COMMENTS

BIOMED: GR-034

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 51 PSI PASS 60 PSI 40 PSI PASS PASS ZONE P

MED AIR 55 PSI PASS 60 PSI 40 PSI N/A N/A ZONE

VACUUM 23" HG PASS N/A 12" HG N/A N/A ZONE

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 51 PSI PASS 60 PSI 40 PSI N/A N/A ZONE

MED AIR 55 PSI PASS 60 PSI 40 PSI N/A N/A ZONE

VACUUM 25" HG PASS N/A 12" HG N/A N/A ZONE

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 51 PSI PASS 60 PSI 40 PSI PASS PASS ZONE P

MED AIR 55 PSI PASS 60 PSI 40 PSI PASS PASS ZONE P

VACUUM 23" HG PASS N/A 12" HG PASS PASS ZONE P

FLOOR: 1ST ALARM LOCATION:

INSIDE DENTAL DEPARTMENT ALARM MAKE AND MODEL: BEACON MEDAES MEGA 3

AREA MONITORED: COMMENTS

AREA ALARM ANALYSIS

1ST FLOOR

AREA MONITORED: COMMENTS

DENTAL CLINIC ROOMS: 1E-113,

1E-114, 1E-116, 1E-129, 1E-130, 1E-130A

MEDICAL AIR AND

VACUUM ARE FOR

FUTURE USE: ALARM

AUDIBLE/VISUAL

SIGNALS NOT ABLE TO

BE TESTED

ROOM 1A-144

FOR FUTURE USE:

ALARM AUDIBLE/VISUAL

SIGNALS NOT ABLE TO

BE TESTED

AREA MONITORED: COMMENTS

END OF 1ST FLOOR AREA ALARM ANALYSIS

EXAM ROOMS: 1A-053, 1A-061,

1A-062

NEXT TO EXAM 1A-061 ALARM MAKE AND MODEL: BEACON MEDAES MEGA 3

HALLWAY OUTSIDE 1A-144 ALARM MAKE AND MODEL: BEACON MEDAES MEGA 3

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 54 PSI PASS 60 PSI 40 PSI PASS PASS ZONE P

VACUUM 26" HG PASS N/A 12" HG PASS PASS ZONE P

FLOOR: 2ND ALARM LOCATION:

END OF 2ND FLOOR AREA ALARM ANALYSIS

ACROSS FROM 2A-063 BONE DENSITY ALARM MAKE AND MODEL: BEACON MEDAES MEGA 3

AREA ALARM ANALYSIS

2ND FLOOR

AREA MONITORED: COMMENTS

2A CT: 2002 & 2005

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 51 PSI PASS 60 PSI 40 PSI PASS PASS ZONE P

MED AIR 54 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 N/A PASS 60 PSI 40 PSI N/A N/A ZONE

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

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

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 51 PSI PASS 60 PSI 40 PSI PASS PASS ZONE P

MED AIR 55 PSI PASS 60 PSI 40 PSI PASS PASS ZONE P

VACUUM 23" 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 52 PSI PASS 60 PSI 40 PSI PASS PASS ZONE P

MED AIR 55 PSI PASS 60 PSI 40 PSI PASS PASS ZONE P

VACUUM 25" 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

DENTAL AIR 100 PSI PASS 120 PSI 80 PSI 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 51 PSI PASS 60 PSI 40 PSI PASS PASS ZONE P

MED AIR 55 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 51 PSI PASS 60 PSI 40 PSI PASS PASS ZONE P

MED AIR 53 PSI PASS 60 PSI 40 PSI PASS PASS ZONE P

VACUUM 25" HG PASS N/A 12" HG PASS PASS ZONE P

FLOOR: 3RD ALARM LOCATION:

BEACON MEDAES MEGA 3

ALARM MAKE AND MODEL: BEACON MEDAES MEGA 3

AREA MONITORED: COMMENTS

AREA MONITORED: COMMENTS

3E: 3E-110E, 110F

AREA MONITORED: COMMENTS

ENDOSCOPE SUITE

ACROSS FROM 3E-110E SCOPE STORAGE

ENDOSCOPY RECOVERY: 3A-

OUTSIDE OF 3A-116 ENDO RECOVERY ALARM MAKE AND MODEL: BEACON MEDAES MEGA 3

ALARM MAKE AND MODEL: BEACON MEDAES MEGA 3

AREA MONITORED: COMMENTS

OUTSIDE OF SCOPE CLEANING ALARM MAKE AND MODEL: BEACON MEDAES MEGA 3

ACROSS FROM NURSE STATION ALARM MAKE AND MODEL: BEACON MEDAES MEGA 3

AREA MONITORED: COMMENTS

3A: 3A-154

NEXT TO 3A-154 ALARM MAKE AND MODEL:

AREA MONITORED: COMMENTS

3A & 3C: 3A-037, 3C-041A, 3C-041B

AREA ALARM SHOULD

READ 3A-037, 3C-041A,

& 3C-041B

AREA ALARM ANALYSIS

3RD FLOOR

AREA MONITORED: COMMENTS

3A: 3A-003 & 3A-004

3B: 3B-009, 3B-011, 3B-012, 3B-014, 3B-017, 3B-018, 3B-

020, 3B-023, 3B-24, 3B-029, 3B-030, 3B-033

POWER IS OFF

UNDER CONSTRUCTION

ACROSS FROM NURSE STATION ALARM MAKE AND MODEL: BEACON MEDAES MEGA 3

OUTSIDE OF 3A-004

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 51 PSI PASS 60 PSI 40 PSI PASS PASS ZONE P

MED AIR 54 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:

COMMENTS

3F: 3F-121, 3F-124, 3F-125, 3F-127, 3F-133, 3F-136, 3F-

138, 3F-141, 3F-144, 3F-

146, 3F-147, 3F-149

NEXT TO 3F-124 ALARM MAKE AND MODEL: BEACON MEDAES MEGA 3

END OF 3RD FLOOR AREA ALARM ANALYSIS

AREA MONITORED:

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 51 PSI PASS 60 PSI 40 PSI PASS PASS ZONE P

MED AIR 54 PSI PASS 60 PSI 40 PSI PASS PASS ZONE P

VACUUM 23" 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 54 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 51 PSI PASS 60 PSI 40 PSI PASS PASS ZONE P

MED AIR 54 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 51 PSI PASS 60 PSI 40 PSI PASS PASS ZONE P

MED AIR 54 PSI PASS 60 PSI 40 PSI PASS PASS ZONE P

VACUUM 26" 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 55 PSI PASS 60 PSI 40 PSI PASS PASS ZONE P

VACUUM 26" 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 54 PSI PASS 60 PSI 40 PSI PASS PASS ZONE P

VACUUM 23" HG PASS N/A 12" HG PASS PASS ZONE P

FLOOR: 4TH ALARM LOCATION:

OUTSIDE OF 4A-080 ALARM MAKE AND MODEL: BEACON MEDAES MEGA 3

ACROSS FROM 4F-104 ALARM MAKE AND MODEL: BEACON MEDAES MEGA 3

AREA MONITORED: COMMENTS

4A-080

AREA MONITORED: COMMENTS

4B: 4B-009, 4B-012, 4B-018, 4B-020, 4B-024, 4B-027

ACROSS FROM 4B-009

4F: 4F-086, 4F-089, 4F-093, 4F-095, 4F-101, 4F-104

OUTSIDE OF 4A-003 ALARM MAKE AND MODEL: BEACON MEDAES MEGA 3

AREA MONITORED: COMMENTS

4A: 4A-109, 4A-110, 4A-059, 4A-065

OUTSIDE OF 4A-110 ALARM MAKE AND MODEL: BEACON MEDAES MEGA 3

AREA MONITORED: COMMENTS

AREA ALARM ANALYSIS

4TH FLOOR

AREA MONITORED: COMMENTS

4A: 4A-003, 4A-004, 4A-048, 4A-051

ALARM MAKE AND MODEL: BEACON MEDAES MEGA 3

AREA MONITORED: COMMENTS

4E: 4E-073 & 4E-076

NEXT TO 4E-072 ELECTRICAL CLOSET ALARM MAKE AND MODEL: BEACON MEDAES MEGA 3

AREA ALARM ANALYSIS

4TH 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 51 PSI PASS 60 PSI 40 PSI PASS PASS ZONE P

MED AIR 54 PSI PASS 60 PSI 40 PSI PASS PASS ZONE P

VACUUM 24" HG PASS N/A 12" HG PASS PASS ZONE P

FLOOR: 4TH ALARM LOCATION:

AREA MONITORED: COMMENTS

4C: 4C-037 & 4C-038

NEXT TO 4A-045 STAFF ROOM ALARM MAKE AND MODEL: BEACON MEDAES MEGA 3

END OF 4TH FLOOR AREA ALARM ANALYSIS

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 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 )

Zone valve boxes shall not be located in closed or locked rooms, areas, or closets. (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 53 PSI PASS PASS 1-1/4" BALL PASS PASS P

MED AIR 54 PSI PASS PASS 1" BALL PASS PASS P

VACUUM 26" HG PASS PASS 2" BALL PASS PASS P

FLOOR: GROUND VALVE LOCATION:

GAS

GAUGE

READING

GAS LABELED

CORRECTLY

ZONE LABELED

CORRECTLY

VALVE SIZE &

TYPE

PROPER

LOCATION

LEAKAGE PASS FAIL

MED AIR 53 PSI PASS PASS 3/4" BALL PASS PASS P

FLOOR: GROUND VALVE LOCATION:

COMMENTS

END OF GROUND FLOOR ZONE VALVE ANALYSIS

ACROSS FROM URGENT CARE BREAK ROOM VALVE MANUFACTURER: BEACON MEDAES

BIOMED: GR-034

NOTE: OUTLETS CAPPED

IN 35 & 36

OUTSIDE OF BIOMED VALVE MANUFACTURER: BEACON MEDAES

AREA SERVED:

ZONE VALVE ANALYSIS

GROUND FLOOR

AREA SERVED: COMMENTS

URGENT CARE: LL12, LL13, LL14, LL15,

LL16, LL17, LL25, LL38

GAS

GAUGE

READING

GAS LABELED

CORRECTLY

ZONE LABELED

CORRECTLY

VALVE SIZE &

TYPE

PROPER

LOCATION

LEAKAGE PASS FAIL

OXYGEN 51 PSI PASS PASS 1/2" BALL PASS PASS P

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

VACUUM 26" 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 50 PSI PASS PASS 1/2" BALL PASS PASS P

MED AIR 52 PSI PASS PASS 3/4" BALL PASS PASS P

VACUUM 26" 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 52 PSI PASS PASS 1/2" BALL PASS PASS P

MED AIR 54 PSI PASS PASS 1/2" BALL PASS PASS P

VACUUM 24" HG PASS PASS 3/4" BALL PASS PASS P

FLOOR: 1ST VALVE LOCATION:

AREA SERVED: COMMENTS

END OF 1ST FLOOR ZONE VALVE ANALYSIS

NEXT TO EXAM 1A-061 VALVE MANUFACTURER: BEACON MEDAES

PRIMARY CARE: 1A-053, 1A-061, 1A-062

AREA SERVED: COMMENTS

ROOM 1A-144 - FOR FUTURE USE

FOR FUTURE USE.

CAPPED ABOVE CEILING.

OUTSIDE OF ROOM 1A-144 VALVE MANUFACTURER: BEACON MEDAES

OUTSIDE DENTAL ENTRANCE VALVE MANUFACTURER: BEACON MEDAES

ZONE VALVE ANALYSIS

1ST FLOOR

AREA SERVED: COMMENTS

DENTAL CLINIC ROOMS: 1E-113, 1E-114,

1E-116, 1E-129, 1E-130, 1E-130A

MEDICAL AIR AND

VACUUM ARE FOR

FUTURE USE

GAS

GAUGE

READING

GAS LABELED

CORRECTLY

ZONE LABELED

CORRECTLY

VALVE SIZE &

TYPE

PROPER

LOCATION

LEAKAGE PASS FAIL

OXYGEN 49 PSI PASS PASS 3/4" BALL PASS PASS P

MED AIR 53 PSI PASS PASS 3/4" BALL PASS PASS P

VACUUM 26" HG PASS PASS 3/4" BALL PASS PASS P

FLOOR: 2ND VALVE LOCATION:

END OF 2ND FLOOR ZONE VALVE ANALYSIS

ZONE VALVE ANALYSIS

2ND FLOOR

AREA SERVED: COMMENTS

2A CT: 2002 & 2005

ACROSS FROM 2A-063 BONE DENSITY VALVE MANUFACTURER: BEACON MEDAES

GAS

GAUGE

READING

GAS LABELED

CORRECTLY

ZONE LABELED

CORRECTLY

VALVE SIZE &

TYPE

PROPER

LOCATION

LEAKAGE PASS FAIL

OXYGEN 51 PSI PASS PASS 3/4" BALL PASS PASS P

MED AIR 53 PSI PASS PASS 1/2" BALL PASS PASS P

VACUUM 23" 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 0 PSI PASS PASS 1" BALL PASS PASS

MED AIR 0 PSI PASS PASS 3/4" BALL PASS PASS

VACUUM 0" HG PASS PASS 3/4" BALL PASS PASS

FLOOR: 3RD VALVE LOCATION:

GAS

GAUGE

READING

GAS LABELED

CORRECTLY

ZONE LABELED

CORRECTLY

VALVE SIZE &

TYPE

PROPER

LOCATION

LEAKAGE PASS FAIL

OXYGEN 51 PSI PASS PASS 1" BALL PASS PASS P

MED AIR 54 PSI PASS PASS 3/4" BALL PASS PASS P

VACUUM 23" 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 48 PSI PASS PASS 3/4" BALL PASS PASS P

MED AIR 54 PSI PASS PASS 3/4" BALL PASS PASS P

VACUUM 26" 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

DENTAL AIR 100 PSI 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 51 PSI PASS PASS 3/4" BALL PASS PASS P

VACUUM 24" HG PASS PASS 1" BALL PASS PASS P

FLOOR: 3RD VALVE LOCATION:

AREA SERVED: COMMENTS

3A: 3A-154

NEXT TO 3A-154 VALVE MANUFACTURER: BEACON MEDAES

AREA SERVED: COMMENTS

3A & 3C: 3A-037, 3C-041A, 3C-041B

ZONE VALVE SHOULD

READ 3A-037, 3C-041A, &

3C-041B

NEXT TO 3A-045 VALVE MANUFACTURER: BEACON MEDAES

AREA SERVED: COMMENTS

ENDOSCOPY: 3E-111, 3E-111B, 3E-111C,

3E-113

OUTSIDE OF ENDO ENTRANCE VALVE MANUFACTURER: BEACON MEDAES

OUTSIDE OF 3A-004 VALVE MANUFACTURER: BEACON MEDAES

AREA SERVED: COMMENTS

3B: 3B-009, 3B-011, 3B-012, 3B-014, 3B-

017, 3B-018, 3B-020, 3B-023, 3B-24, 3B-

029, 3B-030, 3B-033

AREA UNDER

CONSTRUCTION.

HANDLES ARE REMOVED

AND ZONE VALVES ARE

TAGGED OUT

ACROSS FROM NURSE STATION VALVE MANUFACTURER: BEACON MEDAES

ZONE VALVE ANALYSIS

3RD FLOOR

AREA SERVED: COMMENTS

3A: 3A-003 & 3A-004

AREA SERVED: COMMENTS

3E: 3E-110E

ACROSS FROM 3E-110E SCOPE STORAGE VALVE MANUFACTURER: BEACON MEDAES

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 1" BALL PASS PASS P

MED AIR 51 PSI PASS PASS 3/4" BALL PASS PASS P

VACUUM 26" 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 52 PSI PASS PASS 3/4" BALL PASS PASS P

MED AIR 54 PSI PASS PASS 3/4" BALL PASS PASS P

VACUUM 23" HG PASS PASS 1" BALL PASS PASS P

FLOOR: 3RD VALVE LOCATION:

END OF 3RD FLOOR ZONE VALVE ANALYSIS

AREA SERVED: COMMENTS

ENDO RECOVERY: 3A-116

OUTSIDE OF 3A-116 ENDO RECOVERY VALVE MANUFACTURER: BEACON MEDAES

AREA SERVED: COMMENTS

3F: 3F-121, 3F-124, 3F-125, 3F-127, 3F-

133, 3F-136, 3F-138, 3F-141, 3F-144, 3F-

146, 3F-147, 3F-149

NEXT TO 3F-124 VALVE MANUFACTURER: BEACON MEDAES

GAS

GAUGE

READING

GAS LABELED

CORRECTLY

ZONE LABELED

CORRECTLY

VALVE SIZE &

TYPE

PROPER

LOCATION

LEAKAGE PASS FAIL

OXYGEN 52 PSI PASS PASS 3/4" BALL PASS PASS P

MED AIR 53 PSI PASS PASS 1/2" BALL PASS PASS P

VACUUM 24" HG PASS PASS 3/4" 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 51 PSI PASS PASS 1/2" BALL PASS PASS P

MED AIR 54 PSI PASS PASS 1/2" BALL PASS PASS P

VACUUM 21" HG PASS PASS 3/4" 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 50 PSI PASS PASS 3/4" BALL PASS PASS P

MED AIR 55 PSI PASS PASS 3/4" BALL PASS PASS P

VACUUM 23" HG PASS PASS 3/4" 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 52 PSI PASS PASS 1/2" BALL PASS PASS P

MED AIR 54 PSI PASS PASS 1/2" BALL PASS PASS P

VACUUM 23" HG PASS PASS 3/4" 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 52 PSI PASS PASS 1/2" BALL PASS PASS P

MED AIR 53 PSI PASS PASS 1/2" BALL PASS PASS P

VACUUM 25" HG PASS PASS 3/4" 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 50 PSI PASS PASS 3/4" BALL PASS PASS P

MED AIR 52 PSI PASS PASS 3/4" BALL PASS PASS P

VACUUM 24" HG PASS PASS 1-1/2" BALL PASS PASS P

FLOOR: 4TH VALVE LOCATION:

AREA SERVED: COMMENTS

4F: 4F-086, 4F-089, 4F-093, 4F-095, 4F-

101, 4F-104

ACROSS FROM 4F-104 VALVE MANUFACTURER: BEACON MEDAES

AREA SERVED: COMMENTS

4A-080

OUTSIDE OF 4A-080 VALVE MANUFACTURER: BEACON MEDAES

AREA SERVED: COMMENTS

4E: 4E-073 & 4E-076

NEXT TO 4E-072 ELECTRICAL CLOSET VALVE MANUFACTURER: BEACON MEDAES

ZONE VALVE ANALYSIS

4TH FLOOR

AREA SERVED: COMMENTS

4A: 4A-003, 4A-004, 4A-048, 4A-051

OUTSIDE OF 4A-003 VALVE MANUFACTURER: BEACON MEDAES

AREA SERVED: COMMENTS

4A: 4A-109, 4A-110, 4A-059, 4A-065

OUTSIDE OF 4A-110 VALVE MANUFACTURER: BEACON MEDAES

AREA SERVED: COMMENTS

4B: 4B-009, 4B-012, 4B-018, 4B-020, 4B-

024, 4B-027

ACROSS FROM 4B-009 VALVE MANUFACTURER: BEACON MEDAES

ZONE VALVE ANALYSIS

4TH FLOOR

GAS

GAUGE

READING

GAS LABELED

CORRECTLY

ZONE LABELED

CORRECTLY

VALVE SIZE &

TYPE

PROPER

LOCATION

LEAKAGE PASS FAIL

OXYGEN 52 PSI PASS PASS 1/2" BALL PASS PASS P

MED AIR 56 PSI PASS PASS 1/2" BALL PASS PASS P

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

FLOOR: 4TH VALVE LOCATION:

END OF 4TH FLOOR ZONE VALVE ANALYSIS

AREA SERVED: COMMENTS

4C: 4C-037 & 4C-038

NEXT TO 4A-045 STAFF ROOM VALVE MANUFACTURER: BEACON MEDAES

OUTLET ANALYSIS

OUTLET CODE REQUIREMENTS

Each station outlet/inlet for medical gases or vacuums shall be gas-specific, whether the outlet/inlet is threaded or is a noninterchangeable quick coupler. (NFPA 99 2024 5.1.5.1)

Each outlet/inlet shall be legibly identified in accordance with 5.1.11.3.1. (NFPA 99 2024 5.1.11.3)

Each station outlet/inlet, including those mounted in columns, hose reels, ceiling tracks, or other special installations, shall be designed so that parts or components that are required to be gas specific for compliance with 5.1.5.1 and 5.1.5.9 cannot be interchanged between the station outlet/inlet for different gases. (NFPA 99 2024 5.1.5.7)

All gas outlets with a gauge pressure of 345 kPa (50 psi), including, but not limited to, oxygen, nitrous oxide, medical air, and carbon dioxide, shall deliver 100 SLPM (3.5 SCFM) with a pressure drop of not more than 35 kPa (5 psi) and static pressure of 345 kPa to 380 kPa (50 psi to 55 psi).

(NFPA 99 2024 5.1.12.4.10.2)

Support gas outlets shall deliver 140 SLPM (5.0 SCFM) with a pressure drop of not more than 35 kPa (5 psi) gauge and static pressure of 1100 kPa to 1275 kPa (160 psi to 185 psi) gauge.

(NFPA 99 2024 5.1.12.4.10.3)

Medical–surgical vacuum inlets shall draw 85 Nl/min (3 SCFM) without reducing the vacuum pressure below 300 mm (12 in.) gauge HgV at any adjacent station inlet. (NFPA 99 2024 5.1.12.4.10.4)

Oxygen and medical air outlets serving critical care areas shall allow a transient flow rate of 170 SLPM

(6 SCFM) for 3 seconds. (NFPA 99 2024 5.1.12.4.10.5)

Medical gas concentration & flow rate requirements. (NFPA 99 2024 Table 5.1.12.4.11)

GAS FLOW RATE CONCENTRATION

OXYGEN Non-critical 3.5 SCFM Critical 6.0 SCFM ≥99% oxygen

MEDICAL AIR Non-critical 3.5 SCFM Critical 6.0 SCFM 19.5%–23.5% oxygen

NITROUS OXIDE 3.5 SCFM ≥99% nitrous oxide

NITROGEN 5.0 SCFM ≤1% O2 or ≥99% N2

OTHER GASES 3.5 SCFM

As specified by ±1%, unless otherwise specified

VACUUM 3.0 SCFM N/A

WAGD 3.0 SCFM N/A

OUTLET LOCATION

Le ak ag e w

A d ap te r Le ak ag e w

/o

A d ap te r O p er at io n al

Fl o w

St at ic P re ss u re

C o n ce n tr at io n

C o n d it io

La b el in g

PASS FAIL REPAIRED BY

GROUND FLOOR OXYGEN MEDICAL AIR VACUUM

BIOMED GD-035 1 BEACON DC CH P P P P P P P

URGENT CARE

LL12 2 2 2 AMICO SB CH P P P P P P P

LL13 2 2 2 AMICO SB CH P P P P P P P

LL14 2 2 2 AMICO SB CH P P P P P P P

LL15 2 2 2 AMICO SB CH P P P P P P P

LL16 2 2 2 AMICO SB CH P P P P P P P

LL17 2 2 2 AMICO SB CH P P P P P P P

LL25 2 2 2 AMICO SB CH P P P P P P P

LL38 2 2 2 AMICO SB CH P P P P P P P

TOTAL COUNT: 16 17 16

GAS TYPE & OUTLET QUANTITY OUTLET SPECS COMMENTS

OUTLET LOCATION

Le ak ag e w

A d ap te r Le ak ag e ap te r O p er at io w

St at ic P re ss u re

C o n ce n tr at io n

C o n d it io el in g

PASS FAIL REPAIRED BY

2ND FLOOR OXYGEN MEDICAL AIR VACUUM

CT 2002 1 1 1 BEACON SB DISS P P P P P P P

CT 2005 1 1 1 BEACON SB DISS

TOTAL COUNT: 2 2 2

OUTLET ANALYSIS

ROOM IS UNDER CONSTRUCTION

OUTLET LOCATION

Le ak ag e w

A d ap te r Le ak ag e ap te r O p er at io w

St at ic P re ss u re

C o n ce n tr at io n

C o n d it io el in g

PASS FAIL REPAIRED BY

1ST FLOOR OXYGEN MEDICAL AIR VACUUM

DENTAL CLINIC

1E-113 1 ALLIED 400 CH P P P P P P P

1E-114 1 ALLIED 400 CH P P P P P P P

1E-116 1 ALLIED 400 CH P P P P P P P

1E-129 1 ALLIED 400 CH P P P P P P P

1E-130 1 ALLIED 400 CH P P P P P P P

1E-130A 1 ALLIED 400 CH P P P P P P P

1A-053 1 1 1 BEACON SB CH P P P P P P P

1A-061 1 1 1 ALLIED 400 CH P P P P P P P

1A-062 1 1 1 ALLIED 400 CH P P P P P P P

TOTAL COUNT: 9 3 3

OUTLET LOCATION

Le ak ag e w

A d ap te r Le ak ag e ap te r O p er at io w

St at ic P re ss u re

C o n ce n tr at io n

C o n d it io el in g

PASS FAIL REPAIRED BY

3RD FLOOR OXYGEN MEDICAL AIR VACUUM

3A-003 4 4 4 AMICO SB CH P P P P P P P

3A-004 4 4 4 AMICO SB CH P P P P P P P

3B-009

3B-011

3B-012

3B-014

3B-017

3B-018

3B-020

3B-023

3B-024

3B-029

3B-030

3B-033

3A-037 2 2 2 AMICO SB CH P P P P P P P

3C-041A 4 4 4 AMICO SB CH P P P P P P P

3C-041B 4 4 4 AMICO SB CH P P P P P P P

3A-154 PROCEDURE 4 4 4 AMICO SB CH P P P P P P P

3E-110E 3 BEACON DC CH P P P P P P P

3E-111 - BED 1 2 2 2 ALLIED 400 CH P P P P P P P

3E-111 - BED 2 2 2 2 ALLIED 400 CH P P P P P P P

3E-111 - BED 3 2 2 2 ALLIED 400 CH P P P P P P P

3E-111 - BED 4 2 2 2 ALLIED 400 CH P P P P P P P

3E-111B 4 4 4 AMICO SB CH P P P P P P P

3E-111C 4 4 4 AMICO SB CH P P P P P P P

3E-113 2 2 2 ALLIED 400 CH P P P P P P P

3A-116 ENDO RECOVERY 4 4 4 AMICO SB CH P P P P P P P

TOTAL COUNT: 44 47 44

DENTAL AIR

ROOM IS UNDER CONSTRUCTION

ROOM IS UNDER CONSTRUCTION

ROOM IS UNDER CONSTRUCTION

ROOM IS UNDER CONSTRUCTION

ROOM IS UNDER CONSTRUCTION

ROOM IS UNDER CONSTRUCTION

ROOM IS UNDER CONSTRUCTION

ROOM IS UNDER CONSTRUCTION

OUTLET ANALYSIS

GAS TYPE & OUTLET QUANTITY OUTLET SPECS COMMENTS

ROOM IS UNDER CONSTRUCTION

ROOM IS UNDER CONSTRUCTION

OUTLET LOCATION

Le ak ag e w

A d ap te r Le ak ag e ap te r O p er at io w

St at ic P re ss u re

C o n ce n tr at io n

C o n d it io el in g

PASS FAIL REPAIRED BY

3RD FLOOR OXYGEN MEDICAL AIR VACUUM

OUTLET ANALYSIS

GAS TYPE & OUTLET QUANTITY OUTLET SPECS COMMENTS

3F-121 1 1 1 BEACON SB CH P P P P P P P

3F-124 1 1 1 BEACON SB CH P P P P P P P

3F-125 1 1 1 BEACON SB CH P P P P P P P

3F-127 1 1 1 BEACON SB CH P P P P P P P

3F-133 1 1 1 BEACON SB CH P P P P P P P

3F-136 1 1 1 BEACON SB CH P P P P P P P

3F-138 1 1 1 BEACON SB CH P P P P P P P

3F-141 1 1 1 BEACON SB CH P P P P P P P

3F-144 1 1 1 BEACON SB CH P P P P P P P

3F-146 1 1 1 BEACON SB CH P P P P P P P

3F-147 1 1 1 BEACON SB CH P P P P P P P

3F-149 1 1 1 BEACON SB CH P P P P P P P

TOTAL COUNT: 12 12 12

OUTLET LOCATION

Le ak ag e w

A d ap te r Le ak ag e ap te r O p er at io w

St at ic P re ss u re

C o n ce n tr at io n

C o n d it io el in g

PASS FAIL REPAIRED BY

4TH FLOOR OXYGEN MEDICAL AIR VACUUM

4A-003 2 2 2 AMICO SB CH P P P P P P P

4A-004 1 1 1 AMICO SB CH P P P P P P P

4A-048 1 1 1 AMICO SB CH P P P P P P P

4A-051 2 2 2 AMICO SB CH P P P P P P P

4A-109 1 1 1 AMICO SB CH P P P P P P P

4A-110 1 1 1 AMICO SB CH P P P P P P P

4A-059 1 1 1 AMICO SB CH P P P P P P P

4A-065 1 1 1 AMICO SB CH P P P P P P P

4F-086 2 2 2 AMICO SB CH P P P P P P P

4F-089 2 2 2 AMICO SB CH P P P P P P P

4F-093 1 1 1 AMICO SB CH P P P P P P P

4F-095 2 2 2 AMICO SB CH P P P P P P P

4F-101 1 1 1 AMICO SB CH P P P P P P P

4F-104 2 2 2 AMICO SB CH P P P P P P P

4A-080 1 1 1 AMICO SB CH P P P P P P P

4E-73 2 2 2 AMICO SB CH P P P P P P P

4E-76 1 1 1 AMICO SB CH P P P P P P P

4B-009 1 1 1 AMICO SB CH P P P P P P P

4B-012 2 2 2 AMICO SB CH P P P P P P P

4B-018 2 2 2 AMICO SB CH P P P P P P P

4B-020 2 2 2 AMICO SB CH P P P P P P P

4B-024 2 2 2 AMICO SB CH P P P P P P P

4B-027 2 2 2 AMICO SB CH P P P P P P P

4C-037 2 2 2 AMICO SB CH P P P P P P P

4C-038 2 2 2 AMICO SB CH P P P P P P P

TOTAL COUNT: 39 39 39

OUTLET PURITY &

CROSS CONNECT

ANALYSIS

VHA DIRECTIVE 7515

1.REASON FOR ISSUE: This Veterans Health Administration (VHA) directiveestablishes policy for the

Department of Veterans Affairs (VA) regarding the safeinstallation, operation, and maintenance of

Medical Gas and Vacuum Systems at VAmedical facilities.

VHA DIRECTIVE 7515(1) A-1 APPENDIX A

(1) Cross connection verification of 10 percent of the existing outlets annually. Testing cannot be repeated on an outlet until all outlets in the hospital have been tested once. Additionally, testing of newly installed outlets must not supersede the testing of existing outlets.

2) Purity verification at 10 percent of the existing outlets annually.

OUTLET PURITY & CROSS CONNECT REQUIREMENTS

OUTLET LOCATION

O2

AIR

COMMENTS

OUTLETS TESTED OXY MED AIR

MED

VAC

LL12 2 2 2 99.9% 21.3%

LL25 2 2 2 99.9% 21.3%

3A-004 4 4 4 99.9% 21.3%

3E-111B 4 4 4 99.9% 21.3%

3F-121 1 1 1 99.9% 21.3%

4F-086 2 2 2 99.9% 21.3%

4C-038 2 2 2 99.9% 21.3%

TOTAL COUNT: 17 17 17

OUTLET CROSS-CONNECT &

PURITY TESTING

GAS TYPE & OUTLET

QUANTITY

CROSS-CONNECT

PROCEDURE

PURITY

ANALYSIS

CROSS

CONNECT

STATUS

PASS/FAIL

INDIVIDUAL

PRESSURIZATION

PASS PASS

INDIVIDUAL

PRESSURIZATION

PASS PASS

INDIVIDUAL

PRESSURIZATION

PASS PASS

INDIVIDUAL

PRESSURIZATION

PASS PASS

INDIVIDUAL

PRESSURIZATION

PASS PASS

INDIVIDUAL

PRESSURIZATION

PASS PASS

INDIVIDUAL

PRESSURIZATION

PASS PASS

CSMEDGAS.COM COMPLIANCE SOLUTIONS 1-833-5MEDGAS

MEDICAL GAS SOURCE

EQUIPMENT ANALYSIS

LOCATION BULK TANK FARM

AREA(S) OF FACILITY SERVED ENTIRE FACILITY

BULK SUPPLIER OZARC GAS

SYSTEM TYPE LIQUID X HP - 10 X 10

PRIMARY LIQUID LEVEL 75"

PRIMARY PRESSURE 180 PSI

RESERVE LIQUID LEVEL N/A

RESERVE PRESSURE 1550 PSI

PRIMARY FINAL LINE PRESSURE 180 PSI

RESERVE FINAL LINE PRESSURE 190 PSI

SOURCE VALVE PRESSURE 51 PSI

MAIN VALVE PRESSURE 51 PSI

SOURCE VALVE TYPE BALL JOINT

SOURCE VALVE LOCATION SOILED UTILITY ROOM

PRESSURE SWITCH LOCATION GD-041 EQUIPMENT STORAGE

EOSC VALVE SIZE 2"

EOSC LOCATION(S) EXTERIOR WALL NEAR BULK

PASS FAIL N/A

P

P

P

P

P

P

P

P

P

P

P

P

P

P

Piped w/brazed copper, brass, or stainless & no flex connects/fittings wear & leaks

Reserve and primary check valves in place for reserve to feed automatically

Reserve economizer in place to feed upstream final regulators

Drainage prevented towards (buildings, drains, etc.) & from hazards

Labeling: pipeline, source/main valves & "Oxygen-No Smoking, No Open Flames"

Vaporizer appears adequately sized & isolation valves arranged for service w/o supply interruption

Emergency Supply (3' clearance) or (IBER) w/2 checks, secured, & labeled

Distance from the following: 1' - all structures (Type I & II), * 50' - wood framed Type III, IV, or V building types, * 50' - Public assembly or nearest non- ambulatory patient, * 5' -

Property lines & overhead electrical wiring, 10' building openings, * 10' - public sidewalks & parked vehicles, * 15' - Hazardous piping materials & below ground flammable liquid tanks, * 25' - 0-1000 gal flammable liquids/liquefied gas, below ground flammable liquid fill or vent, 0-25,000 scf flammable gases, or slow burning solids, * 50' - >1000 gal flammable liquids/liquefied gas, >25,000 scf flammable gases, or rapidly burning solids, 3' - combustible surfaces (asphalt & expansion joint filler) where liquid oxygen may fall, 8' - Sewer or drain openings to delivery connects, reliefs, mobile supply equipment, & liquid withdrawal connects, Walls may not form a 3-4 sided court.

MEETS ALL NFPA 99 2024 CODE REQUIREMENTS PASS

ADDITIONAL COMMENTS

Proper fill circuit (inlet, strainer, check valve, purge valve, supports)

BULK OXYGEN

SOURCE EVALUATION DATA

NFPA 99 2024 SCHEMATIC

NFPA 99 2024 CHECKLIST

System visibly complies with above schematic per NFPA 99.

Enclosure (min 6' height) non-combustible, proper ventilation & 2 lockable entries/exits

Containers permanently anchored & cylinders adequately secured

Noncombustible pad w/3' maintenance clearance, accessible for delivery & pad adequately sized for vehicles

Top & bottom fill, hose purge, & vent valves present

LOCATION BASEMENT MECHANICAL ROOM LINE PRESSURE

AREA(S) OF FACILITY SERVED ENTIRE FACILITY DRYER TYPE

MANUFACTURER POWEREX DRYER INFO

MODEL NUMBER MTD050525 DEW POINT MONITOR INFO

SERIAL NUMBER (H)11/30/2018-6183006-287 CO MONITOR INFO

SYSTEM TYPE RECIPROCATING SOURCE VALVE LOCATION

CONFIGURATION DUPLEX PRESSURE SWITCH LOCATION

PUMP MAKE AND MODEL BALDOR EM3312T PUMP 1 HOURS

HORSEPOWER 5 HP PUMP 2 HOURS

LEAD ON/OFF 105/95 PSI PUMP 3 HOURS

LAG ON/OFF 95/85 PSI PUMP 4 HOURS

ELEMENT NFPA LIMIT READING PASS/FAIL

DEW POINT (MONITOR ON SYSTEM) 35 DEG F -19 DEG F PASS

DEW POINT (CS MONITOR) 35 DEG F -21 DEG F PASS

CARBON MONOXIDE (MONITOR ON SYSTEM) 10 PPM 0 PPM PASS

CARBON MONOXIDE (CS MONITOR) 10 PPM 0 PPM PASS

CARBON DIOXIDE 500 PPM 103 PPM PASS

METHANE 25 PPM 0 PPM PASS

CHLOROFORM 2 PPM 0 PPM PASS

OXYGEN 19.5%-23.5% 21.3% PASS

PASS FAIL N/A

P

P

P

P

P

P

P

P

P

P

P

P

P

P

P

P

P

P

N/A

MEDICAL AIR SYSTEM

SOURCE EVALUATION DATA

110 PSI

DESICCANT

POWEREX PDM11003AJ

POWEREX DK964700AJ

ENMET CO-GUARD

BEHIND SOURCE

BEHIND SOURCE

System power supplied from emergency power

N/A

NFPA 99 2024 SCHEMATIC MEDICAL AIR PURITY ANALYSIS

COMMENTS

NFPA 99 2024 CHECKLIST

System visibly complies with above schematic per NFPA 99.

Indoors in a dedicated mechanical equipment area, adequately ventilated and with any required utilities

System has two or more medical air compressors

System is supplied with flexible connectors on inlet and outlet sides of the compressors

Intake above roof level, >20' above ground, 10 ft from doors, windows, other openings, and 25' from exhausts

System is equipped with manual disconnects

System is equipped with a local lag, dew point and CO alarm

The local alarms are wired to the master alarm panel

Receiver tank is supplied with an Auto drain, pressure gauge, sight glass, pressure relief, & ASME label

There is a receiver bypass valve so the receiver can be serviced without interruption of the system

Each pump has an isolation valve so a pump can be serviced without interruption of the system

System automatically alternates the pumps evenly

Duplexed dryer system

1/4" sample port installed

Source valve in proper location and labeled

Mainline and intake piping properly labeled

Intake turned down and screened

MEETS ALL NFPA 99 2024 CODE REQUIREMENTS PASS

ADDITIONAL COMMENTS

LOCATION BASEMENT MECHANICAL ROOM LINE PRESSURE

MANUFACTURER BEACON MEDAES DRYER INFO

MODEL NUMBER 4107005549 DEW POINT MONITOR INFO

SERIAL NUMBER HOP401608 CO MONITOR INFO

SYSTEM TYPE DUPLEX SOURCE VALVE LOCATION

CONFIGURATION DUPLEX PRESSURE SWITCH LOCATION

PUMP MAKE AND MODEL BEACON MEDAES AIA2498719 PUMP 1 HOURS

HORSEPOWER 10 HP PUMP 2 HOURS

LEAD ON/OFF 105/95 PSI PUMP 3 HOURS

LAG ON/OFF 95/85 PSI PUMP 4 HOURS

ELEMENT NFPA LIMIT READING PASS/FAIL

DEW POINT (MONITOR ON SYSTEM) 35 DEG F -11 DEG C PASS

DEW POINT (CS MONITOR) 35 DEG F -13 DEG C PASS

CARBON MONOXIDE (MONITOR ON SYSTEM) 10 PPM 0 PPM PASS

CARBON MONOXIDE (CS MONITOR) 10 PPM 0 PPM PASS

CARBON DIOXIDE 500 PPM 114 PPM PASS

METHANE 25 PPM 0 PPM PASS

CHLOROFORM 2 PPM 0 PPM PASS

OXYGEN 19.5%-23.5% 21.3% PASS

PASS FAIL N/A

P

P

P

P

P

P

P

P

P

P

P

P

P

P

P

P

P

PIntake turned down and screened

MEETS ALL NFPA 99 2024 CODE REQUIREMENTS PASS

ADDITIONAL COMMENTS

Intake above roof level, >20' above ground, 10 ft from doors, windows, other openings, and 25' from exhausts

System is equipped with manual disconnects

System is equipped with a local lag, dew point and CO alarm

The local alarms are wired to the master alarm panel

Receiver tank is supplied with an Auto drain, pressure gauge, sight glass, pressure relief, & ASME label

There is a receiver bypass valve so the receiver can be serviced without interruption of the system

Each pump has an isolation valve so a pump can be serviced without interruption of the system

System automatically alternates the pumps evenly

Duplexed dryer system

1/4" sample port installed

Source valve in proper location and labeled

Mainline and intake piping properly labeled

System power supplied from emergency power

N/A

NFPA 99 2024 SCHEMATIC MEDICAL AIR PURITY ANALYSIS

COMMENTS

NFPA 99 2024 CHECKLIST

System visibly complies with above schematic per NFPA 99.

Indoors in a dedicated mechanical equipment area, adequately ventilated and with any required utilities

System has two or more medical air compressors

System is supplied with flexible connectors on inlet and outlet sides of the compressors

N/A

MEDICAL AIR SYSTEM

SOURCE EVALUATION DATA

96 PSI

DESICCANT

BEACON MEDAES SF72

INTERNAL

INTERNAL

BEHIND SOURCE

BEHIND SOURCE

LOCATION BASEMENT MECHANICAL ROOM

MANUFACTURER ALLEN-BRADLEY

MODEL NUMBER 4000054719

SERIAL NUMBER CA 1786010-01

SYSTEM TYPE LUBE VANE

CONFIGURATION DUPLEX

PUMP MAKE AND MODEL FLOWSERVE 4000054719

HORSEPOWER 4.2 HP

LEAD ON/OFF 22/18" HG

LAG ON/OFF 19/16" HG

LINE PRESSURE 22" HG

SOURCE VALVE LOCATION BEHIND SOURCE

PRESSURE SWITCH LOCATION BEHIND SOURCE

PUMP 1 HOURS 7088

PUMP 2 HOURS 7123

PUMP 3 HOURS N/A

PUMP 4 HOURS N/A

PASS FAIL N/A

P

P

P

P

P

P

P

P

P

P

P

P

P

P

P

P

P

NFPA 99 2024 CHECKLIST

MEDICAL VACUUM SYSTEM

SOURCE EVALUATION DATA

NFPA 99 2024 SCHEMATIC

Each pump has an isolation valve so a pump can be serviced without interruption of the system

System visibly complies with above schematic per NFPA 99.

Located in a dedicated mechanical equipment area, adequately ventilated and with any required utilities

System has two or more medical vacuum pumps

System has flexible connectors

System has antivibration mountings

System power supplied from emergency power

System is equipped with manual disconnects

System is equipped with a local lag alarm

The local alarms are wired to the master alarm panel

Receiver tank is supplied with an Auto drain & ASME label

There is a receiver bypass valve so the receiver can be serviced without interruption of the system

PASS

ADDITIONAL COMMENTS

System automatically alternates the pumps evenly

Source valve in proper location and labeled

Mainline and exhaust piping properly labeled

Exhaust is turned down and screened

Exhaust ≥25' from doors, windows, intakes, building openings & public assembly & copper or stainless, no dips, drip legs installed, & sufficient diameter

MEETS ALL NFPA 99 2024 CODE REQUIREMENTS

LOCATION BASEMENT MECHANICAL ROOM

MANUFACTURER ALLEN-BRADLEY

MODEL NUMBER 4000054719

SERIAL NUMBER CA 1786010-01

SYSTEM TYPE LUBE VANE

CONFIGURATION DUPLEX

PUMP MAKE AND MODEL FLOWSERVE 4000054719

HORSEPOWER 4.2 HP

LEAD ON/OFF 22/18" HG

LAG ON/OFF 19/16" HG

LINE PRESSURE 21" HG

SOURCE VALVE LOCATION BEHIND VACUUM SYSTEM 1

PRESSURE SWITCH LOCATION BEHIND VACUUM SYSTEM 1

PUMP 1 HOURS 6865

PUMP 2 HOURS 6857

PUMP 3 HOURS N/A

PUMP 4 HOURS N/A

PASS FAIL N/A

P

P

P

P

P

P

P

P

P

P

P

P

P

P

P

P

P

PASS

ADDITIONAL COMMENTS

System automatically alternates the pumps evenly

Source valve in proper location and labeled

Mainline and exhaust piping properly labeled

Exhaust is turned down and screened

Exhaust ≥25' from doors, windows, intakes, building openings & public assembly & copper or stainless, no dips, drip legs installed, & sufficient diameter

MEETS ALL NFPA 99 2024 CODE REQUIREMENTS

Each pump has an isolation valve so a pump can be serviced without interruption of the system

System visibly complies with above schematic per NFPA 99.

Located in a dedicated mechanical equipment area, adequately ventilated and with any required utilities

System has two or more medical vacuum pumps

System has flexible connectors

System has antivibration mountings

System power supplied from emergency power

System is equipped with manual disconnects

System is equipped with a local lag alarm

The local alarms are wired to the master alarm panel

Receiver tank is supplied with an Auto drain & ASME label

There is a receiver bypass valve so the receiver can be serviced without interruption of the system

NFPA 99 2024 CHECKLIST

MEDICAL VACUUM SYSTEM

SOURCE EVALUATION DATA

NFPA 99 2024 SCHEMATIC

LOCATION PENTHOUSE LINE PRESSURE

MANUFACTURER ATLAS-COPCO DRYER INFO

MODEL NUMBER SF8+ DEW POINT MONITOR INFO

SERIAL NUMBER API775262 CO MONITOR INFO

SYSTEM TYPE SCROLL SOURCE VALVE LOCATION

CONFIGURATION DUPLEX PRESSURE SWITCH LOCATION

PUMP MAKE AND MODEL N/A PUMP 1 HOURS

HORSEPOWER 9.92 HP PUMP 2 HOURS

LEAD ON/OFF 100/110 PSI PUMP 3 HOURS

LAG ON/OFF 85/95 PSI PUMP 4 HOURS

ELEMENT NFPA LIMIT READING PASS/FAIL

DEW POINT (MONITOR ON SYSTEM) NEG 22 DEG F -32 DEG C PASS

DEW POINT (CS MONITOR) NEG 22 DEG F -30 DEG C PASS

CARBON MONOXIDE (MONITOR ON SYSTEM) 10 PPM 0 PPM PASS

CARBON MONOXIDE (CS MONITOR) 10 PPM 0 PPM PASS

OXYGEN 19.5%-23.5% 21.3%

PASS FAIL N/A

P

P

P

P

P

P

P

P

P

P

P

P

P

P

P

P

N/A

LAB AIR SYSTEM

SOURCE EVALUATION DATA

108 PSI

DESICCANT

ATLAS COPCO 1624 7324 80

INTERNAL

INTERNAL

ABOVE SOURCE

WALL ACROSS FROM SOURCE

N/A

NFPA 99 2024 SCHEMATIC LAB AIR PURITY ANALYSIS

COMMENTS

Each pump has an isolation valve so a pump can be serviced without interruption of the system

NFPA 99 2024 CHECKLIST

System visibly complies with above schematic per NFPA 99.

Indoors in a dedicated…