va medgas_1 Report.pdf

ALEXANDRIA VA MEDICAL CENTER

2495 Shreveport Hwy 71

Pineville, Louisiana 71360

MEDICAL GAS AND VACUUM

EQUIPMENT

System includes Oxygen, Vacuum, Instrument Air, and Medical

Air.

There is no nitrogen included in the system. All nitrogen is contained in bottle at place of use as a stand-alone system.

They are not monitored by or connected to the system.

BUILDING 7 OXYGEN SUPPLY

BUILDING 45 OXYGEN SUPPLY

BUILDING 7 MEDICAL AIR

Serial Number: 5101627-186

INSTRUMENT AIR BUILDING 7

Amico Compressor

Serial Number: SMB1730 JOB # 09621

Model A-SCD-Q-120P-SS-N-050-20863-0

MAIN MEDICAL VACUUM BUILDING 7

Model: Powerex VPT 15052P1

Serial Number: 1-2-19-6192317-189

Startup Date: 2/22/2019

Run Time Hours as: PUMP 1 - 10545

PUMP 2- 10812

PUMP 3 - 10944

DENTAL VACUUM BUILDING 7

Ramvac (Dental Vacuum) Model

818E.1050.3

PUMP 1 S/N BN1408140 PUMP 2 S/N BN1407124

AIR STAR 70 VACUUM PUMP - DENTAL BUILDING 7

Model AS70

Serial Number: AS700-18070006

Meter Reading

MEDICAL VACUUM AT NURSING HOME

Powerx (Medical Vacuum) Model VV0TD050456192317

Serial Number: 12-28-18 6192317-183

Hours: Pump 1 — 5003

Pump 2- 6381

Medical Gas and Vacuum Monitoring Panels

Total of three of these monitors.

One located in Basement in Biomed Office.

One located at admitting on first floor.

One located on second floor.

Do not turn off

Oxygen Valve ontact Charge

NURSE

Vacuum and Oxygen Alarm Panels located on 2nd, 3rd, and 4th Floor and both ends totaling 8 panels. Along with Zone Valves.

Medical Vacuum, Oxygen, and Medical Air Monitoring

There are three of these panels in the Imaging Department on first floor and four on the fourth floor in the operating rooms area and recovery.

Monitors Medical vacuum, oxygen, and medical air.

Zone Valves for Nursing Home — Building 45

Master Alarm Panel for Nursing Home — Building 45

Field Service Report for Maintenance of medical gas equipment as described in contract #36C25618D00792022

P.O. Box 6302 Chesapeake, VA 23322

757.842.4825 Office GCSI

General Contracting Solutions, Inc.

DBE, SWaM, EDWOSB, WOSB, and Micro-Business Certified Service Disabled Veteran Owned Small Business Verified

January 14, 2022

Department of Veterans Affairs 2495 Shreveport Highway Pineville LA 71360-4044

Subject: Maintenance of medical gas equipment as described in contract #36C25618D0079

The following is a summary of the work performed and condition of the medical equipment at the Pineville VA on January 12 - 13 of 2022. Next regular secluded visit June 10, 2022.

Dental Compressor:

Air Techniques Ref: Model Airstar 70 Ser # AS700-18070006 Volts: 220 VAC Amps 24.0 Hours: 801

• Drained tank

• Checked air filter, cleaned Unit

Dental Vacuum Systems:

Ram-Vac # 1 Model # 818E.1050.3 Ser # BN1408140 Hrs : NA

Ram-Vac # 1 Model # 818E.1050.3 Ser# BN1408124 Hrs : NA

Note: These systems were not serviced at this time because of the COVID-19 emergency.

• Systems will be serviced at the June campaign.

Laboratory Compressor:

Amico / Powerex, Quadplex unit.

Model # A-SCD-Q-120P-SS-N-050-20863-0

SER #

HRS unit # 1 / 4,748 UNIT # 2 / 2,618 UNIT # 3 / 4,405 UNIT # 4 /5,196

• Cleaned all air filters including filters on dryer.

• Blew out dirt in radiators.

• Cleaned unit, tightened miscellaneous screws.

• Adjusted to manufacturer recommendations.

Note: Number 2 compressor pump is still not running and should be considered for replacement.

This unit is running very well.

757.842.4825 Office GCSI

General Contracting Solutions, Inc.

Medical Air Compressor Powerex, Triplex unit.

Model # MST1000525

SER # 510627-186

HRS unit # 1/2166.2 UNIT # 2 / 2136.0 UNIT #3 / 2,180.7

• Cleaned all air filters including filters on dryer.

• Adjusted belt tension on compressor

• Blew out dirt in radiators.

• Cleaned unit, tightened miscellaneous screws.

• Adjusted unit to manufacturer recommendations.

Note: Changed out Shuttle valve. Compressor running very well.

Medical Vacuum System Powerex Triplex unit.

Model #

SER #

HRS unit # 1 7,712.0 UNIT # 2 / 7978.0 UNIT # 3 / 8111.0

• Cleaned blower fans

• Cleaned fan shield

• Topped off oil.

• Adjusted according to manufacturer recommendations.

Note: New Chip installed at last campaign and seems to be working because duty cycle is down to 29% which is a very good duty cycle.

Control Air System Powerex, Duplex unit.

Model # STD050322

SER # 5636494-236

HRS unit # 1 / 421 .4 UNIT # 2 / 1.4

Note: this unit is not in contract. However, the #2 compressor has never run and should be considered for replacement.

757.842.4825 Office GCSI

General Contracting Solutions, Inc.

CLC Vacuum system Powerex, Duplex Vacuum unit. New Unit Model #

SER #

HRS unit # 1 / 3,586.0 UNIT #2 / 5,067.0

• Total HR's 8,653.0 unit is running at 16% duty cycle

• Unit was due for 5000 HR service

• Cleaned fan and hub

• Cleaned unit

• Adjusted according to manufacturer recommendations.

Note: Found Vacuum #1 was off line causing Vacuum #2 to have more hours than normal. Reset breaker and adjusted AMP switch to 7 AMP's (amp reading was 6.2).

Had hospital personnel check on vacuum the following week and found system to be working according to manufacturer recommendations.

Note: Randy Brossett of hospital engineering noted during an "Oxygen Low Reserve alarm" that the medical gas master alarm panel at the entrance of the hospital was not reading the same verbiage as the master alarm in the engineering department. EMGS Inc. troubleshot the oxygen farm and found that 2 wires were in the incorrect position. GCSI team changed the wiring and ran a simulated alarm through the control box in the liquid oxygen farm and found alarms verbiage to be current.

VAMC Alexandria

Pineville, LA

Evergreen

MEDICAL SERVICES

1-800-872-8992 www.evergreenmedicaLcom

- System Dew Point Page(s) 73

- Particulate Contaminants Page(s) 74-75

Randall Brossett

Biomed

03/29/2023

Jason Cates

William Sigler

Medical Gas Contact Name:

Medical Gas Contact Dept:

Inspection Dates(s):

Territory MGR

Lead Technician(s)

ASSE 6030 CREDENTIAL: 00042161

ASSE 6030 CREDENTIAL: 12544604

- Gaseous Contaminants.. . Page(s) 76-77

Section 8 - Source EQPT Summary.. P. 78

- Source Equipment .. . Page(s) 79-84

Evergreen Medical Services, Inc. in accordance with applicable NEPA & CMS codes and standards has evaluated the medical piping systems indicated in this report. These .systems have been found to be within applicable guidelines except as noted within this report. Any deficiencies cited are based on the most current applicable edition of NP PA 99.

Conflicts may occur when different editions of NEPA 99 have been adopted by different Allis, and compliance occurs with one edition but not the other. Changes made to newer editions of NEPA 99 are done so to improve the system's quality, integrity, fire resistance, effectiveness, durability, and safety. Dependent on the opinion of the AILI(s), the newer code edition is generally acceptable as equivalent or superior to an older version(s).

Per NFPA 99 an existing system that is not in strict compliance with the applicable codes may continue to he used as long as it is not a distinct hazard to safety. Fire/Explosion hazards, labeling, manifbld enclosures, medical air usage, & maintenance codes apply to new & existing fqcilities.

InfOrmation recorded on this report represent findings on the indicated evaluation date(s) only. Any action taken in response to recommendations included in this report should be recorded on the appropriate pages. This report should not be copied unless in entirety.

Medical Facility:

City, State:

REPORT CONTENTS

Section 1 - Systems Overview. age(s) 3-5

Section 2 - Deficiencies

- Area Alarm Deficiencies.... Page(s) 6-7

- Zone Valve Deficiencies .. . . Page(s) 8-10

-Outlets & Inlets Deficiencies. Page(s) 11-12

Section 3- Master Alarms ... Page(s) 13-17

- Master Alarm Inventory. . Page(s) 18

Section 4 - Area Alarms Page(s) 19-24

- Area Alarm Inventory Page(s) 25

Section 5 - Zone Valves ..... Page(s) 26-33

- Zone Valve Inventory Page(s) 34

Section 6- Outlets & Inlets . Page(s) 35-71

- Outlets & Inlets Inventory. Page(s) 72

Section 7 - Contaminants

VAMC Alexandria

Pineville, LA

Nos Evergreen acnvia, 03/29/2023

MEDICAL GAS INSPECTION REPORT

Medical Gas and Vacuum Systems Inspection/Testing

VAMC Alexandria www.evergrecn m ed ica I.com 2021 Evergreen Medical Servicvs, Inc - rER 2.21 Corporate Office: 1-800-872-8992

MASTER ALARMS/SIGNALS (EACH SIGNAL COUNTED INDIVIDUALLY)

Total Master Alarm Signals 56

Quantity of Deficient Master Alarm Signals 0

Total Quantity of Master Alarm Signals has remained the same from previous nzedical gas systems inspection.

Quantity of Passing Master Alarm Signals 56

AREA ALARMS (EACH SYSTEM GAS COUNTED AS SEPARATE ALARM)

ZONE VALVES (EACH SYSTEM GAS COUNTED INDIVIDUALLY)

Total Zone Valves 89

Quantity of Passing Zone Valves

Quantity of Deficient Zone Valves

Total Quantity of Zone Valves has remained the same from previous medical gas systems inspection.

r. ()wooly 01 vAlog AM(' i .4111VA

0 Omolloy

11elic unt Awe

1 arlivN

0.0% iltiatully l'asmog ;11,7Nie,.

.11,1171, Signal.% o Quantio• of klicion Master

:Ilan» Signals

- - I I I-rr":"1 11- -1

Total Area Alarms

Quantity of Passing Area Alarms 58

Quantity of Deficient Area Alarms

Total Quantity of Area Alarms has remained the same from previous medical gas systems inspection.

1.7%

0 0 b =C3

DD

03/29/2023 GAS SYSTEMS OVERVIEW VAMC Alexandria

Medical Gas and Vacuum Systems Inspection/Testing ww%.evergreen inedical.com ; 21721 Evergreen .1 ledwal Services. - IHI 2.21 .orporale Office: I -S00-872-74992

OUTLETS, INLETS & MANUFACTURED ASSEMBLIES

Total Outlets & Inlets 666

Quantity of Passing Outlets/Inlets 661

0.8"

Quantity of Deficient Outlets/Inlets 5

Total Ouantity of Owlets. Inlets and Mcmuliwiured Assemblies has remained the same from previous medical gas systems inspedion.

SYSTEM DEW POINT

Total Dew Point Test Sites

Quantity of Passing Test Sites

00 0 maniat

Quantity of Deficient Test Sites 0

0 )1h1111;11

The Test Sites are selected in order 10 represent System Dew

.5 (•11, Point in both high-use and low-use areas tar the systems tested.

00Q0

PARTICULATE CONTAMINANTS

Total Particulate Contaminant Test Sites 12

Quantity of Passing Test Sites 12

The Test Sites are selected in order to represent Particulate Contaminants in both high-use and low-use areas/or the systems 100% tested.

Quantity of Deficient Test Sites

03/29/2023 GAS SYSTEMS OVERVIEW VAMC Alexandria

Medical Gas and Vacuum Systems Inspection/Testing Pineville, LA

WW W.CV e rgreen me(l ica I. co in • 21)21 Evergreen Iledical Servrces. br - III? 22/ 'orporatc Office: 1-800-872-8992 o 011(111111.1'

PasSing Solirce

Symons

(hhifIll/.1' k fieleill Solfree

Total Source Systems

Quantity of Passing Source Systems

Quantity of Deficient Source Systems

Total Ouamily olSource Equipment has remained the same from previous medical gas .systents inspection.

GASEOUS CONTAMINANTS

Total Gaseous Contaminants Test Sites

Quantity of Passing Test Sites

1"")

1?

00 0

:701,11111f .v ul l'assing res1

Quantity of Deficient Test Sites 0

\Iles

ClOnanio-

The Test Sites are selected in order to represent Gaseous

Jkliesenfl'esi

C'ontaminanls in all separate distribution and source Aystents.

I 00° Saes

SOURCE EQUIPMENT

03/29/2023 GAS SYSTEMS OVERVIEW VAMC Alexandria

Medical Gas and Vacuum Systems Inspection/Testing Pineville, LA

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03/29/2023

AREA ALARM DEFICIENCIES

Medical Gas and Vacuum Systems Inspection/Testing

VAMC Alexandria Pineville, LA

AREA ALARM DEFICIENCIES OVERVIEW

DEFICIENCY DESCRIPTION

QTY

DEFICIENT

QTY

CORRECTED

ACTION NEEDED

A.) Alarm Set Points: Incorrect High and/or Low Alarm Set Point(s) 0 0 Adjust Set Points to 1 /-20% Operating Pressure

B) Transducer Location: Incorrect Transducer Location (I 0 Move Transducers to Correct Side of Zone Valve

( ') Transducer Location: No Demand Check 0 0 Install Demand Check

I)) Transducer Function: Incorrect (ias Pressure Displayed 1 0 Repair/Recalibrate/Replace Transducer

E) Alarm Location: Improper Alarm Panel Location (I 0 Move Alarm to Appropriate Location

F) Alarm Location: No Alarm in Place 0 0 Install Area Alarm & Transducer

() Panel Function: Visual and/or Audible Alarm Function Failure (1 0 Repair/Replace Annunciator Module / Ribbon Cable /Alarm Panel

II) Panel Function: Power Failure 0 0 Repair/Replace Power Supply

I) Panel Function: Incorrect Power Source 0 0 Connect Alarm to Life Safely Branch

.1) Module Function: Module Display Blank or Error Message 0 0 Repair/Replace Module or Defective Transducer

K) Labeling: Area Monitored Labeling Missing/Incorrect (1 0 Label Area Monitored

I.) Labeling: Gas System Monitored Not Labeled 0 0 Label Gas System Monitored

Al) Other: 0 0 Inaccurate Gauge

TOTALS: 1 0

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V A

M C

A le x an d ri a P in ev il le

, L ra te O ff ic e:

I

-8

-8

-8 w w .e ve rg re e n m e tl i c a lc o m

N

DEFICIENCY DETAIL AND/OR

CORRECTIVE ACTION*

*Please Date, Describe Action Taken, & Refer to Work

Order if Applicable

D ) T ra ns du ce r Fu nc tio n:

In co rr ec t G as

P re ss ur e D is pl ay ed

D E

F

IC

IE

N

C Y

C O

D E

Other

Labeling

Module Function

Panel Function

Panel Location

Transducer Function

Transducer Location

Alarm Set Points

R

E A

A L

A R

M D

E F

IC

IE

N C

IE

S

B R

E A

K D

O W

N (B

V

IT

E M

N U

M B

E R

D E

F

IC

IE

N

T A

R E

A A

L A

R M

L O

C A

T

IO

Low Pressure Alarm Setting (Positive in PSI/Negative in Inilig) cl

High Pressure Alarm Setting (Positive in PSI/Negative in In/Hg)

Pressure Reading (Positive in PSINegative in In/Hg) rn

Model

P

Manufacturer

C o t.)

t, m

System Gas

Area/Zone Monitored

R e co ve ry

-6

Is o l at io n

R m

Alarm Physical Location

B ld g

. 4 th F

L

R ec o ve ry

# cr, ei

03/29/2023 ZONE VALVE DEFICIENCIES VAMC Alexandria

Medical Gas and Vacuum Systems Inspection/Testing Pineville, LA

ZONE VALVE DEFICIENCIES OVERVIEW

DEFICIENCY DESCRIPTION

QTY

DEFICIENT

QTY

CORRECTED

ACTION NEEDED

A: Gauge: Inaccurate Pressure Reading 0 0 Replace Gauge

B:Gauge: Incorrect Scale Range (/ 0 Install Gauge With Correct Scale Range

C: Gauge: No Gauge in Port 0 0 Install Gauge

I): Gauge: On Source Side of Valve 0 0 Repipe Valve So Gauge is Downstream of Valve

I.:: General Condition: Missing/Broken Handle 0 0 Replace Handle

F: General Condition: Missing/Broken Window 0 0 Replace Window

G: Labeling: Inaccurate Rooms/Area Served 0 0 Verift Rooms/Area Served and Relabel

II: Labeling: Labeled as if in Series 0 0 Verify Rooms/Area Served and Relabel (Repiping or Decommissioning

Valve May Be Necessary)

I: Labeling: Missing Non-Standard Pressure Verbiage 0 0 Label All Required Components with Non-Standard Pressure

.1: Labeling: Missing System Gas 0 0 Update Label to Include System Gas

K: Labeling: Missing Warning Verbiage 0 0 Update Label to Include Warning Verbiage

1: Labeling: Rooms/Area not Attributed a Zone Valve 0 0 Verib if Rooms/Area is Served by an Existing Zone Valve (Installation

Necessary. if Rooms/Area is not Currently Served by a Zone Valve)

NI: Leak: Extemal Leak 0 0 Rebuild if Possible or Replace Leaking Valve

N: Leak: Gas Passes Through Valve When Closed 0 0 Rebuild if Possible or Replace Leaking Valve

0: Leak: Gauge Connection Leaks 0 0 Re-install Gauge Using Oxygen-Safe Sealant (Replacement of ['cave May be Necessary)

P: Location: Hidden or Not Accessible 0 0 Move Valve to Visible and Accessible Location

Q: Location: Improper Location t/ 6 Move Valve to Compliant Location

R: Location: No Valve in Place 0 0 Install Zone Valve

S: Other: 0 0 N/A

TOTALS: 0 6

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03/29/2023 ZONE VALVE DEFICIENCIES VAMC Alexandria

Medical Gas and Vacuum Systems Inspection/Testing

Pineville, LA

ZONE VALVE DEFICIENCIES BREAKDOWN (BY ITEM NUMBER)

D E

F

IC

IE

N

C Y

D E

T A

IL

A

N D

/O

O

R R

E C

T

IV

E A

C T

IO

N

*P le a se

D ate, D escrib e A ction

Taken, & R efe r to W ork

O rde r if A pp lica b le

DEFICIENCY

DEFICIENT VALVE LOCATION

CODE

L o catio n

(0 ,S =

O utsid e & p p

O pposite)

R o o m s o r A re a S erv ed

S y ste m

G as

M an u factu rer co A2 n f, n o or r.

G au g e P ress u re

R ead in g

(P ositive in P

SI/ N

egativ e in "H g)

G a u ge

G en eral C o n d itio

L ab elin g

L eaks

L o catio th er

Bldg. 7, 4th FI, ry Recove Recovery 1-6+ Isolation Rm. 02 Beacon V

56 V V V V QV V

Q) Location: Improper Location- Observation Only:

Correction Action needed when Medical Gas is remodeled or updated

Bldg. 7, 4th Fl.

Recovery Recovery 1-6+ Isolation Rm. MA Beacon V

52 V V V V QV V

Q) Location Improper Location- Observation Only:

Correction Action needed when Medical Gas is remodeled or updated

Bldg. 7, 4th FI, ry Recove Recovery 1-6+ Isolation Rm. VAC Beacon V

VIVI

QV V

Q) Location_ Improper Location- Observation Only:

Correction Action needed when Medical Gas is remodeled or updated

Bldg. 7, 1st FI, US

ETU (ER)

ETU (ER) 02 Beacon V

57 V V 1 .1 Qv' V

Correction Action needed when Medical Gas is remodeled or updated

Bldg. 7, 1st Fl. I/S

ETU (ER)

ETU (ER) MA Beacon V

52 V V V V QV V

Correction Action needed when Medical Gas is remodeled or updated vvw.evergreenntedical.coni 1., 2021 Evergreen Aledicul Services. - !'El? 2.21 Corporate Office: 1-800-872-8992

DEFICIENCY

CODE

DEFICIENT VALVE LOCATION D

E

F

IC

IE

N

C Y D

E T

A

IL

A N

D

*N

IJ

A

V A

II

I0

ZONE VALVE DEFICIENCIES BREAKDOWN (BY ITEM NUMBER)

c.)

N o m p le uo p uo j p la u a la in p u jn u pa w s e al v

J o st u o o ll

Bldg. 7. 1st Fl.1/S

ETU (ER)

Q) Location Improper Location- Observation Only:

Correction Action needed when Medical Gas is remodeled or updated

Vt Vt Vt QI 71 VAC 27 Beacon ETU (ER)

03/29/2023 ZONE VALVE DEFICIENCIES VAMC Alexandria

Medical Gas and Vacuum Systems Inspection/Testing

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OUTLET & INLET DEFICIENCIES

Medical Gas and Vacuum Systems Inspection/Testing

VAMC Alexandria Pineville, LA

OUTLET/INLET DEFICIENCIES OVERVIEW

DEFICIENCY DESCRIPTION

QTY

DEFICIENT

QTY

CORRECTED

ACTION NEEDED

A: Gas Concentration: Cross-Connection Found 0 0 Identib, point of cross-connection and separate

13: Gas Concentration: Gas Concentration Contaminated 0 0 Purge system and/or remove contamination source

C: Gas Concentration: Water Present 0 0 Purge system and/or service dryer (if Medical Air)

I): General Condition: Damaged Faceplate 0 0 Replace Damaged Faceplate

V: General Condition: Damaged Hose Assembly 0 0 Replace Damaged Hose Assembly

F: General Condition: Failed Adapter Connect and Release 0 0 Rebuild/Replace Damaged Faceplate

C: General Condition: Incorrect Gas Connection 0 0 Replace with Correct Gas Specific Faceplate

I I: General Condition: Missing Screws 0 0 Replace Missing Screws

I: Labeling: Missing 'Use No Oil' 0 0 Replace Damaged Faceplate

.1: Labeling: Missing System Label 0 0 Replace System Label

K.: Labeling: No 'Use No Oil' 0 0 Replace or Convert to Compliant Outlet/Inlet Style

I.: Labeling: No System Label 0 0 Replace or Convert to Compliant Outlet/Inlet Style

NI: Leak: Inner Check 2 0 Rebuild Inner Check - Temporary Shutdown Required

N: Leak: Outer Check 3 0 Rebuild Outer Check

0: Low Flow: Depressurized or Disconnected from System 0 0 Identifr point of disconnection and repair

I': Low Flow: Pressure Gas 0 0 Rebuild Outlet Remove Obstruction

Q: Low Flow: Undersized Piping/Components 0 0 Replace or Convert to Compliant Outlet/Inlet Style

R: Low Flow: Vacuum 0 0 Rebuild Inlet and Flush with Emyme

5: Static Pressure: Pressure Out of Required Range 0 0 Reset System Pressure or Label as Nonstandard

1: Location: Insufficient Terminals per Bed 0 0 Install Outlets/Inlets to Meet Required Minimum

I: Location: Terminals in Non-Compliant Location 0 0 Remove Outlets/Inlets from Non-Compliant Area

V: Other 0 0 NA

TOTALS: 5 0

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OUTLET & INLET DEFICIENCIES

Medical Gas and Vacuum Systems Inspection/Testing

VAMC Alexandria

Pineville, LA

OUTLET/INLET DEFICIENCIES BREAKDOWN

DEFICIENT OUTLET/INLET LOCATION

(BY ITEM NUMBER)

DEFICIENCY CODE D

E

F

IC

IE

N

C Y D

E T

A

IL

A N

D

R R

E C

T

IV

E A

C T

IO

N

*P le a se

D ate, D escribe A ction

Taken, & R efer to 1Vork O rde r if A pp lica b le re a o r Z one

R o o m o r B e d

(Invento ry take n clo ckw is e aro u d room , fro m top to botto m an d io r le ft to rig h t)

Syste m

G as

M an u facturer

CD

Position

G as C oncentratio

G en eral C ondition

L abeling r ' co

CA

M inim u m

Flo

S tatic P ress u ufficie n t T erm in als/B ed

E= 0 , Ambulatory 409

Rms 405A, 405H+ 405E

409 Rm 4051-1 02 Beacon DIA III Headwall

(Recessed)

Isl./N./111N)

Leak: Outer Check

Ambulatory 409

Rms 405A, 405H+ 405E

409 km 4051-1 02 Beacon DIA III Headwall

111N1111N)

Leak Outer Check

171 Surgery Bronchoscopy

(OR 6)

MA Beacon DIA III

Wall (Recessed)

1 1 1 N 1 1 1 1 N) Leak: Outer Check

179 Surgery Bronchoscopy

(OR 6)

VAC Beacon DIA III

Wall

V 1 1

M1 1 V 1 M) Leak: Inner Check

180 Surgery Bronchoscopy

(OR 6)

VAC Beacon DIA III

Wall

VV./MI./VIM)

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03/29/2023 MASTER ALARMS VAMC Alexandria

Medical Gas and Vacuum Systems Inspection/Testing

MASTER ALARMS: LOCATION & SPECIFICATION FUNCTION & CONDITION

M aste r A la rm Panel

L ocation &

* If M ultiple P anels Pe r Location (e.g. "E ngineering P a n el 42")

System G as

M anufacturer onditio n M onitored

Sw itc h o r Sourc e Location

U nit o f M easure

Se t Point

Initiating D evice eling om ponent C ondition

Bldg.

7 Basement

Biomed

(Bld

7)

Amico

A2M

Primary

Liquid

Level

Low

Bldg.

7 - 02

Pad

"1120

1 1 1 1 I PASS

Bldg.

7 Basement

Biomed

(Bld

7)

Amico

A2M

Secondary

Liquid

Supply in

Use

Bldg.

7 -02

Pad psi

1 1 1 is/ PASS

Bldg. 7 Basement Biomed (13Id 7)

Amico A2M Reserve Liquid Level Low Bldg. 7 - 02 Pad 27 "1120

11111

PASS

Bldg. 7 Basement Biomed (Bld 7)

02 Amico A2M Reserve Pressure Low Bldg. 7-02 Pad 150 psi

./111,/

Bldg. 7 Basement Biomed (Bld 7)

02 Amico A2M High Line Pressure Inside Hospital 0/S Mechanical Rm. 27

60 psi s/ 1 1 1 I PASS

Bldg. 7 Basement

Inside Hospital 0/S

40 psi 1 1 1 1 1 PASS

Bldg. 7 Basement

MA Amico A2M High Line Pressure Mechanical Rm. 27 60 psi

11111

Bldg. 7 Basement Biomed (Bld 7)

MA Amico A2M Low Line Pressure Mechanical Rm. 27 40 psi 1 V 1 1 V PASS

9 Bldg. 7 Basement

MA Amico A2M High Dew Point Temp Mechanical Rm. 27 35 'I' 1

Is/1J

Bldg. 7 Basement

MA Amico A2M Medical Air Malfunction Mechanical Rm. 27 10 ppm 1 1

III

Bldg. 7 Basement Biomed (Bld 7)

Vac Amico A2M Lag in use Mechanical Rm. 27 16 "1lg 1 1 1 1 1 PASS

Bldg. 7 Basement

Vac Amico A2M Low line pressure Mechanical Rm. 27 12 "Hg

VIII./

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Medical Gas and Vacuum Systems Inspection/Testing Pineville, LA

MASTER ALARMS: LOCATION & SPECIFICATION FUNCTION & CONDITION

4t

M ast er Al arm P anel ocati on

* If M ultiple P anels P er Location

( e.g. "E ngineering P anel '42"2

System G as c c —

, e, 9 es -1

M od el

C ondi ti on M oni t or ed

S wit ch or So ur ce L ocati on

U nit of M easur e

S et P oi nt

I niti ati n g D evi ce c *0 eD — t— w

''-et, C om ponent

C ondi ti on

Bldg. 7 Basement Biomed (Bld 7)

IA Amico A2M High Line Pressure Mechanical Rm. 27 70 psi 1 I I 1 I

Bldg. 7 Basement Biomed (Bid 7)

IA Amico A2M Low Line Pressure Mechanical Rm. 27 50 psi I I I V I PASS

15 Bldg. 7 1st H Admissions Desk

02 Amico A2M Primary Liquid Level Low Bldg. 7 - 02 Pad 35 1-120 1 1 1 1 1 PASS

Bldg. 7 1st Fl

Admissions Desk 02 Amico A2M

Secondary Liquid Supply in Use

Bldg. 7 -02 Pad 130 psi I I I I I PASS

Bldg. 7 1st Fl

Admissions Desk 02 Amico A2M Reserve Liquid Level Low Bldg. 7-02 Pad

27 "11201IIII

Bldg. 7 1st H

Admissions Desk 02 Amico A2M Reserve Pressure Low Bldg. 7-02 Pad 150 psi I I I I I PASS

13Idg. 7 1st Fl

Admissions Desk 02 Amico A2M High Line Pressure Inside Hospital 0/5

60 psi

I./III

Bldg. 7 1st H

Admissions Desk 02 Amico A2M Low Line Pressure Inside Hospital 0/5

Mechanical Rm. 27 40 psi I I I I I PASS

Bldg. 7 1st Fl

MA Amico A2M High Line Pressure Mechanical Rm. 27 60 psi

I./ 1 1 1 PASS

Bldg. 7 1st Fl

Admissions Desk MA Amico A2M Low Line Pressure Mechanical Rm. 27 40 psi I I V I I PASS

Bldg. 7 1st Fl

Admissions Desk MA Amico A2M High Dew Point Temp Mechanical Rm. 27 35 oF I I I I I PASS

Bldg. 7 1st Fl

Admissions Desk MA Amico A2M Medical Air Malfunction Mechanical Rm. 27 10 ppm I I I I I PASS www.evergrecti In ed ical.com 2021 Evergreen Medical Svrvices. Inc 1.7:11 2.21 Corporate Office: I-800-872-8992

MASTER ALARMS

Medical Gas and Vacuum Systems Inspection/Testing

VAMC Alexandria ste r A la rm

Pa n e l

L o c a tio n

* If M ultiple P anels P e r Location

(e.g. "E ngineering Pa n el 42")

S yste m G a s

M a n u fa c tu re r

M o d e l

C o n d itio n

M o n ito d itc h o r S o u rc e L o c a

U it o f M e a su e t P o in t

In itia tin g D e vice

= ma P a n e l

L a b e lin g

O th e r

C o m p o n e n t C o n d

Bldg. 7 1st Fl

Vac Amico A2M Lag in use Mechanical Rm. 27 16 "Hg

Isl./II

Bldg. 7 1st Fl

Admissions Desk Vac Amico A2M Low line pressure Mechanical Rm. 27 12 "Hg I I I I I PASS

Bldg. 7 1st Fl

IA Amico A2M High Line Pressure Mechanical Rm. 27 70 psi

././ 1

11 PASS

Bldg. 7 1st Fl

Admissions Desk IA Amico A2M Low Line Pressure Mechanical Rm. 27 50 psi I I I I I PASS

Bldg. 7 1st Fl

Admissions Desk 02 Alnico A2M Primary Liquid Level Low

Bld 45 Bldg. 45 - 02 Pad 32 "1120 1 1 1

II PASS

Bldg. 7 1st Fl

Admissions Desk 02 Amico A2M

Reserve Cylinders in Use Bld 45

Bldg. 45 -02 Pad 140 psi I I I I I PASS

31 Bldg. 7 1st Fl Admissions Desk

02 Amico A2M Reserve Cylinders Low Pressure Bld 45

Bldg. 45 -02 Pad 650 psi

Isis/II

Bld g. 7 1st Fl

Admissions Desk 02 Amico A2M High Line Pressure Bld 45

Inside Hospital I/S 1st Floor Medicine

Rm.

60 psi I I I I I PASS

Bldg. 7 1st Fl

Admissions Desk 02 Amico A2M Low Line Pressure Bld 45

Inside Hospital I/S 1st Floor Medicine

Rm.

40 psi I I I I I PASS

Bldg. 7 1st Fl

Admissions Desk Vac Amico A2M Lag in use Bld 45 Penthouse

Mechanical Room 16 "Hg I I I I I PASS

35 Bldg. 7 1st Fl Admissions Desk Vac Amico A2M Low line pressure Bld 45 Penthouse

Mechanical Room 12 "Hg I I I V I PASS

Bld 45- 1st Floor Nurses Station

02 Amico A2M Primary Liquid Level Low

Bld 45 Bldg. 45 -02 Pad 32 "H20 I I I I I PASS www.evergreennictlical.com 2021 Evergreen .1,1edwal .S.9rvices. Inc - l'El? 2.21 (orjairalt Office: I-800-8724I992

Medical Gas and Vacuum Systems Inspection/Testing r A la rm Panel

L ocatio n

* If M ultiple P anels P er Location

(e.g. "E ngineering P a n el 42'2

System G as

M anufacturer

M odel

C onditio n M onitored

Sw itc h o r So u rce Location

U nit o f M easure

Se t Point

Initiating D evice

= CIC1

Panel

L abeling

O th e r crl C om ponent C ondition

Bld 45- 1st Floor Nurses Station

02 Amico A2M Reserve Cylinders in Use Bid 45

Bldg. 45 -02 Pad 140 psi I I I I I

38 Bld 45- 1st Floor Nurses Station

02 Amico A2M Reserve Cylinders Low Pressure Bld 45

Bldg. 45 -02 Pad 650 psi I I I I I PASS

Bid 45- 1st Floor Nurses Station

02 Alnico A2M High Line Pressure Bld 45 Inside Hospital US 1st Floor Medicine

Rm.

60 psi I I I I I PASS

Bld 45- 1st Floor Nurses Station

02 Amico A2M Low Line Pressure Bld 45 Inside Hospital US 1st Floor Medicine

Rm.

40 psi I I I I I PASS

Bld 45- 1st Floor Nurses Station

Vac Amico A2M Lag in use Bid 45 Penthouse Mechanical Room

16 "Hg

I./III

Bld 45- 1st Floor Nurses Station

Vac Amico A2M Low line pressure Bld 45 Penthouse Mechanical Room

12 "Hg I I I I I PASS

Bldg. 7 2nd Fl 231

Nurses Station 02 Amico A2M Primary Liquid Level Low Bldg. 7 - 02 Pad 35 "1120 I I I I I PASS

Bldg. 7 2nd Fl 231

Nurses Station 02 Amico A2M Secondary Liquid Supply in Use Bldg. 7 -02 Pad 130 psi I I I I I PASS

Bldg. 7 2nd Fl 231

Nurses Station 02 Amico A2M Reserve Liquid Level Low Bldg. 7 -02 Pad 27 "1120 1 1 1 1 1 PASS

Bldg. 7 2nd Fl 231

Nurses Station 02 Amico A2M Reserve Pressure Low Bldg. 7 -02 Pad 150 psi I I I I I PASS

Bldg. 7 2nd Fl 231

Nurses Station 02 Amico A2M High Line Pressure Inside Hospital 0/S

60 psi I 1 I

Is/ PASS

Bldg. 7 2nd Fl 231

Nurses Station 02 Amico A2M Low Line Pressure Inside Hospital 0/S

Mechanical Rm. 27 40 psi 1 ./ I I I PASS www.evergreenniedical.com 2021 Evergreen:Wei/1ml Services. Inc - ITI? 2.21 Corporate Office: 1-800-872-8992

Medical Gas and Vacuum Systems Inspection/Testing r A la rm Panel

L ocatio n

* If M ultiple P anels P e r Location

(e .g. " E ngineering P a n el 42")

System G as

M anufacturer

M odel

C onditio n M onitored

Sw itch or Sou rce Location

U nit of M easure

Se t Point

Initiating D evice

C11:1

CD

L ab eling

CD ..1

C om ponent C ondition

IIIdg.

7 2nd Fl

231 Nurses

Station

MA

Amico

A2M

High

Line

Pressure

Mechanical

Rm.

psi

I

II 1 I

Bldg. 7 2nd Fl 231

Nurses Station MA Amico A2M Low Line Pressure Mechanical Rm. 27 40 psi V 1 1 1 I PASS

51 Bldg. 72nd Fl 231 Nurses Station

MA Amico A2M High Dew Point Temp Mechanical Rm. 27 35 "F 1 1 1

Bldg. 72nd Fl 231

Nurses Station MA Amico A2M Medical Air Malfunction Mechanical Rm. 27 10 ppm I I I I I PASS

53 Bldg. 7 2nd Fl 231 Nurses Station

Vac Amico A2M Lag in use Mechanical Rm. 27 16 "Hg I I I I I PASS

Bldg. 7 2nd Fl 231

Nurses Station Vac Amico A2M Low line pressure Mechanical Rm. 27 12 "Lig I I I I I PASS

55 Bldg. 7 2nd Fl 231 Nurses Station

IA Amico A2M High Line Pressure Mechanical Rm. 27 70 psi I I I I I PASS

Bldg. 7 2nd Fl 231

Nurses Station IA Amico A2M Low Line Pressure Mechanical Rm. 27 50 psi I I I I I PASS ww,n.evergreenmedical.com 1, 2021 Evergreen Aledwal Serwees. Inc. 1.1.1? 2.21 orporate Office: I-801)-872-8992

03/29/2023 MASTER ALARM INVENTORY VAMC Alexandria

Medical Gas and Vacuum Systems Inspection/Testing Pineville, LA

TOTAL

MASTER ALARM

PANELS

MASTER ALARM SIGNALS

BY SYSTEM GAS:

56 TOTAL MASTER ALARM SIGNALS:

MASTER ALARMS BREAKDOWN (*EACH MASTER ALARM SIGNAL COUNTED AS SEPARATE ALARM BY SYSTEM GAS BELOW)

MANUFACTURER

(Or Current Owner)

MODEL MASTER ALARM PANEL DESCRIPTION

I (-)

.00 :

n :

v :

Amico A2M Gray Cover with Red LED Indicators 28 12 0 0 0 10 0 6 0 www,.evergreenmedical.com ; 2021 Evergreen Ilechcal Services. Inc 1E1? 2.21 ( .orporate Office: 1-S00-872-$992

03/29/2023 AREA ALARMS VAMC Alexandria

Medical Gas and Vacuum Systems Inspection/Testing Pineville, LA

AREA ALARMS: LOCATION & SPECIFICATION FUNCTION AND CONDITION

A la rm Ph ysica l L ocation

A rea/Z o n e M onitored

S yste m G as

M an u factu rer

4 o cs.

eD

P ressu re R eading (P ositiv e in P

S/N egativ e in In

' H g)

H igh P ressu re A la rm

Setting (P ositiv e in P

SI N

egative in In,H g)

L ow

P ressu re A la rm

Setting

(P ositiv e in P

SI N

egative in In ilg)

A la rm Se t P oints

T ran sd u c e r L ocatio n

T ra nsd u c e r F unction

A la rm L ocation

P anel F un ction

M od ule F unction

L ab eling

O th er

C om p o n en t C ondition

0/S Audiology/Speech

Clinic Rms 464 A/B, 493 02 Beacon Series 2 56 60 38 1 1 1 1 1 1 1 1 PASS

0/S Audiology/Speech

Clinic Rms 464 A/B, 493 VAC Beacon Series 2 27

12 II

1 1 1 1 PASS

Bldg. 7, 4th Fl S. 0/S

407-420, 423-432 02 Beacon Series 2 56 60 40 I 1 1 1 1 1 1 1 PASS

Bldg. 7, 4th Fl S. 0/S

407-420, 423-432 VAC Beacon Series 2 27

12 1 1 1 1 1 1 1 1 PASS

5 ()pp 439G 4390 & 439F 02 Beacon Mega 2 54 60 38 1 1 1 1 1 1 /I

6 Opp 4390 4390 & 439F MA Beacon Mega 2 50 60 40 1 1 1 s/ 1 1 1 1 PASS

7 Opp 439G 4390 & 439F VAC Beacon Mega 2 28

Bldg. 7, 0/S 4th Fl.

Oncology Ambulatory 409 Rms

405E MA Beacon Mega 2 50 60 40 1 1 1 1 1 1 1 1 PASS

Bldg. 7, 4th FI, OR Area, US Rm 445

OR 1-5 & Bronchoscopy 02 Amico A2A 54 60 40 1 1 1 1 1 1 1 1 PASS

Bldg. 7, 4th F1, OR Area, I/S Rm 445

OR 1-5 & Bronchoscopy (Labeled - "Not in Use")

N2() Amico A2A N/A 60 40 1 1 1 1 1 1 1 1 NOT IN USE

Bldg. 7, 4th Fl, OR Area, US Rm 445

OR 1-5& 13ronchoscopy MA Amico A2A 51 60 40 1 1 1 1 1 1 1 1 l'ASS

Bldg. 7, 4th Fl, OR Area, I/S Rm 445

OR 1-5 & Bronchoscopy VAC Amico A2A /7

13 Bldg. 7, 4th Fl, OR Area, VS Rm 445

OR 1-5 & Bronchoscopy N2 Amico A2A N/A 195 140 I 1 1 1 1 1 1 1 NOT IN USE wwv.evel-green m et! ical.com 2021 Evergreen :Willey! Sen:ices. Inc. 1.1.7? 2.21 Corpora te Office: 0 -8011-872-8992

AREA ALARMS

Medical Gas and Vacuum Systems Inspection/Testing

VAMC Alexandria Pineville, LA

AREA ALARMS: LOCATION & SPECIFICATION FUNCTION AND CONDITION

4 t

A la rm Ph ysic a l L ocation

A rea/Z on e M onitored

System G as

M anufacturer

M od el

P ressu re R eading (Positive in PSI N egative in In H g)

H ig h P ressu re A la rm

Setting (Positiv e in

PSI N

egative in In/H g)

L o w Pressu re A la rm

Setting (P ositive in

PSI N

egative in In lIg)

A la rm Se t P oints

T ransd u cer L ocation

T ransd u cer F unction

A la rm L ocation

P an el Fun ction

M od ule F unction

L abeling

5.?

fD

C om p o n en t C ondition

Bldg.

7, 4th H

OR Area, US km km

(Patient

Holding Area)

. 02

Amico

A2A

N/A

Bldg.

7, 4th

FI,

OR Area, US

Rm km

(Patient

Holding Area)

(Labeled

- "Not in Use")

N20

Amico

A2A

N/A

NOT IN USE

Bldg. 7, 4th F1, OR Area, US Rm 445

Rm 446 (Patient Holding Area)

MA Amico A2A N/A 60 40 V V V I V V V V NOT IN USE

Bldg. 7, 4th F1, OR Area, US Rm 445

Rm 446 (Patient Holding Area)

VAC Amico A2A N/A

12 V V V V V V V V NOT IN USE

Bldg. 7, 4th FI, U S OR

Core OR 1-5 & Bronc 02 Amico A2A 55 60 40 V V V V V V V V PASS

Bldg. 7, 4th FL US OR

Core OR 1-5 & Bronc

(Labeled - "Not in Use") N2() Amico A2A N/A 60 40 V V V V V V ../ V NOT IN USE

Bldg. 7, 4th F1, U S OR

Core OR 1-5 & Bronc MA Amico A2A 51 60 40 V ../ V V V V V V PASS

Bldg. 7, 4th Fl, US OR

Core OR 1-5 & Bronc VAC Amico A2A 26

12 V V V V V V V V PASS

Bldg. 7, 4th H. I/S OR

Core

OR 1-5 &

Bronc N2

Amico A2A N/A 195 140 V V V V V V V

Bldg. 7, 4th Fl, US OR

Core Rm 446 02 Amico A2A N/A 60 40 V V V V V ../ V V NOT IN USE

Bldg. 7, 4th Fl, US OR

Core Rm 446 (Labeled - "Not in Use") N20 Amico A2A N/A 60 40 V V V V V V V V NOT IN USE

Bldg. 7, 4th FL US OR

Core km 446 MA Amico A2A N/A 60 40 V V V V V V V ../ NOT IN USE www.evergreenmedical.com 2021 Evergreen Iledtcal Services. Inc. -1'1...R2.21 Corporaic Office: I-800-872-8992

Medical Gas and Vacuum Systems Inspection/Testing Pineville, LA

AREA ALARMS: LOCATION & SPECIFICATION FUNCTION AND CONDITION

;t

Al arm

Ph ysi cal L ocati on

A rea/Z one M oni t ored

S yst em G as

M an uf act ur er

M od el

P ressure

R eadi n g

(Positiv e in

PSI N

egative in In H g)

H ig h Pressu re Alarm Setting

(Positive in

PSI N

egativ e in In H g.)

L o w Pressure A larm Setting

(P ositiv e in PSI N egative in hi H g)

A larm

Se t Points

T ransduce r L ocation

T ransd u cer F unction

A larm

L ocation

Panel F unction

M odule Function

L abeling

0 = f9 -I om ponent

C ondi ti on

Bldg. 7, 4th F1, 1/S OR

Core Rm 446 VAC Amico A2A N/A

12 s/ 1 1 1 1 1 1 1 NOT IN USE

Bldg. 7, 4th FL, Recovery Recovery 1-6+ Isolation

Rm.

02 Beacon P0321 58 60 40 1 1 1 1 1 1 1 1 PASS

Bldg. 7, 4th FL, Recovery Recovery 1-6+ Isolation

Rm.

MA Beacon P0321 52 60 40 1 J 1 1 1 1 1 1 PASS

Bldg. 7, 4th FL, Recovery Recovery 1-6+ Isolation

Rm.

VAC Beacon P0321 30+

12 1 1 D 1 1 1 1 ./ FAIL

30 Bldg. 7, 3rd Fl North 367-374 & 378-387 02 Beacon Series 2 57 60 42 1 1 1 1 1 1 1 1 PASS

31 Bldg. 7, 3rd Fl North 367-374 & 378-387 VAC Beacon Series 2 25

Bldg. 7, 3rd Fl, MICU

0/5 Rm. 396 349 A-G 02 Beacon P0321 55 60 40 s/ ./ 1 s/ 1 1 1 1 PASS

Bldg. 7, 3rd El, M1CU

0/S Rm. 396 349 A-G & (369-371) MA Beacon 1'0321 50 60 40 1 1 1 1 1 1 1 1 PASS

Bldg. 7, 3rd Fl, MICtJ

0/S Rm. 396 349 A-G VAC Beacon P0321 29

Bldg. 7, 3rd Fl South, 0/S Rm. 327

Rms 307,312 & 315-322, Dental Surgery Rm.

309A 02 Beacon Series 2 56 60 40 1 1 1 1 1 1 1 1 PASS

Bldg. 7, 3rd Fl South, 0/S Rm. 327

Rms 307,312 & 315-322, Dental Surgery Rm.

309A VAC Beacon Series 2 29

12 1 1 1 1 1 V 11

Bldg. 7 2nd Fl N 0/S

Respiratiory Dept 262-268, 271-280, 287-

02 Beacon Series 2 58 60 40 1 1 1 1 1 1 1 1 PASS

%VW, .evergreenmedical.com 2021 Evergreen .1.1ethcaI Services. Inc. - VER 2.21 Corporate Office: I-SOf-872-8992

Medical Gas and Vacuum Systems Inspection/Testing

Pineville, LA

AREA ALARMS: LOCATION & SPECIFICATION FUNCTION AND CONDITION

4t

Al arm

Ph ysi cal L ocati on

A r ea/Z o ne M oni t ored

S yst em G as

M anuf act urer

M od el

P ress ure R e adi n g

(P ositiv e in P

SI N

egativ e in In/H g.)

H ig h P ressure A larm Setting

(P ositiv e in P

SIN

egativ e in la llg)

L ow

Pressu re A la rm

Setting (P ositiv e in P

SI N

egativ e in In'lig)

A la rm Se t P oints

T ransd u cer L ocation

T ransd u cer F unction

A la rm L ocation

P a n e l Function

M od ule F unction

L abeling

O th er

C om p o n en t C ondition

Bldg. 7 2nd FIN 0/S

Respiratiory Dept

262-268, 271-280, 287-

VAC Beacon Series 2 27

12 1 1 1 1 1 1 1 I PASS

39 Bldg. 7, 2nd Fl South 206-212. 218-227 & 23,1.-

02 Beacon Series 2 57 60 40 1 1 1 1 1 1 1 1 PASS

40 Bldg. 7, 2nd Fl South 206-212, 218-227 & 234.

VAC Beacon Series 2 25

Bldg. 7, 1st Fl

Radiology. 0/S Rm.

156 Center Core

Radiology Rms. 153-156 02 Beacon P0321 58 60 40 ./

1111111

Bldg. 7, 1st Fl

Radiology, 0/S Rm.

156 Center Core

Radiology Rms. 153-156 MA Beacon P0321 53 60 40 1 1 1 1 1 1 1 1 PASS

Bldg. 7, 1st Fl

Radiology, 0/S Rm.

156 Center Core Radiology Rms. 153-156 VAC Beacon P0321 28

12 1 1 1 1 1 1 1 I PASS

Bldg. 7, 1st Fl

Radiology I/S Rm. 139 Rms. 142, 116, 117, &

02 Beacon P0321 58 60 40 1 1 I I 1 I 1 1 PASS

Bldg. 7. 1st Fl

Radiology 1/S Rm. 139

Rms. 142, 116, 117. &

MA Beacon P0321

51 60 40 1 1 1 1 1 1 1 1 PASS

Bldg. 7, 1st Fl

Radiology I/S Rm. 139 Rms. 142, 116, 117, &

VAC Beacon 1'0321 27

Bldg. 7, 1st Fl

Radiology, 1/S 135 Ultrasound

Ultrasound Rm. 135 02 Beacon P0321 58 60 40 1 1 1 I 1 I 1 1 PASS vv‘ .ev erg reen met! ica I.co m , 21121 Evergreen Medical Service.v. Ira. 113? 2.21 'orpora t c Office: I -800-872-N992

AREA ALARMS

Medical Gas and Vacuum Systems Inspection/Testing

VAMC Alexandria

Pineville, LA

AREA ALARMS: LOCATION & SPECIFICATION FUNCTION AND CONDITION

4t

Al arm

Ph ysi cal L oc ati on

A r ea/Z o ne M oni t ored

S yst em G as

Nl anuf act ur er

M od el

P r essur e R eadi n g

(P ositiv e in P

SI N

eg a tiv e in In/H g

H ig h P ressu re A larm

Setting (P ositive in P

SI N

eg a tive in In llg

L o w Pressu re A la rm

Setting (P ositiv e in P

SI N

eg a tiv e in In H g.)

A la rm Se t P oints

T ransd u cer L ocation

T ransd uce r F unction

A la rm Location

P an el F unction

M od ule F unction

L abeling et -, C om po n en t C ondition

Bldg. 7, 1st Fl Radiology, 1/S 135

Ultrasound Ultrasound Rm. 135 MA Beacon P0321 51 60 40 V V V V V V V V PASS

Bldg. 7, 1st Fl

Radiology, US 135

Ultrasound Ultrasound Rm. 135 N20 Beacon P0321 0 210 140 V V V V V V V V NOT N USE

Bldg. 7, 1st Fl

Radiology, US 135

Ultrasound Ultrasound Rm. 135 VAC Beacon P0321 27

12 V V V V V V V V PASS

Bldg. 7, 1st F1, 1/S El

(ER)

ETU (ER) 02 Beacon P0321 57 60 40 1 V V V V V V V PASS

Bldg. 7, 1st FI, I/S FIT

(ER)

ETU (ER) MA Beacon P0321 52 60 40 V V V V ../ V V V PASS

Bldg. 7, 1st FL US Fru

(ER)

ETU (ER) VAC Beacon P0321 28

12 V V V V V V /V

Bldg. 45 1st Fl, Nurses

Station 142-145, 160-163, &

02 Allied Impact 55 60 40 V V V V V V V V PASS

Bldg. 45 1st F1, Nurses

Station

142-145, 160-163, &

VAC Allied Impact 26 60 40 V V V V V V V V PASS

Bldg. 45 2nd F1, Nurses

Station 240-243, 259-263, and

02 Allied Impact 54 60 40 V V V V V V V V PASS

Bldg. 45 2nd FL Nurses

Station 240-243, 259-263, and

VAC Allied Impact 25 60 40 1 V 1 1 1 1 1 ../ PASS

Bldg. 45 1st F1, Nurses

Station

1-131, 132, 133 (Labeled

- "Not in Use")

02 Beacon P0321 N/A 60 40 1 ./ 1 s/ ,./ ../ ./ I NOT IN USE www.evergreenmedicaLcom 2021 Evergrven Services. - VEI? 2.21 Corporate Office: 1-800-S72-8902

M C

A le xa n dr ia

E A

A L

A R ag e of

F U

N C

T I O

N A

N D

C O

N D

IT

Co mp one nt

Co ndi tion cr:

Z

Oth er

Labeling

Module Function `>

Panel Function `>

Alarm Location `T, Transducer Function "?

Transducer Location

Alarm Set Points `>

Low Pressure Alarm Setting (Positive in PSI/Negative in In Jig)

c) .1.

High Pressure Alarm Setting (Positive in PSI Negative in h? Hg) 4̀:'

Pressure Reading (Positive in PSI Negative in In/Hg)

A R

E A

A L

A R

M S

L

O C

A T

IO

N

S

P E

C

IF

IC

A

T

Mo del r-1 en a.

Manufacturer

B ea co n

Sys tem

Ga s c-,1 ,--, Area/Zone Monitored

2-

9, (L el ed

"N ot i n

U se

Alarm Physical Location

'B ld g.

2n d

FI

, N ur se s

St at io

# 59

AREA ALARMS INVENTORY

Medical Gas and Vacuum Systems Inspection/Testing

VAMC Alexandria Pineville, LA

TOTAL

AREA ALARM

PANELS

TOTAL AREA ALARM SIGNALS

BY SYSTEM GAS:

59 TOTAL AREA ALARM SIGNALS:

AREA ALARMS BREAKDOWN (EACH AREA ALARM SIGNAL COUNTED AS SEPARATE ALARM BY SYSTEM GAS BELOW)

MANUFACTURER

(Or Current Parent

Company)

MODEL AREA ALARM DESCRIPTION

0 0

J>

Allied Impact Ivory Cover - Digital LEDs 2 0 2 0 0 0

Amico A2A Gray Cover with Digital Pressure 4 4 4 2 0 4 0 0 0

Beacon Mega 2 Tan Cover - Digital LEDs 1 2 0 0 0 I 0 0 0

Beacon P0321 White with Murphy gauges-"Area Line Press. Alm" 8 6 0 1 0 6 0 0 0

Beacon Series 2 Round Gauges - Black Faceplate with silver trim 6 0 0 0 0 6 0 0 0 www.evergreenmedical.com I., 2021 Evergreen 1/eihcal Services. Inc (TR 221 ('orporate Office: I-800-872-8992

03/29/2023 ZONE VALVES VAMC Alexandria

Medical Gas and Vacuum Systems Inspection/Testing

ZONE VALVES: LOCATION & SPECIFICATION FUNCTION AND CONDITION

B Ph ysic a l L ocation

R o o m s o r A re a S erved

S yste m G as

M an ufactu rer

B all

G ate/G lobe

G au g e P ressu re R eadin g (P osi tive in P

SI./ N

egative in "H g)

G au ge

G en eral C ondition

c. z, cr fp n L eaks

L ocation

5.* fi, C om p o n en t C ondition

Bldg. 7, 4th Fl N. 0/S Audiology/Speech Clinic

Rms 464 A/B, 493 02 Amico I

N/A V V V V V V PASS

Bldg. 7, 4th Fl N. 0/S

Audiology/Speech Clinic Rms 464 A/B, 493 VAC Amico V

3 Bldg. 7, 4th Fl S. 0/5 423 407-420, 423-432 02 Amico V

N/A V V V V I V PASS

4 Bldg. 7, 4th Fl S. 0/5 423 407-420, 423-432 VAC Amico V

_5 Bldg. 7 4th Fir S.- 0/S 440 439G+ 439F 02 Beacon V

0 V V V V V V NOT IN USE

6 Bldg. 7 4th Fir S.- 0/S 440 439G+ 439F MA Beacon V

0 V V V V V I NOT IN USE

7 Bldg. 7 4th FIr S.- 0/5 440 4390+ 439F VAC Beacon V

0 V V I I I V NOT IN USE

8 Bldg. 74th Fir 0/5 403 Ambulatory 409 Rm 405E MA Beacon I

50 V V V V V V PASS

OR Patient Holding Rm.

Rm 446 (Patient Holding) - Labeled

"Not in use" N20 Beacon V

OR Patient Holding Rm.

Rm 446 (Patient Holding)-Not In Use 02 Beacon V

OR Patient Holding Rm.

Rm 446 (Patient Holding)-Not In Use MA Beacon V

0 V i V V V V NOT IN USE

OR Patient Ilolding Rm.

Rm 446 (Patient Holding)-Not In Use VAC Beacon V

Bldg. 7, 4th El, 0/S OR 1

Center Core OR I/Rm 450- Labeled-Not In Use N20 Beacon V www.evergreenmedicalcom i• 2021 Evergreen Medical Services. mi. - VER 2.21 Corporate Office: 1-800-872-8992

ZONE VALVES

Medical Gas and Vacuum Systems Inspection/Testing

VAMC Alexandria

Pineville, LA

B Ph ysical L ocation

R o o m s o r A re a Served

Syste m

G as

M an ufactu rer

B all

E)

"e5eD er et

G aug e P ressu re R eadin g

(P ositiv e in P

SI

/ N egative in "H g)

G au ge

G en eral C ondition r w cr eo E

(FQ

L eak s

L ocation

-9-

= ft, C om ponent

C ondi ti on

Bldg. 7, 4th FL 0/S OR I

OR 1/Rm 450 02 Beacon V

56 V V V V V V PASS

Bldg. 7, 4th El, 0/S OR I

OR I /Rm 450 MA Beacon V

50 V V V V V V PASS

Bldg. 7, 4th FL 0/S OR 1

OR I/Rm 450 VAC Beacon V

27 V V V V V V PASS

Bldg. 7, 4th FL 0/S OR 2

OR 2/Rm 451 - Labeled-Not In Use N20 Beacon V

Vs/1/V/

Bldg. 7, 4th Fl, 0/S OR 2

OR 2/Rm 451 02 Beacon V

58 V V V V V V PASS

Bldg. 7, 4th El, 0/S OR 2

OR 2/Rm 451 MA Beacon V

52 V V V V V V PASS

Bldg. 7, 4th F1, 0/S OR 2

OR 2/Rm 451 VAC Beacon V

29 V V V V V V PASS

Bldg. 7, 4th FL 0/S OR 3

OR 3/Rm 457 02 Beacon V

56 V V V V V V PASS

Bldg.. 7, 4th FL 0/S OR 3

OR 3/Rm 457- Labeled-Not In Use N20 Beacon V

Bldg. 7, 4th Fl, 0/S OR 3

OR 3/Rm 457 MA Beacon V

52 V V V V V V PASS

Bldg. 7, 4th FL 0/S OR 3

OR 3/Rm 457 VAC Beacon V

26 V V V V V .7 PASS

Bldg. 7, 4th El, 0/S OR 4

OR 4/Rm 459 02 Beacon V

56 V V V V I V PASS

www.evergreenmedicaLcom r 2021 Evergreen Itedical Services, Inc:. - FER 2.21 (:orporate Office: 1-800-872-8992

Medical Gas and Vacuum Systems Inspection/Testing Pineville, LA

ZONE VALVES: LOCATION & SPECIFICATION FUNCTION AND CONDITION

ZVB

Ph ysi c al L ocati on

R ooms or A rea S er ved

Cr a; c.

M anuf act ur er i B all e, cr ro

G aug e Pressu re R eading

(Positive in PSI Negative in "Hg)

G auge

G eneral C ondition a' cia L eaks

L ocation eo 9

C om pon e n t C ondition

Bldg.

7, 4th

FI,

0/S

OR

Center

Core

OR

4/ Rm

459-

Labeled-Not

In

Use

N20

Beacon

0111111

Bldg. 7, 4th Fl, 0/S OR 4

OR 4/Rm 459 MA Beacon 1

111111

Bldg. 7, 4th El, 0/S OR 4

OR 4/Rm 459 VAC Beacon 1

23 11 i .7 1 1 PASS

Bldg. 7, 4th Fl, 0/S OR 5

OR 5/Rm 460- Labeled-Not In Use N20 Beacon 1

0111111

Bldg. 7, 4th F1, 0/S OR 5

OR 5/Rm 460 02 Beacon 1

56 1 1 I 1 1 I PASS

Bldg. 7, 4th Fl, 0/S OR 5

OR 5/Rm 460 MA Beacon 1

Bldg. 7, 4th El, 0/S OR 5

OR 5/Rm 460 VAC Beacon 1

27 1 1 i 1 1 I PASS

Bldg. 7. 4th Fl 0/S

Bronchoscopy (OR6) Bronchoscopy (OR 6) 02 Beacon 1

5611IIII

Bldg. 7, 4th Fl 0/S

Bronchoscopy (OR6) Bronchoscopy (OR 6)+ Clean Utlity MA Beacon 1

50 1 1 1 1 1 1 PASS

Bldg. 7, 4th Fl 0/S

Bronchoscopy (0R6) Bronchoscopy (OR 6) "Not in Use" N20 Beacon 1

0 1 1 1 1 ./ 1 NOT IN USE

Bldg. 7, 4th Fl 0/S

Bronchoscopy (0R6) Bronchoscopy (OR 6) VAC Beacon 1

37 Bldg. 7, 4th Fl, Recovery Recovery 1-6+ Isolation Rm. 02 Beacon 1

1 Qs/ V PASS www.evergreentnedicalcom 2021 Evergreen ,1.1eilical Services. Inc. FER 2.21 ( rpora le Office: I -800-872-8992

Medical Gas and Vacuum Systems Inspection/Testing

B Ph ysical L ocation

R oom s o r A re a Served

Syste m

G as

M anufactu rer cr.

ro

G au g e Pressu re R eadin g (P ositive in P S I: N egative in "H g)

C') lc , G en eral C ondition

L ab eling r, L ocation er, .„

C om p o n en t C ondition

Bldg.

4th Fl, Recovery

Recovery

1-6+

Isolation

Rm.

MA

52 V V V ../ QV V PASS

39 Bldg. 7, 4th Fl, Recovery Recovery 1-6+ Isolation Rm. VAC Beacon V

29 V V V V QV V PASS

Bldg. 7, 3rd Fl Lab, 0/S

Rm. 357 Not in Use MA Beacon ../

55 V V V V V ,/ PASS

Bldg. 7, 3rd Fl Lab, 0/S

Rm. 357 Not in Use VAC Beacon V

29 V ../ V V V V PASS

Bldg. 7, 3rd Fl Lab, 0/S

Rm. 350A 3501) & 350F IA Beacon V

63 ,/ I ../ V V ./ PASS

Bldg. 7, 3rd Fl Lab, 0/S

Rm. 350A 350D & 350F VAC Beacon V

25 V V I ,/ V V PASS

44 Bldg. 7, 3rd Fl North 367-374 & 378-387 ( 7B North) 02 Beacon V

45 Bldg. 7, 3rd Fl North 367-374 & 378-387 ( 7B North) VAC Beacon V

N/A .7 V V V ./ V PASS

Bldg. 7. 3rd Fl, MICU 0/S

Rm. 397 MICU 394 A-G 02 Beacon V

56 V ../ V V V V PASS

Bldg. 7, 3rd FI, MICU 0/S

MICU 349 A-G & (369-371) MA Beacon V

51 V V ./ V V V PASS

Bldg. 7, 3rd F1, MICU 0/S

MICU 394 A-C) VAC Beacon V

28 V V V I V V PASS

Bldg. 7, 3rd 11 South, 0/S

Rm. 327 Rms 307,312 & 315-322, Dental

Surgery Rm. 309A 02 Beacon V www.evergreenmedicalcom 2021 Evergreen Medical Services. Inc. - VER 2.21 Corporate Office: 1-800-872-8992

Medical Gas and Vacuum Systems Inspection/Testing Pineville, LA

ZONE VALVES: LOCATION & SPECIFICATION FUNCTION AND CONDITION

It

Z V

B P h ysic a l L ocation

R o o m s o r A re a Served

Syste m

G as

M an u factu rer to , C") 20 et, e 5 Zi,7 o-fli au g e P ressu re R eadin g

(Positive in

PSI/ N

egative in "H g)

P = IC eD

G en er al C ondi ti on

L ab eli n g

L eak s

L ocati on

O th er

C om ponent

C ondi ti on

Bldg. 7, 3rd Fl South, 0/S

Rm. 327 Rms 307,312 & 315-322, Dental

Surgery Rm. 309A VAC Beacon 1

N/A 1 1 1 1 11

Bldg. 72nd Fl North 0/S

Respriatory 262-268, 271-280, 287-297 02 Beacon 1

NIAIIIIII

Bldg. 72nd Fl North 0/S

Respriatory 262-268, 271-280, 287-297 VAC Beacon I

NIAIIIII

I PASS

Bldg. 7 2nd Fl North Opp

NS

206-212, 218-227 & 234-244 02 Beacon . I

Bldg. 72nd Fl North Opp

NS

206-212, 218-227 & 234-244 VAC Beacon I

Bldg. 7, 1st Fl Radiology, 0/S Rm. 156 Center Core

Radiology Rms. 153-156 02 Beacon 1

57 1, 1 1

1.7.,/

Bldg. 7, 1st Fl Radiology, Radiology Rms. 153-156 MA Beacon 1

52 1 1 1 1 1 1 PASS

Bldg. 7, 1st Fl Radiology, Radiology Rms. 153-156 VAC Beacon I

29 1 1 1 1 1 1 PASS

Bldg. 7, 1st Fl Radiology

I/S Rm. 139 Rms. 142, 116, 117, & 118 02 Beacon 1

J./Is/II

Bldg. 7, 1st Fl Radiology

US Rm. 139 Rms. 142, 116, 117, & 118 MA Beacon 1

Bldg. 7, 1st Fl Radiology

I/S Rm. 139 Rms. 142, 116, 117, & 118 VAC Beacon 1

Bldg. 7, 1st Fl Radiology, 0/S CT Control Rm CT Scan (128), MRI (126), EKG (121) 02 Beacon 1

57 1 1 1 1 1 1 PASS

www.evergreenmedical.com • 2021 Evergreen Medical Services. Inc. - VER 2.21 'orpo rate Office: 1-800-872-8992

Medical Gas and Vacuum Systems Inspection/Testing

T

I3 P h ysic a l L ocation

R o o m s o r A re a S erved

S yste m G as

4: = r, 5-ft .1 ca = -o cs-eo

G au g e Pressu re R eadin g (Positive in PSI/ Negative in "Hg) n .

C cm, m

G en eral C ondition

L ab elin r-co so r .

L ocati on

O th er

C om pon ent C ondi ti on

Bldg. 7, 1st Fl Radiology„

0/S CT Control Rm c .

r Scan (128), MRI (126), EKG (121) MA Beacon 1

Bldg. 7, 1st Fl Radiology, 0/S CT Control Rm

C r Scan (128), MRI (126), EKG (121) VAC Beacon 1

28 1 1 1 1 1 1 PASS

Bldg. 7, 1st Fl Radiology, 0/S 135 Ultrasound Ultrasound Rm. 135 02 Beacon 1

1IIIII

Bldg. 7, 1st Fl Radiology, 0/5 135 Ultrasound Ultrasound Rm. 135 MA Beacon 1

Bldg. 7, 1st Fl Radiology, 0/S 135 Ultrasound Ultrasound Rm. 135 VAC Beacon 1

67 Bldg. 7, 1st FL 0/S 130 130-132 - Labeled "Not in use MA Beacon I

NIA./

1 1./

68 Bldg. 7, 1st F1, 0/5 130 130-132 - Labeled "Not in use VAC Beacon I

N/A ./ I 1 I 1 I NOT IN USE

Bldg. 7, 1st F1, I/S Fru

ETU (ER) 02 Beacon I

IIIIQ./../

Bldg. 7, 1st El, I/S ETU

ETU (ER) MA Beacon 1

J./Is/WI

Bldg. 7, 1st 11,1/S ETU

ETU (ER) VAC Beacon 1

27 1 1 1

1Q././

72 Bldg. 7, 1st FL Opp A 23 A 23 - Labeled "Not in use 02 Beacon I

73 Bldg. 7, 1st Ft, Opp A 23 A 23 - Labeled "Not in use MA Beacon 1

1 1 1 1 1 1 NOT IN USE

74 Bldg. 7, 1st FI, Opp A 23 A 23 - Labeled "Not in use VAC Beacon 1

1 1 1 1 1 1 NOT IN USE

www.evergreenmedical.com • 2021 Evergrven Ile.dical,Verwees, Inc:. FER 2.21 Corporate Office: 1-800-872-8992

Medical Gas and Vacuum Systems Inspection/Testing

B P h ysical L ocation

R o o m s o r A re a Served

S yste m G as

M an u factu rer

B all aC

F Cr f9

G au g e P ressu re R eading

(Positive in P

SI

N egativ e in "H g) ca

CM

f'D

G en eral C ondition

L ab elin g

L eak s

L ocation f9 .2

C om ponen t C ondition

Bldg

Basement

Fl -1/S Rm.

Decontamination

SPD

Decontamination

Rm.

IA

I I I I I I PASS

Bldg 7, Basement Fl - I/S Rm. 25 Decontamination

SPD Decontamination Rm. 25 VAC Beacon I

IIIIII

Bldg. 7. 1st Fl, 1/S Rm. 33 - SPD Scope Processing Rm.

Rm. 33 - SPD Scope Processing Rm. IA Amico I

Bldg. 7 - Basement Fl. - Opp Mechanical Rm. 27 , Main Shutoff valve for Bldg 7 - Labeled Not in use

N20 Beacon I

I./Is/II

Bldg. 7- Basement Fl. - Opp Mechanical Rm. 27

Main Shutoff valve for Bldg 7 N2 Beacon

Bldg. 7 - Basement Fl. - Opp Mechanical Rm. 27

Main Shutoff valve for Bldg 7 02 Beacon I

Bldg. 7 - 1/S Basement Fl -

Biomedical Engineering Rm. 57

Biomedical Engineering 02 Beacon 1

57 1 1 1 1 11

Bldg. 7 - I/S Basement Fl -

Biomedical Engineering

Biomedical Engineering MA Beacon 1

Bldg. 7 - 1/S Basement Fl -

Biomedical Engineering

Biomedical Engineering VAC Beacon 1

30 I 1 1 1 1 1 PASS

Bldg. 45 2nd Fl, Nurses

Station 240-243, 259-263, & 265 02 Allied 1

56 1../

1 1 1,/ www.evergreenmedical.com • 2021 Evergreen Iledical Serwees, - I.1:1? 2.21 'orporate Office: I -800-872-8992

ZONE VALVES

Medical Gas and Vacuum Systems Inspection/Testing

VAMC Alexandria

B Physic a l Location

R oom s o r A re a Served

System G as anufacturer a:

ft, G au ge P re ssure R eadi n g

(P ositive in P

SI

/ N egativ e in "H g)

G au ge

G eneral C ondition

L abeling

L eaks ocation om p o n en t C ondition

Bldg.

2nd Fl, Nurses Station

240-243, 259-263, VAC

Allied

27 I 1 1

I I PASS

Bldg. 45 1st Fl, Nurses

142-145, 160-163, & 165 VAC Allied 1

27 1 1 I III I PASS

Bldg. 45 1st Fl. Nurses

142-145, 160-163, & 165 02 Allied 1

56 1 1

At/ 1/1 PASS

Bldg. 45 1st Fl, Nurses

131, 132,…