S30. 2024 Annual Medical Gas Inspection - G.V. Sonny Montgomery VAMC.pdf
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About this file
This document is a comprehensive annual medical gas inspection report for the G. V. (Sonny) Montgomery VA Medical Center in Jackson, Mississippi, conducted on October 15-18, 2024, by Environmental & Medical Gas Services. The inspection covered multiple medical gas systems, including oxygen, medical air, medical vacuum, nitrous oxide, and nitrogen across various hospital areas such as ambulatory surgery, emergency department, ICU, cardiology, dialysis, and patient rooms.
The report details extensive testing of medical gas infrastructure, including zone valves, area alarms, master alarms, outlet testing, and manifold systems. Several deficiencies were identified, including leaking oxygen outlets in the ENT Clinic, improperly labeled nitrogen manifold pipelines, and a zone valve located inside the area it serves in the Ambulatory Surgery area. Recommendations include replacing outlets, adding proper signage, replacing pigtails, and relocating zone valves to comply with medical gas system safety standards. The inspection was performed in accordance with NFPA 99 standards and covered 368 oxygen outlets, 360 medical air outlets, 448 medical vacuum outlets, and various other medical gas system components.
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G. V. (SONNY) MONTGOMERY VA MEDICAL CENTER
Location: Jackson, MS
2024 ANNUAL MEDICAL
GAS INSPECTION
Date: 10/15/2024 - 10/18/2024
Medical Gas Survey & Inspection Performed by:
Report ID: BTM24289-1
ENVIRONMENTAL & MEDICAL GAS SERVICES
218 W Lorenz Blvd. - Jackson, MS 39213 Ph: (601)981-1861 • Fax: (601)981-1869 www.emgsi.com • testing@emgsi.com
Index Title:
Index:
Affidavit:
Credentials:
Inventory:
Summary of Findings:
Detail Report on Findings:
Summary of Corrections Detail Report on Corrections:
Master Alarms Testing:
Area Alarms Testing:
Zone Valves Testing:
Outlet Purity Testing:
Outlet Testing:
Manifold Testing:
Compressor Testing:
Vacuum Testing:
Bulk Gas Testing:
EOSC Testing:
Page 4 - 6 Page 7 - 8 Page 9 - 13 Page 14 - 23 Page 24 - 26 Page 27 - 34 Page 35 - 41 Page 42 - 75 Page 76 - 125 Page 126 - 128 Page 129 - 186 Page 187 - 193 Page 194 - 199 Page 200 - 204 Page 205 - 210 Page 211 - 213
FINAL FIELD AFFIDAVIT
ANNUAL INSPECTION/TESTING SERVICES
MEDICAL GAS SYSTEMS & EQUIPMENT
Company - CONFIDENTIAL
Repairs were made to the medical gas system(s) at G. V. (Sonny) Montgomery VA Medical Center by a qualified ASSE 6040 Technician (see name above). These repairs occurred during the same time period as the testing so documentation is included as applicable to any repairs made.
Environmental & Medical Gas Services 218 W Lorenz Blvd.
Jackson, MS 39213
Ph: (601)981-1861 Fax: (601)981-1869 www.emgsi.com
Bryan Teasley Environmental & Medical Gas Services Representative
10/15/2024 - 10/18/2024
Field Affidavit # BTM24289-1
Stephen Bishop G. V. (Sonny) Montgomery VA Medical Center Jackson, MS
Primary Med Gas Authorized Person:
To Whom It May Concern:
In accordance with the terms of the contract documents and NFPA 99 - 2012 edition, I the undersigned, as a duly appointed representative of Capitol Medical Supply, Inc., have conducted the following:
Annual Inspection Completed per the requirements of NFPA 99
SEE ATTACHED DATA SHEETS: DATA SHEETS MUST BE ATTACHED
The Contractor verifies that he is responsible for identification of all the equipment to be certified in the system as of this date. Any equipment not listed on the attached worksheets is the responsibility of the Contractor
HOLD HARMLESS CLAUSE:
The above certification applies to the condition of the detailed, itemized list of equipment as of date noted. Capitol Medical Supply, Inc. will be held harmless from any liability caused by any modification of the piping system including but not limited to the gas outlets, alarms, zone valves, manifolds or supply gases at a later date.
Representative Credentials
Page: 4COMPANY Confidential
Page: 5
Representative Credentials
Page: 6
Representative Credentials
Inventory Totals
Page: 7COMPANY Confidential
Medical Gas Inventory Totals
Page: 8
G. V. (Sonny) Montgomery VA Medical Center
Outlets Oxygen - 368 Med Air - 360 Med Vac - 448 Nitrous Oxide - 7 Nitrogen - 9
WAGD - 4
Zone Valves Oxygen - 47 Med Air - 49 Med Vac - 49 Nitrous Oxide - 7 Nitrogen - 7
Area Alarms Oxygen - 33 Med Air - 33 Med Vac - 33 Nitrous Oxide - 1 Nitrogen - 1
Master Alarms Oxygen - 12 Med Air - 16 Med Vac - 10 Nitrous Oxide - 6 Nitrogen - 6
1196 159
101 50
Findings
Page: 9COMPANY Confidential
Deficiency List G. V. (Sonny) Montgomery VA Medical Center
BTM24289-1 -- 2024 Annual Medical Gas Inspection
Item Description DateRecommendationID#
Summary of Findings
Environmental & Medical Gas Services 218 W Lorenz Blvd.
Jackson, MS 39213
(601)981-1861 (601)981-1869 www.emgsi.com
25116 Manifold Room Behind Shipping Nitrogen Amico
M2HD-D-HH-U-NIT
Medical gas cylinders need to have proper signage and segragation, indicating which cylinders are full/empty.
Recommend adding signage as to which cylinders are empty/full. 10/18/2024
25118 Manifold Room Behind Shipping Nitrogen Amico
M2HD-D-HH-U-NIT
Pigtails are to be replaced every 5 years per the manufacturer's recommendation.
Recommend replacing the pigtails.
8x Nitrogen
10/18/2024
25163 Manifold Room Behind Shipping Nitrogen Amico
M2HD-D-HH-U-NIT
Pipingtypepropertlylabeled = FAIL Recommend installing proper Nitrogen labels on the pipeline 10/21/2024
25119 Manifold Room loading Dock N2O Amico M2HD-
D-HH-U-N2O
Pigtails are to be replaced every 5 years per the manufacturer's recommendation.
Recommend replacing the pigtails.
8x N2O
10/18/2024
25120 Manifold Room loading Dock N2O Amico M2HD-
D-HH-U-N2O
Pipingtypepropertlylabeled = FAIL 10/18/2024
25165 Medical Vacuum Exhaust Exhaust for the Medical Vacuum system is not turned down with a non corrosive screen installed.
Install a 90 degree turn down with a non corrosive screen. 10/18/2024
25171 Zone Valve serving Neurology Lab gas turrets.
MGZV02-06
The lab is being used as a break room now. Recommend removing handles from zone valve and draining the line pressures.
10/18/2024
Deficiency List for G. V. (Sonny) Montgomery VA Medical Center10/21/2024 Page: 10
BTM24289-1 -- 2024 Annual Medical Gas Inspection
Item Description DateRecommendationID#
Summary of Findings
Environmental & Medical Gas Services 218 W Lorenz Blvd.
Jackson, MS 39213
(601)981-1861 (601)981-1869 www.emgsi.com
25182 Floor 3 Area Served: ENT Clinic
(MGZV03-04)
Room Number: C331 Gas Type: Oxygen Outlet Number: 1 Outlet Model: Horizon
Leaking from front body Recommend replacing the outlet. 10/21/2024
25185 Floor 3 Area Served: ENT Clinic
(MGZV03-04)
Room Number: C334 Gas Type: Oxygen Outlet Number: 1 Outlet Model: Horizon
Leaking from front body Recommend replacing the outlet. 10/21/2024
25186 Floor 3 Area Served: ENT Clinic
(MGZV03-04)
Room Number: C334 Gas Type: Oxygen Outlet Number: 2 Outlet Model: Horizon
Leaking from front body Recommend replacing the outlet. 10/21/2024
25183 Floor 3 Area Served: ENT Clinic
(MGZV03-04)
Room Number: C335 Gas Type: Oxygen Outlet Number: 1 Outlet Model: Horizon
Leaking from front body Recommend replacing the outlet. 10/21/2024
25184 Floor 3 Area Served: ENT Clinic
(MGZV03-04)
Room Number: C335 Gas Type: Oxygen Outlet Number: 2 Outlet Model: Horizon
Leaking from front body Recommend replacing the outlet. 10/21/2024
Deficiency List for G. V. (Sonny) Montgomery VA Medical Center10/21/2024 Page: 11
BTM24289-1 -- 2024 Annual Medical Gas Inspection
Item Description DateRecommendationID#
Summary of Findings
Environmental & Medical Gas Services 218 W Lorenz Blvd.
Jackson, MS 39213
(601)981-1861 (601)981-1869 www.emgsi.com
25187 Floor 4 Area Served: Cardiology
(MGZV04-06)
Room Number: K-429 Gas Type: Med Vac Outlet Number: 3 Outlet Model: Diamond 3
Inlet is being used with a WAGD hose Recommend replacing the vacuum ceiling inlet with a WAGD inlet.
Hose Vac DISS fitting to be replaced with a WAGD Female DISS as well
10/21/2024
Deficiency List for G. V. (Sonny) Montgomery VA Medical Center10/21/2024 Page: 12
BTM24289-1 -- 2024 Annual Medical Gas Inspection
Item Description DateRecommendationID#
Summary of Findings
Environmental & Medical Gas Services 218 W Lorenz Blvd.
Jackson, MS 39213
(601)981-1861 (601)981-1869 www.emgsi.com
25193 Basement Ambulatory Surgery 1-10 Oxygen, MedAir,MedVac Zone Valve MGZVB-11
Intervening wall exists = FAIL
Zone Valve is inside the area it serves.
Recommend relocating the zone valve to a place where a wall intervenes it from the outlets it serves.
Deficiency List for G. V. (Sonny) Montgomery VA Medical Center10/21/2024 Page: 13
BTM24289-1 -- 2024 Annual Medical Gas Inspection
Item Deficiency Description Priority DateRecommended SolutionID#
Detail Report on Findings
Environmental & Medical Gas Services 218 W Lorenz Blvd.
Jackson, MS 39213
(601)981-1861 (601)981-1869 www.emgsi.com
General Medical Gas Issues
Manifold Room Behind Shipping Nitrogen Amico
M2HD-D-HH-U-NIT
Medical gas cylinders need to have proper signage and segragation, indicating which cylinders are full/empty.
Medium 10/18/2024Recommend adding signage as to which cylinders are empty/full.
25116
Page: 14
BTM24289-1 -- 2024 Annual Medical Gas Inspection
Item Deficiency Description Priority DateRecommended SolutionID#
Detail Report on Findings
Environmental & Medical Gas Services 218 W Lorenz Blvd.
Jackson, MS 39213
(601)981-1861 (601)981-1869 www.emgsi.com
Manifold Room Behind Shipping Nitrogen Amico
M2HD-D-HH-U-NIT
Pigtails are to be replaced every 5 years per the manufacturer's recommendation.
Medium 10/18/2024Recommend replacing the pigtails.
8x Nitrogen25118
Page: 15
BTM24289-1 -- 2024 Annual Medical Gas Inspection
Item Deficiency Description Priority DateRecommended SolutionID#
Detail Report on Findings
Environmental & Medical Gas Services 218 W Lorenz Blvd.
Jackson, MS 39213
(601)981-1861 (601)981-1869 www.emgsi.com
Manifold Room Behind Shipping Nitrogen Amico
M2HD-D-HH-U-NIT
Pipingtypepropertlylabeled = FAIL Medium 10/21/2024Recommend installing proper Nitrogen labels on the pipeline25163
Manifold Room loading Dock N2O Amico M2HD-D-
HH-U-N2O
Pigtails are to be replaced every 5 years per the manufacturer's recommendation.
Medium 10/18/2024Recommend replacing the pigtails.
8x N2O25119
Page: 16
BTM24289-1 -- 2024 Annual Medical Gas Inspection
Item Deficiency Description Priority DateRecommended SolutionID#
Detail Report on Findings
Environmental & Medical Gas Services 218 W Lorenz Blvd.
Jackson, MS 39213
(601)981-1861 (601)981-1869 www.emgsi.com
Manifold Room loading Dock N2O Amico M2HD-D-
HH-U-N2O
Pipingtypepropertlylabeled = FAIL Medium 10/18/2024
25120
Page: 17
BTM24289-1 -- 2024 Annual Medical Gas Inspection
Item Deficiency Description Priority DateRecommended SolutionID#
Detail Report on Findings
Environmental & Medical Gas Services 218 W Lorenz Blvd.
Jackson, MS 39213
(601)981-1861 (601)981-1869 www.emgsi.com
Medical Vacuum Exhaust Exhaust for the Medical Vacuum system is not turned down with a non corrosive screen installed.
Medium 10/18/2024Install a 90 degree turn down with a non corrosive screen.
25165
Page: 18
BTM24289-1 -- 2024 Annual Medical Gas Inspection
Item Deficiency Description Priority DateRecommended SolutionID#
Detail Report on Findings
Environmental & Medical Gas Services 218 W Lorenz Blvd.
Jackson, MS 39213
(601)981-1861 (601)981-1869 www.emgsi.com
Zone Valve serving Neurology Lab gas turrets.
MGZV02-06
The lab is being used as a break room now. Medium 10/18/2024Recommend removing handles from zone valve and draining the line pressures.
25171
Page: 19
BTM24289-1 -- 2024 Annual Medical Gas Inspection
Item Deficiency Description Priority DateRecommended SolutionID#
Detail Report on Findings
Environmental & Medical Gas Services 218 W Lorenz Blvd.
Jackson, MS 39213
(601)981-1861 (601)981-1869 www.emgsi.com
Medical Gas Outlet / Inlet Issues
Floor 3 Area Served: ENT Clinic
(MGZV03-04)
Room Number: C331 Gas Type: Oxygen Outlet Number: 1 Outlet Model: Horizon
Leaking from front body Medium 10/21/2024Recommend replacing the outlet.
25182
Floor 3 Area Served: ENT Clinic
(MGZV03-04)
Room Number: C334 Gas Type: Oxygen Outlet Number: 1 Outlet Model: Horizon
Leaking from front body Medium 10/21/2024Recommend replacing the outlet.
25185
Floor 3 Area Served: ENT Clinic
(MGZV03-04)
Room Number: C334 Gas Type: Oxygen Outlet Number: 2 Outlet Model: Horizon
Leaking from front body Medium 10/21/2024Recommend replacing the outlet.
25186
Page: 20
BTM24289-1 -- 2024 Annual Medical Gas Inspection
Item Deficiency Description Priority DateRecommended SolutionID#
Detail Report on Findings
Environmental & Medical Gas Services 218 W Lorenz Blvd.
Jackson, MS 39213
(601)981-1861 (601)981-1869 www.emgsi.com
Floor 3 Area Served: ENT Clinic
(MGZV03-04)
Room Number: C335 Gas Type: Oxygen Outlet Number: 1 Outlet Model: Horizon
Leaking from front body Medium 10/21/2024Recommend replacing the outlet.
25183
Floor 3 Area Served: ENT Clinic
(MGZV03-04)
Room Number: C335 Gas Type: Oxygen Outlet Number: 2 Outlet Model: Horizon
Leaking from front body Medium 10/21/2024Recommend replacing the outlet.
25184
Page: 21
BTM24289-1 -- 2024 Annual Medical Gas Inspection
Item Deficiency Description Priority DateRecommended SolutionID#
Detail Report on Findings
Environmental & Medical Gas Services 218 W Lorenz Blvd.
Jackson, MS 39213
(601)981-1861 (601)981-1869 www.emgsi.com
Floor 4 Area Served: Cardiology
(MGZV04-06)
Room Number: K-429 Gas Type: Med Vac Outlet Number: 3 Outlet Model: Diamond 3
Inlet is being used with a WAGD hose Medium 10/21/2024Recommend replacing the vacuum ceiling inlet with a WAGD inlet.
Hose Vac DISS fitting to be replaced with a WAGD Female DISS as well
25187
Page: 22
BTM24289-1 -- 2024 Annual Medical Gas Inspection
Item Deficiency Description Priority DateRecommended SolutionID#
Detail Report on Findings
Environmental & Medical Gas Services 218 W Lorenz Blvd.
Jackson, MS 39213
(601)981-1861 (601)981-1869 www.emgsi.com
Medical Gas Zone Valve Issues
Basement Ambulatory Surgery 1-10 Oxygen, MedAir,MedVac Zone Valve
MGZVB-11
Intervening wall exists = FAIL
Zone Valve is inside the area it serves.
Medium 10/21/2024Recommend relocating the zone valve to a place where a wall intervenes it from the outlets it serves.25193
Page: 23
Corrections
Page: 24COMPANY Confidential
Corrections List
BTM24289-1 -- 2024 Annual Medical Gas Inspection
Item Description DateCorrective ActionID#
Summary of Corrections
Environmental & Medical Gas Services 218 W Lorenz Blvd.
Jackson, MS 39213
(601)981-1861 (601)981-1869 www.emgsi.com
25179 Bulk Oxygen Valve Tag There were no tags identifying areas served. Tag had become discolored from the elements.
Replaced tag with a new metal source valve tag. Date found:
10/21/2024
Date repaired:
10/21/2024
25178 Medical Air Source Valve Tag
There were no tags identifying areas served. Added Source Valve Tag Date found:
10/21/2024
Date repaired:
10/21/2024
25177 Medical Vacuum Source Valve Tag
There were no tags identifying areas served. Replaced Source Valve Tag with correct labeling and color. Date found:
10/21/2024
Date repaired:
Correction List for G. V. (Sonny) Montgomery VA Medical Center10/21/2024 Page: 25
Corrections List
BTM24289-1 -- 2024 Annual Medical Gas Inspection
Item Description DateCorrective ActionID#
Summary of Corrections
Environmental & Medical Gas Services 218 W Lorenz Blvd.
Jackson, MS 39213
(601)981-1861 (601)981-1869 www.emgsi.com
25189 Basement Area Served: Radiology
(MGZVB-03)
Room Number: B07 Gas Type: Oxygen Outlet Number: 1 Outlet Model: Diamond 3
Leaking from back body Outlet repaired with repair kit Date found:
10/17/2024
Date repaired:
10/17/2024
25192 Floor 2 Area Served: Module C
(MGZV02-03)
Room Number: C-221 Gas Type: Oxygen Outlet Number: 1 Outlet Model: O-QDWAL
Leaking from front body Outlet repaired with repair kit Date found:
10/21/2024
Date repaired:
10/21/2024
25191 Floor 3 Area Served: PMRS
(MGZV03-01)
Room Number: 3049 Gas Type: Oxygen Outlet Number: 1 Outlet Model: O-QDWAL
Leaking from front body Outlet repaired with repair kit Date found:
10/15/2024
Date repaired:
10/15/2024
25033 Floor 4 Area Served: Dialysis
(MGZV04-05)
Room Number: 6 Gas Type: Med Air Outlet Number: 1 Outlet Model: O-QDWAL
Leaking from front body Outlet repaired with repair kit Date found:
10/15/2024
Date repaired:
10/15/2024
25188 Floor 4 Area Served: Patient
(MGZV04-03)
Room Number: 4130 Gas Type: Med Air Outlet Number: 1 Outlet Model: O-QDCON
Leaking from front body Outlet repaired with repair kit Date found:
10/15/2024
Date repaired:
10/15/2024
Correction List for G. V. (Sonny) Montgomery VA Medical Center10/21/2024 Page: 26
Closed / Resolved Issue List
BTM24289-1 -- 2024 Annual Medical Gas Inspection
Item Description Resolution Date
Completed
Detail Report on Corrections
Environmental & Medical Gas Services 218 W Lorenz Blvd.
Jackson, MS 39213
(601)981-1861 (601)981-1869 www.emgsi.com
ID#
There were no tags identifying areas served. Tag had become discolored from the elements.
Replaced tag with a new metal source valve tag.
10/21/2024Bulk Oxygen Valve Tag
25179
Page: 27
BTM24289-1 -- 2024 Annual Medical Gas Inspection
Item Description Resolution Date
Completed
Detail Report on Corrections
Environmental & Medical Gas Services 218 W Lorenz Blvd.
Jackson, MS 39213
(601)981-1861 (601)981-1869 www.emgsi.com
ID#
There were no tags identifying areas served. Added Source Valve Tag 10/21/2024Medical Air Source Valve Tag
25178
Page: 28
BTM24289-1 -- 2024 Annual Medical Gas Inspection
Item Description Resolution Date
Completed
Detail Report on Corrections
Environmental & Medical Gas Services 218 W Lorenz Blvd.
Jackson, MS 39213
(601)981-1861 (601)981-1869 www.emgsi.com
ID#
There were no tags identifying areas served. Replaced Source Valve Tag with correct labeling and color.
10/21/2024Medical Vacuum Source Valve Tag
25177
Page: 29
BTM24289-1 -- 2024 Annual Medical Gas Inspection
Item Description Resolution Date
Completed
Detail Report on Corrections
Environmental & Medical Gas Services 218 W Lorenz Blvd.
Jackson, MS 39213
(601)981-1861 (601)981-1869 www.emgsi.com
ID#
Leaking from back body Outlet repaired with repair kit 10/17/2024Basement Area Served: Radiology (MGZVB -03) Room Number: B07 Gas Type: Oxygen Outlet Number: 1 Outlet Model: Diamond 3
25189
Page: 30
BTM24289-1 -- 2024 Annual Medical Gas Inspection
Item Description Resolution Date
Completed
Detail Report on Corrections
Environmental & Medical Gas Services 218 W Lorenz Blvd.
Jackson, MS 39213
(601)981-1861 (601)981-1869 www.emgsi.com
ID#
Leaking from front body Outlet repaired with repair kit 10/21/2024Floor 2 Area Served: Module C (MGZV02 -03) Room Number: C-221 Gas Type: Oxygen Outlet Number: 1 Outlet Model: O-QDWAL
25192
Page: 31
BTM24289-1 -- 2024 Annual Medical Gas Inspection
Item Description Resolution Date
Completed
Detail Report on Corrections
Environmental & Medical Gas Services 218 W Lorenz Blvd.
Jackson, MS 39213
(601)981-1861 (601)981-1869 www.emgsi.com
ID#
Leaking from front body Outlet repaired with repair kit 10/15/2024Floor 3 Area Served: PMRS (MGZV03-01) Room Number: 3049 Gas Type: Oxygen Outlet Number: 1 Outlet Model: O-QDWAL
25191
Page: 32
BTM24289-1 -- 2024 Annual Medical Gas Inspection
Item Description Resolution Date
Completed
Detail Report on Corrections
Environmental & Medical Gas Services 218 W Lorenz Blvd.
Jackson, MS 39213
(601)981-1861 (601)981-1869 www.emgsi.com
ID#
Leaking from front body Outlet repaired with repair kit 10/15/2024Floor 4 Area Served: Dialysis (MGZV04-05) Room Number: 6 Gas Type: Med Air Outlet Number: 1 Outlet Model: O-QDWAL
25033
Page: 33
BTM24289-1 -- 2024 Annual Medical Gas Inspection
Item Description Resolution Date
Completed
Detail Report on Corrections
Environmental & Medical Gas Services 218 W Lorenz Blvd.
Jackson, MS 39213
(601)981-1861 (601)981-1869 www.emgsi.com
ID#
Leaking from front body Outlet repaired with repair kit 10/15/2024Floor 4 Area Served: Patient (MGZV04-03) Room Number: 4130 Gas Type: Med Air Outlet Number: 1 Outlet Model: O-QDCON
25188
Page: 34
Master Alarms
Page: 35COMPANY Confidential
Master Alarm Report G. V. (Sonny) Montgomery VA Medical CenterFacility 10/18/2024Date Stephen BishopJob Contact Bryan TeasleyInspector
Alarm Visual Test
EngineeringPanel Location Alert-2 AreaModel AmicoManufacturer MGMA01-01Label
Master Alarm Panel Verification Audible TestSensor Location
Environmental & Medical Gas Services 218 W Lorenz Blvd.
Jackson, MS 39213
Phone: (601)981-1861 Fax: (601)981-1869 www.emgsi.com
PASSPASSBoiler RoomOxygen High Line Pressure
Oxygen Bulk Tank - Outside Plant Ops.
PASSPASSBoiler RoomOxygen Low Line Pressure
Oxygen Bulk Tank - Outside Plant Ops.
PASSPASSASEOxygen Reserve Supply in Use
Oxygen Bulk Tank - Outside Plant Ops.
PASSPASSASEOxygen Main Tank Liquid Level Low
Oxygen Bulk Tank - Outside Plant Ops.
PASSPASSASEOxygen Reserve Tank Liquid Level Low
Oxygen Bulk Tank - Outside Plant Ops.
PASSPASSASEOxygen Reserve Low Pressure
Oxygen Bulk Tank - Outside Plant Ops.
PASSPASSBoiler RoomMed Air High Line Pressure
Med Air Air Compressor - Boiler Room
PASSPASSBoiler RoomMed Air Low Line Pressure
Med Air Air Compressor - Boiler Room
PASSPASSASEMed Air Dew Point High Med Air Air Compressor -
Boiler Room
COMPANY Confidential Page: 36
Alarm Visual Test
EngineeringPanel Location Alert-2 AreaModel AmicoManufacturer MGMA01-01Label
Master Alarm Panel Verification Audible TestSensor Location
PASSPASSASEMed Air Carbon Monoxide High
Med Air Air Compressor - Boiler Room
PASSPASSASEMed Air Lag Compressor in Use
Med Air Air Compressor - Boiler Room
PASSPASSASEMed Air Compressor High Temp Unit 1
Med Air Air Compressor - Boiler Room
PASSPASSASEMed Air Compressor High Temp Unit 2
Med Air Air Compressor - Boiler Room
PASSPASSASEMed Air Compressor High Temp Unit 3
Med Air Air Compressor - Boiler Room
PASSPASSBoiler RoomMed Vac Low Vacuum Med Vac Vacuum Pump -
Boiler Room PASSPASSASEMed Vac Lag Pump in
Use Med Vac Vacuum Pump -
Boiler Room PASSPASSASEMed Vac Pump High
Temp Unit 1 Med Vac Vacuum Pump -
Boiler Room PASSPASSASEMed Vac Pump High
Temp Unit 2 Med Vac Vacuum Pump -
Boiler Room PASSPASSASEMed Vac Pump High
Temp Unit 3 Med Vac Vacuum Pump -
Boiler Room PASSPASSASEN2O High Line Pressure
N2O Manifold - Manifold Room loading Dock
PASSPASSASEN2O Low Line Pressure N2O Manifold - Manifold
Room loading Dock PASSPASSASEN2O Cylinder Bank
Changeover N2O Manifold - Manifold
Room loading Dock COMPANY Confidential Page: 37
EngineeringPanel Location Alert-2 AreaModel AmicoManufacturer MGMA01-01Label
Master Alarm Panel Verification Audible TestSensor Location
PASSPASSASENitrogen High Line Pressure
Nitrogen Manifold - Manifold Room Behind
Shipping PASSPASSASENitrogen Low Line
Pressure Nitrogen Manifold -
Manifold Room Behind Shipping
PASSPASSASENitrogen Cylinder Bank Changeover
Nitrogen Manifold - Manifold Room Behind
Shipping Inspection Items
The following items were inspected as part of the verification in accordance with NFPA 99:
PASSItem 1: Functional test passed with no failures detected
Item 2: All low voltage wiring is supervised Item 3: Means to test for visual or audible alarm failure (i.e. test switch) Item 4: Provision for automatic restart in the event of a power outage Item 5: Visual and audible indication that wiring to an alarm initiating device is disconnected Item 6: Alarm panel is powered from the Life Safety Branch of the Emergency Power Circuit
PASS
PASS
PASS
PASS
PASS
COMPANY Confidential Page: 38
PBXPanel Location Tan FaceModel MedaesManufacturer MGMA01-02Label
Master Alarm Panel Verification Audible TestSensor Location
PASSPASSBoiler RoomOxygen High Line Pressure
Oxygen Bulk Tank - Outside Plant Ops.
PASSPASSBoiler RoomOxygen Low Line Pressure
Oxygen Bulk Tank - Outside Plant Ops.
PASSPASSASEOxygen Reserve Supply in Use
Oxygen Bulk Tank - Outside Plant Ops.
PASSPASSASEOxygen Main Tank Liquid Level Low
Oxygen Bulk Tank - Outside Plant Ops.
PASSPASSASEOxygen Reserve Tank Liquid Level Low
Oxygen Bulk Tank - Outside Plant Ops.
PASSPASSASEOxygen Reserve Low Pressure
Oxygen Bulk Tank - Outside Plant Ops.
PASSPASSBoiler RoomMed Air High Line Pressure
Med Air Air Compressor - Boiler Room
PASSPASSBoiler RoomMed Air Low Line Pressure
Med Air Air Compressor - Boiler Room
PASSPASSASEMed Air Dew Point High Med Air Air Compressor -
Boiler Room PASSPASSASEMed Air Carbon Monoxide
High Med Air Air Compressor -
Boiler Room PASSPASSASEMed Air Lag Compressor in Use Med Air Air Compressor -
Boiler Room PASSPASSASEMed Air Compressor High
Temp Unit 1 Med Air Air Compressor -
Boiler Room
COMPANY Confidential Page: 39
MedaesManufacturer MGMA01-02Label
Master Alarm Panel Verification Audible TestSensor Location
PASSPASSASEMed Air Compressor High Temp Unit 2
Med Air Air Compressor - Boiler Room
PASSPASSASEMed Air Compressor High Temp Unit 3
Med Air Air Compressor - Boiler Room
PASSPASSBoiler RoomMed Vac Low Vacuum Med Vac Vacuum Pump -
Boiler Room PASSPASSASEMed Vac Lag Pump in
Use Med Vac Vacuum Pump -
Boiler Room PASSPASSASEMed Vac Pump High
Temp Unit 1 Med Vac Vacuum Pump -
Boiler Room PASSPASSASEMed Vac Pump High
Temp Unit 2 Med Vac Vacuum Pump -
Boiler Room PASSPASSASEMed Vac Pump High
Temp Unit 3 Med Vac Vacuum Pump -
Boiler Room PASSPASSASEN2O High Line Pressure
N2O Manifold - Manifold Room loading Dock
PASSPASSASEN2O Low Line Pressure N2O Manifold - Manifold
Room loading Dock PASSPASSASEN2O Cylinder Bank
Changeover N2O Manifold - Manifold
Room loading Dock PASSPASSASENitrogen High Line
Pressure Nitrogen Manifold -
Manifold Room Behind Shipping
PASSPASSASENitrogen Low Line Pressure
Nitrogen Manifold - Manifold Room Behind
Shipping
COMPANY Confidential Page: 40
MedaesManufacturer MGMA01-02Label
Master Alarm Panel Verification Audible TestSensor Location
PASSPASSASENitrogen Cylinder Bank Changeover
Nitrogen Manifold - Manifold Room Behind
Shipping Inspection Items
The following items were inspected as part of the verification in accordance with NFPA 99:
PASSItem 1: Functional test passed with no failures detected
Item 2: All low voltage wiring is supervised Item 3: Means to test for visual or audible alarm failure (i.e. test switch) Item 4: Provision for automatic restart in the event of a power outage Item 5: Visual and audible indication that wiring to an alarm initiating device is disconnected Item 6: Alarm panel is powered from the Life Safety Branch of the Emergency Power Circuit
PASS
PASS
PASS
PASS
PASS
COMPANY Confidential Page: 41
Area Alarms
Page: 42COMPANY Confidential
Area Alarm Report - Ohmeda - Tan Face
Stephen BishopJob Contact Bryan TeasleyInspector BasementFloor MGAAB-06Label 1-10Room Numbers
Sen Loc to
ZVB
Sensor Type
Environmental & Medical Gas Services 218 W Lorenz Blvd.
Jackson, MS 39213
Phone: (601)981-1861 | Fax: (601)981-1869 www.emgsi.com
PASSPASSPASSAmbulatory Surgery PASS PASS Area(s) Served
Ability for automatic restart
Area Alarm Verification
VIS and AUD indication wiring disc
Means to test VIS and AUD failure
Alarm panel powered from emerg pwr Test Switch
Alarm Type Low Alarm High Alarm Visual Test Audible Test
Oxygen 40 PSI 60 PSI PASS PASS Med Air 40 PSI 60 PSI PASS PASS Med Vac 12” Hg N/A PASS PASS
COMPANY Confidential Page: 43
Area Alarm Report - Amico - Alert-2 Area
Stephen BishopJob Contact Bryan TeasleyInspector BasementFloor MGAAB-08Label A-19-22, A-26-29Room Numbers
Local (in Alarm Box)Sen Loc to
ZVB
Upstream of ZVBSensor Type
Environmental & Medical Gas Services 218 W Lorenz Blvd.
Jackson, MS 39213
Phone: (601)981-1861 | Fax: (601)981-1869 www.emgsi.com
PASSPASSPASSBiomed PASS PASS Area(s) Served
Ability for automatic restart
Area Alarm Verification
VIS and AUD indication wiring disc
Means to test VIS and AUD failure
Alarm panel powered from emerg pwr Test Switch
Alarm Type Low Alarm High Alarm Visual Test Audible Test
Oxygen 40 PSI 60 PSI PASS PASS Med Air 40 PSI 60 PSI PASS PASS
COMPANY Confidential Page: 44
Area Alarm Report - Medaes - Tan Face
Stephen BishopJob Contact Bryan TeasleyInspector BasementFloor MGAAB-04Label F11, F13, F17,F19, B08A-B08FRoom Numbers
Sen Loc to
ZVB
Sensor Type
Environmental & Medical Gas Services 218 W Lorenz Blvd.
Jackson, MS 39213
Phone: (601)981-1861 | Fax: (601)981-1869 www.emgsi.com
PASSPASSPASSCAT SCAN PASS PASS
Area(s) Served
Ability for automatic restart
Area Alarm Verification
VIS and AUD indication wiring disc
Means to test VIS and AUD failure
Alarm panel powered from emerg pwr Test Switch
Alarm Type Low Alarm High Alarm Visual Test Audible Test
Oxygen 40 PSI 60 PSI PASS PASS Med Air 40 PSI 60 PSI PASS PASS
COMPANY Confidential Page: 45
Stephen BishopJob Contact Bryan TeasleyInspector BasementFloor MGAAB-07Label K-3Room Numbers
Sen Loc to
ZVB
Sensor Type
Environmental & Medical Gas Services 218 W Lorenz Blvd.
Jackson, MS 39213
Phone: (601)981-1861 | Fax: (601)981-1869 www.emgsi.com
PASSPASSPASSEKG/LAB PASS PASS
Area(s) Served
Ability for automatic restart
Area Alarm Verification
VIS and AUD indication wiring disc
Means to test VIS and AUD failure
Alarm panel powered from emerg pwr Test Switch
Alarm Type Low Alarm High Alarm Visual Test Audible Test
Oxygen 40 PSI 60 PSI PASS PASS Med Air 40 PSI 60 PSI PASS PASS
COMPANY Confidential Page: 46
Stephen BishopJob Contact Bryan TeasleyInspector BasementFloor MGAAB-09Label K-20B,C,E,F,GRoom Numbers
Local (in Alarm Box)Sen Loc to
ZVB
Upstream of ZVBSensor Type
Environmental & Medical Gas Services 218 W Lorenz Blvd.
Jackson, MS 39213
Phone: (601)981-1861 | Fax: (601)981-1869 www.emgsi.com
PASSPASSPASSEndo PASS PASS Area(s) Served
Ability for automatic restart
Area Alarm Verification
VIS and AUD indication wiring disc
Means to test VIS and AUD failure
Alarm panel powered from emerg pwr Test Switch
Alarm Type Low Alarm High Alarm Visual Test Audible Test
Oxygen 40 PSI 60 PSI PASS PASS Med Air 40 PSI 60 PSI PASS PASS
COMPANY Confidential Page: 47
Stephen BishopJob Contact Bryan TeasleyInspector BasementFloor MGAAB-03Label 1-16Room Numbers
Local (in Alarm Box)Sen Loc to
ZVB
Upstream of ZVBSensor Type
Environmental & Medical Gas Services 218 W Lorenz Blvd.
Jackson, MS 39213
Phone: (601)981-1861 | Fax: (601)981-1869 www.emgsi.com
PASSPASSPASSInfusion PASS PASS Area(s) Served
Ability for automatic restart
Area Alarm Verification
VIS and AUD indication wiring disc
Means to test VIS and AUD failure
Alarm panel powered from emerg pwr Test Switch
Alarm Type Low Alarm High Alarm Visual Test Audible Test
Oxygen 40 PSI 60 PSI PASS PASS Med Air 40 PSI 60 PSI PASS PASS
COMPANY Confidential Page: 48
Stephen BishopJob Contact Bryan TeasleyInspector BasementFloor MGAAB-02Label D-21 - D-38Room Numbers
Local (in Alarm Box)Sen Loc to
ZVB
Upstream of ZVBSensor Type
Environmental & Medical Gas Services 218 W Lorenz Blvd.
Jackson, MS 39213
Phone: (601)981-1861 | Fax: (601)981-1869 www.emgsi.com
PASSPASSPASSOncology PASS PASS Area(s) Served
Ability for automatic restart
Area Alarm Verification
VIS and AUD indication wiring disc
Means to test VIS and AUD failure
Alarm panel powered from emerg pwr Test Switch
Alarm Type Low Alarm High Alarm Visual Test Audible Test
Oxygen 40 PSI 60 PSI PASS PASS Med Air 40 PSI 60 PSI PASS PASS
COMPANY Confidential Page: 49
Stephen BishopJob Contact Bryan TeasleyInspector BasementFloor MGAAB-10Label 1-8, isolationRoom Numbers
Local (in Alarm Box)Sen Loc to
ZVB
Upstream of ZVBSensor Type
Environmental & Medical Gas Services 218 W Lorenz Blvd.
Jackson, MS 39213
Phone: (601)981-1861 | Fax: (601)981-1869 www.emgsi.com
PASSPASSPASSP.A.C.U PASS PASS
Area(s) Served
Ability for automatic restart
Area Alarm Verification
VIS and AUD indication wiring disc
Means to test VIS and AUD failure
Alarm panel powered from emerg pwr Test Switch
Alarm Type Low Alarm High Alarm Visual Test Audible Test
Oxygen 40 PSI 60 PSI PASS PASS Med Air 40 PSI 60 PSI PASS PASS
COMPANY Confidential Page: 50
Stephen BishopJob Contact Bryan TeasleyInspector BasementFloor MGAAB-01Label Bo6,B09Room Numbers
Local (in Alarm Box)Sen Loc to
ZVB
Upstream of ZVBSensor Type
Environmental & Medical Gas Services 218 W Lorenz Blvd.
Jackson, MS 39213
Phone: (601)981-1861 | Fax: (601)981-1869 www.emgsi.com
PASSPASSPASSRadiology PASS PASS Area(s) Served
Ability for automatic restart
Area Alarm Verification
VIS and AUD indication wiring disc
Means to test VIS and AUD failure
Alarm panel powered from emerg pwr Test Switch
Alarm Type Low Alarm High Alarm Visual Test Audible Test
Oxygen 40 PSI 60 PSI PASS PASS Med Air 40 PSI 60 PSI PASS PASS
COMPANY Confidential Page: 51
Stephen BishopJob Contact Bryan TeasleyInspector BasementFloor Label F11,F13,F17,B08A, B08F, F19Room Numbers
Local (in Alarm Box)Sen Loc to
ZVB
Downstream of ZVBSensor Type
Environmental & Medical Gas Services 218 W Lorenz Blvd.
Jackson, MS 39213
Phone: (601)981-1861 | Fax: (601)981-1869 www.emgsi.com
PASSPASSPASSRadiology PASS PASS Area(s) Served
Ability for automatic restart
Area Alarm Verification
VIS and AUD indication wiring disc
Means to test VIS and AUD failure
Alarm panel powered from emerg pwr Test Switch
Alarm Type Low Alarm High Alarm Visual Test Audible Test
Oxygen 40 PSI 60 PSI PASS PASS Med Air 40 PSI 60 PSI PASS PASS
COMPANY Confidential Page: 52
Stephen BishopJob Contact Bryan TeasleyInspector BasementFloor MGAAB-05Label OR1-7, AnesthesiaRoom Numbers
Sen Loc to
ZVB
Sensor Type
Environmental & Medical Gas Services 218 W Lorenz Blvd.
Jackson, MS 39213
Phone: (601)981-1861 | Fax: (601)981-1869 www.emgsi.com
PASSPASSPASSSurgery PASS PASS Area(s) Served
Ability for automatic restart
Area Alarm Verification
VIS and AUD indication wiring disc
Means to test VIS and AUD failure
Alarm panel powered from emerg pwr Test Switch
Alarm Type Low Alarm High Alarm Visual Test Audible Test
Oxygen 40 PSI 60 PSI PASS PASS Med Air 40 PSI 60 PSI PASS PASS Med Vac 12” Hg N/A PASS PASS
N2O 40 PSI 60 PSI PASS PASS
Nitrogen 135 PSI 205 PSI PASS PASS
COMPANY Confidential Page: 53
Stephen BishopJob Contact Bryan TeasleyInspector Floor 1Floor MGAA01-01Label 1121A-H, 1104-1106, 1109-1114, 1119,, 1121A-H, E-139, E-143Room Numbers
Sen Loc to
ZVB
Sensor Type
Environmental & Medical Gas Services 218 W Lorenz Blvd.
Jackson, MS 39213
Phone: (601)981-1861 | Fax: (601)981-1869 www.emgsi.com
PASSPASSPASSEmergency Department PASS PASS Area(s) Served
Ability for automatic restart
Area Alarm Verification
VIS and AUD indication wiring disc
Means to test VIS and AUD failure
Alarm panel powered from emerg pwr Test Switch
Alarm Type Low Alarm High Alarm Visual Test Audible Test
Oxygen 40 PSI 60 PSI PASS PASS Med Air 40 PSI 60 PSI PASS PASS
COMPANY Confidential Page: 54
Area Alarm Report - Amico - Alert-3 LCD
Stephen BishopJob Contact Bryan TeasleyInspector Floor 2Floor MGAA02-06Label H130-H146,H150-H160Room Numbers
Remote (in Zone Valve)Sen Loc to
ZVB
Downstream of ZVBSensor Type
Environmental & Medical Gas Services 218 W Lorenz Blvd.
Jackson, MS 39213
Phone: (601)981-1861 | Fax: (601)981-1869 www.emgsi.com
PASSPASSPASSCLC Patients PASS PASS Area(s) Served
Ability for automatic restart
Area Alarm Verification
VIS and AUD indication wiring disc
Means to test VIS and AUD failure
Alarm panel powered from emerg pwr Test Switch
Alarm Type Low Alarm High Alarm Visual Test Audible Test
Oxygen 40 PSI 60 PSI PASS PASS Med Air 40 PSI 60 PSI PASS PASS
COMPANY Confidential Page: 55
Stephen BishopJob Contact Bryan TeasleyInspector Floor 2Floor MGAA02-02Label 215,216,218,222,224,227Room Numbers
Local (in Alarm Box)Sen Loc to
ZVB
Upstream of ZVBSensor Type
Environmental & Medical Gas Services 218 W Lorenz Blvd.
Jackson, MS 39213
Phone: (601)981-1861 | Fax: (601)981-1869 www.emgsi.com
PASSPASSPASSH.A.C PASS PASS
Area(s) Served
Ability for automatic restart
Area Alarm Verification
VIS and AUD indication wiring disc
Means to test VIS and AUD failure
Alarm panel powered from emerg pwr Test Switch
Alarm Type Low Alarm High Alarm Visual Test Audible Test
Oxygen 40 PSI 60 PSI PASS PASS Med Air 40 PSI 60 PSI PASS PASS
COMPANY Confidential Page: 56
Stephen BishopJob Contact Bryan TeasleyInspector Floor 2Floor MGAA02-03Label C203-C221Room Numbers
Local (in Alarm Box)Sen Loc to
ZVB
Upstream of ZVBSensor Type
Environmental & Medical Gas Services 218 W Lorenz Blvd.
Jackson, MS 39213
Phone: (601)981-1861 | Fax: (601)981-1869 www.emgsi.com
PASSPASSPASSModule C PASS PASS Area(s) Served
Ability for automatic restart
Area Alarm Verification
VIS and AUD indication wiring disc
Means to test VIS and AUD failure
Alarm panel powered from emerg pwr Test Switch
Alarm Type Low Alarm High Alarm Visual Test Audible Test
Oxygen 40 PSI 60 PSI PASS PASS Med Air 40 PSI 60 PSI PASS PASS
COMPANY Confidential Page: 57
Stephen BishopJob Contact Bryan TeasleyInspector Floor 2Floor MGAA02-04Label C234-240Room Numbers
Local (in Alarm Box)Sen Loc to
ZVB
Downstream of ZVBSensor Type
Environmental & Medical Gas Services 218 W Lorenz Blvd.
Jackson, MS 39213
Phone: (601)981-1861 | Fax: (601)981-1869 www.emgsi.com
PASSPASSPASSModule D PASS PASS Area(s) Served
Ability for automatic restart
Area Alarm Verification
VIS and AUD indication wiring disc
Means to test VIS and AUD failure
Alarm panel powered from emerg pwr Test Switch
Alarm Type Low Alarm High Alarm Visual Test Audible Test
Oxygen 40 PSI 60 PSI PASS PASS Med Air 40 PSI 60 PSI PASS PASS
COMPANY Confidential Page: 58
Stephen BishopJob Contact Bryan TeasleyInspector Floor 2Floor MGAA03-03Label 316,319Room Numbers
Local (in Alarm Box)Sen Loc to
ZVB
Upstream of ZVBSensor Type
Environmental & Medical Gas Services 218 W Lorenz Blvd.
Jackson, MS 39213
Phone: (601)981-1861 | Fax: (601)981-1869 www.emgsi.com
PASSPASSPASSModule F PASS PASS Area(s) Served
Ability for automatic restart
Area Alarm Verification
VIS and AUD indication wiring disc
Means to test VIS and AUD failure
Alarm panel powered from emerg pwr Test Switch
Alarm Type Low Alarm High Alarm Visual Test Audible Test
Oxygen 40 PSI 60 PSI PASS PASS Med Air 40 PSI 60 PSI PASS PASS
COMPANY Confidential Page: 59
Stephen BishopJob Contact Bryan TeasleyInspector Floor 2Floor MGAA02-05Label C252,253,255,257,261,262,264,265,255,268-281Room Numbers
Local (in Alarm Box)Sen Loc to
ZVB
Downstream of ZVBSensor Type
Environmental & Medical Gas Services 218 W Lorenz Blvd.
Jackson, MS 39213
Phone: (601)981-1861 | Fax: (601)981-1869 www.emgsi.com
PASSPASSPASSModule G PASS PASS Area(s) Served
Ability for automatic restart
Area Alarm Verification
VIS and AUD indication wiring disc
Means to test VIS and AUD failure
Alarm panel powered from emerg pwr Test Switch
Alarm Type Low Alarm High Alarm Visual Test Audible Test
Oxygen 40 PSI 60 PSI PASS PASS Med Air 40 PSI 60 PSI PASS PASS
COMPANY Confidential Page: 60
Stephen BishopJob Contact Bryan TeasleyInspector Floor 3Floor MGAA03-04Label C326,329,331,332,334,335,336Room Numbers
Local (in Alarm Box)Sen Loc to
ZVB
Downstream of ZVBSensor Type
Environmental & Medical Gas Services 218 W Lorenz Blvd.
Jackson, MS 39213
Phone: (601)981-1861 | Fax: (601)981-1869 www.emgsi.com
PASSPASSPASSENT Clinic PASS PASS Area(s) Served
Ability for automatic restart
Area Alarm Verification
VIS and AUD indication wiring disc
Means to test VIS and AUD failure
Alarm panel powered from emerg pwr Test Switch
Alarm Type Low Alarm High Alarm Visual Test Audible Test
Oxygen 40 PSI 60 PSI PASS PASS Med Air 40 PSI 60 PSI PASS PASS
COMPANY Confidential Page: 61
Stephen BishopJob Contact Bryan TeasleyInspector Floor 3Floor MGAA03-01Label 3048, 3049Room Numbers
Remote (in Zone Valve)Sen Loc to
ZVB
Upstream of ZVBSensor Type
Environmental & Medical Gas Services 218 W Lorenz Blvd.
Jackson, MS 39213
Phone: (601)981-1861 | Fax: (601)981-1869 www.emgsi.com
PASSPASSPASSPMRS PASS PASS
Area(s) Served
Ability for automatic restart
Area Alarm Verification
VIS and AUD indication wiring disc
Means to test VIS and AUD failure
Alarm panel powered from emerg pwr Test Switch
Alarm Type Low Alarm High Alarm Visual Test Audible Test
Oxygen 40 PSI 60 PSI PASS PASS Med Air 40 PSI 60 PSI PASS PASS
COMPANY Confidential Page: 62
Stephen BishopJob Contact Bryan TeasleyInspector Floor 3Floor MGAA02-01Label L231-252Room Numbers
Local (in Alarm Box)Sen Loc to
ZVB
Downstream of ZVBSensor Type
Environmental & Medical Gas Services 218 W Lorenz Blvd.
Jackson, MS 39213
Phone: (601)981-1861 | Fax: (601)981-1869 www.emgsi.com
PASSPASSPASSSleep Lab PASS PASS Area(s) Served
Ability for automatic restart
Area Alarm Verification
VIS and AUD indication wiring disc
Means to test VIS and AUD failure
Alarm panel powered from emerg pwr Test Switch
Alarm Type Low Alarm High Alarm Visual Test Audible Test
Oxygen 40 PSI 60 PSI PASS PASS Med Air 40 PSI 60 PSI PASS PASS
COMPANY Confidential Page: 63
Stephen BishopJob Contact Bryan TeasleyInspector Floor 4Floor MGAA04-06Label K419,422,424,426,429Room Numbers
Local (in Alarm Box)Sen Loc to
ZVB
Downstream of ZVBSensor Type
Environmental & Medical Gas Services 218 W Lorenz Blvd.
Jackson, MS 39213
Phone: (601)981-1861 | Fax: (601)981-1869 www.emgsi.com
PASSPASSPASSCardiology PASS PASS Area(s) Served
Ability for automatic restart
Area Alarm Verification
VIS and AUD indication wiring disc
Means to test VIS and AUD failure
Alarm panel powered from emerg pwr Test Switch
Alarm Type Low Alarm High Alarm Visual Test Audible Test
Oxygen 40 PSI 60 PSI PASS PASS Med Air 40 PSI 60 PSI PASS PASS
COMPANY Confidential Page: 64
Stephen BishopJob Contact Bryan TeasleyInspector Floor 4Floor MGAA04-05Label 1-15Room Numbers
Local (in Alarm Box)Sen Loc to
ZVB
Downstream of ZVBSensor Type
Environmental & Medical Gas Services 218 W Lorenz Blvd.
Jackson, MS 39213
Phone: (601)981-1861 | Fax: (601)981-1869 www.emgsi.com
PASSPASSPASSDialysis PASS PASS Area(s) Served
Ability for automatic restart
Area Alarm Verification
VIS and AUD indication wiring disc
Means to test VIS and AUD failure
Alarm panel powered from emerg pwr Test Switch
Alarm Type Low Alarm High Alarm Visual Test Audible Test
Oxygen 40 PSI 60 PSI PASS PASS Med Air 40 PSI 60 PSI PASS PASS
COMPANY Confidential Page: 65
Area Alarm Report - Amico - AVU-202A4V (Alarm Valve Combo)
Stephen BishopJob Contact Bryan TeasleyInspector Floor 4Floor MGAA04-08Label L421,423,425,427,429,431Room Numbers
Local (in Alarm Box)Sen Loc to
ZVB
Downstream of ZVBSensor Type
Environmental & Medical Gas Services 218 W Lorenz Blvd.
Jackson, MS 39213
Phone: (601)981-1861 | Fax: (601)981-1869 www.emgsi.com
PASSPASSPASSICU PASS PASS
Area(s) Served
Ability for automatic restart
Area Alarm Verification
VIS and AUD indication wiring disc
Means to test VIS and AUD failure
Alarm panel powered from emerg pwr Test Switch
Alarm Type Low Alarm High Alarm Visual Test Audible Test
Oxygen 40 PSI 60 PSI PASS PASS Med Air 40 PSI 60 PSI PASS PASS
COMPANY Confidential Page: 66
Area Alarm Report - Amico - AVU-202A4V (Alarm Valve Combo)
Stephen BishopJob Contact Bryan TeasleyInspector Floor 4Floor MGAA04-07Label L442,444,446,448Room Numbers
Local (in Alarm Box)Sen Loc to
ZVB
Downstream of ZVBSensor Type
Environmental & Medical Gas Services 218 W Lorenz Blvd.
Jackson, MS 39213
Phone: (601)981-1861 | Fax: (601)981-1869 www.emgsi.com
PASSPASSPASSICU PASS PASS
Area(s) Served
Ability for automatic restart
Area Alarm Verification
VIS and AUD indication wiring disc
Means to test VIS and AUD failure
Alarm panel powered from emerg pwr Test Switch
Alarm Type Low Alarm High Alarm Visual Test Audible Test
Oxygen 40 PSI 60 PSI PASS PASS Med Air 40 PSI 60 PSI PASS PASS
COMPANY Confidential Page: 67
Stephen BishopJob Contact Bryan TeasleyInspector Floor 4Floor MGAA04-09Label 4235,4239,4240,4243,4245,4247Room Numbers
Local (in Alarm Box)Sen Loc to
ZVB
Downstream of ZVBSensor Type
Environmental & Medical Gas Services 218 W Lorenz Blvd.
Jackson, MS 39213
Phone: (601)981-1861 | Fax: (601)981-1869 www.emgsi.com
PASSPASSPASSPatients 4C PASS PASS Area(s) Served
Ability for automatic restart
Area Alarm Verification
VIS and AUD indication wiring disc
Means to test VIS and AUD failure
Alarm panel powered from emerg pwr Test Switch
Alarm Type Low Alarm High Alarm Visual Test Audible Test
Oxygen 40 PSI 60 PSI PASS PASS Med Air 40 PSI 60 PSI PASS PASS
COMPANY Confidential Page: 68
Stephen BishopJob Contact Bryan TeasleyInspector Floor 4Floor MGAA04-11Label 4254,4255,4260,4263,4266,4267,4269,4270Room Numbers
Local (in Alarm Box)Sen Loc to
ZVB
Downstream of ZVBSensor Type
Environmental & Medical Gas Services 218 W Lorenz Blvd.
Jackson, MS 39213
Phone: (601)981-1861 | Fax: (601)981-1869 www.emgsi.com
PASSPASSPASSPatients 4C PASS PASS Area(s) Served
Ability for automatic restart
Area Alarm Verification
VIS and AUD indication wiring disc
Means to test VIS and AUD failure
Alarm panel powered from emerg pwr Test Switch
Alarm Type Low Alarm High Alarm Visual Test Audible Test
Oxygen 40 PSI 60 PSI PASS PASS Med Air 40 PSI 60 PSI PASS PASS
COMPANY Confidential Page: 69
Stephen BishopJob Contact Bryan TeasleyInspector Floor 4Floor MGAA04-12Label 4272,4274,4275,4277,4280,4284,4285Room Numbers
Local (in Alarm Box)Sen Loc to
ZVB
Downstream of ZVBSensor Type
Environmental & Medical Gas Services 218 W Lorenz Blvd.
Jackson, MS 39213
Phone: (601)981-1861 | Fax: (601)981-1869 www.emgsi.com
PASSPASSPASSPatients 4C PASS PASS Area(s) Served
Ability for automatic restart
Area Alarm Verification
VIS and AUD indication wiring disc
Means to test VIS and AUD failure
Alarm panel powered from emerg pwr Test Switch
Alarm Type Low Alarm High Alarm Visual Test Audible Test
Oxygen 40 PSI 60 PSI PASS PASS Med Air 40 PSI 60 PSI PASS PASS
COMPANY Confidential Page: 70
Stephen BishopJob Contact Bryan TeasleyInspector Floor 4Floor MGAA04-10Label 4287,4289,4292,4293,4296,4298,4301Room Numbers
Local (in Alarm Box)Sen Loc to
ZVB
Downstream of ZVBSensor Type
Environmental & Medical Gas Services 218 W Lorenz Blvd.
Jackson, MS 39213
Phone: (601)981-1861 | Fax: (601)981-1869 www.emgsi.com
PASSPASSPASSPatients 4C PASS PASS Area(s) Served
Ability for automatic restart
Area Alarm Verification
VIS and AUD indication wiring disc
Means to test VIS and AUD failure
Alarm panel powered from emerg pwr Test Switch
Alarm Type Low Alarm High Alarm Visual Test Audible Test
Oxygen 40 PSI 60 PSI PASS PASS Med Air 40 PSI 60 PSI PASS PASS
COMPANY Confidential Page: 71
Stephen BishopJob Contact Bryan TeasleyInspector Floor 4Floor MGAA04-02Label 4104,4110,4112,4116Room Numbers
Local (in Alarm Box)Sen Loc to
ZVB
Downstream of ZVBSensor Type
Environmental & Medical Gas Services 218 W Lorenz Blvd.
Jackson, MS 39213
Phone: (601)981-1861 | Fax: (601)981-1869 www.emgsi.com
PASSPASSPASSPatients PASS PASS Area(s) Served
Ability for automatic restart
Area Alarm Verification
VIS and AUD indication wiring disc
Means to test VIS and AUD failure
Alarm panel powered from emerg pwr Test Switch
Alarm Type Low Alarm High Alarm Visual Test Audible Test
Oxygen 40 PSI 60 PSI PASS PASS Med Air 40 PSI 60 PSI PASS PASS
COMPANY Confidential Page: 72
Stephen BishopJob Contact Bryan TeasleyInspector Floor 4Floor MGAA04-01Label 4120,4121,4125Room Numbers
Local (in Alarm Box)Sen Loc to
ZVB
Downstream of ZVBSensor Type
Environmental & Medical Gas Services 218 W Lorenz Blvd.
Jackson, MS 39213
Phone: (601)981-1861 | Fax: (601)981-1869 www.emgsi.com
PASSPASSPASSPatients PASS PASS Area(s) Served
Ability for automatic restart
Area Alarm Verification
VIS and AUD indication wiring disc
Means to test VIS and AUD failure
Alarm panel powered from emerg pwr Test Switch
Alarm Type Low Alarm High Alarm Visual Test Audible Test
Oxygen 40 PSI 60 PSI PASS PASS Med Air 40 PSI 60 PSI PASS PASS
COMPANY Confidential Page: 73
Stephen BishopJob Contact Bryan TeasleyInspector Floor 4Floor MGAA04-03Label 4129-4134Room Numbers
Local (in Alarm Box)Sen Loc to
ZVB
Downstream of ZVBSensor Type
Environmental & Medical Gas Services 218 W Lorenz Blvd.
Jackson, MS 39213
Phone: (601)981-1861 | Fax: (601)981-1869 www.emgsi.com
PASSPASSPASSPatients PASS PASS Area(s) Served
Ability for automatic restart
Area Alarm Verification
VIS and AUD indication wiring disc
Means to test VIS and AUD failure
Alarm panel powered from emerg pwr Test Switch
Alarm Type Low Alarm High Alarm Visual Test Audible Test
Oxygen 40 PSI 60 PSI PASS PASS Med Air 40 PSI 60 PSI PASS PASS
COMPANY Confidential Page: 74
Stephen BishopJob Contact Bryan TeasleyInspector Floor 4Floor MGAA04-04Label 4136,4137,4138,4144Room Numbers
Local (in Alarm Box)Sen Loc to
ZVB
Downstream of ZVBSensor Type
Environmental & Medical Gas Services 218 W Lorenz Blvd.
Jackson, MS 39213
Phone: (601)981-1861 | Fax: (601)981-1869 www.emgsi.com
PASSPASSPASSPatients PASS PASS Area(s) Served
Ability for automatic restart
Area Alarm Verification
VIS and AUD indication wiring disc
Means to test VIS and AUD failure
Alarm panel powered from emerg pwr Test Switch
Alarm Type Low Alarm High Alarm Visual Test Audible Test
Oxygen 40 PSI 60 PSI PASS PASS Med Air 40 PSI 60 PSI PASS PASS
COMPANY Confidential Page: 75
Zone Valves
Page: 76COMPANY Confidential
Zone Valve Box Report
Stephen BishopJob Contact Bryan TeasleyInspector BasementFloor MGZVB-11Label
Room Numbers Hill RomManufacturer1-10
Environmental & Medical Gas Services 218 W Lorenz Blvd.
Jackson, MS 39213
Phone: (601)981-1861 | Fax: (601)981-1869 www.emgsi.com
Gas Type Valve Size
Area(s) Served Leak Test
PASS
Zone Valve Box Verification
Not behind doors or hidden
PASSAmbulatory Surgery
Cover plate Accessible
PASS PASS
Intervening wall exist between zone valve and the outlets served
FAIL
1"Oxygen 1"Med Air
1-3/4"Med Vac
COMPANY Confidential Page: 77
Stephen BishopJob Contact Bryan TeasleyInspector BasementFloor MGZVB-13Label
Room Numbers AmicoManufacturerA-19-22 - A-26-29
Environmental & Medical Gas Services 218 W Lorenz Blvd.
Jackson, MS 39213
Phone: (601)981-1861 | Fax: (601)981-1869 www.emgsi.com
Gas Type Valve Size
Area(s) Served Leak Test
PASS
Zone Valve Box Verification
Not behind doors or hidden
PASSBiomed
Cover plate Accessible
PASS PASS
Intervening wall exist between zone valve and the outlets served
PASS
1"Oxygen 1"Med Air
1-1/2"Med Vac
COMPANY Confidential Page: 78
Stephen BishopJob Contact Bryan TeasleyInspector BasementFloor MGZVB-06Label
Room Numbers OhmedaManufacturerB-14
Environmental & Medical Gas Services 218 W Lorenz Blvd.
Jackson, MS 39213
Phone: (601)981-1861 | Fax: (601)981-1869 www.emgsi.com
Gas Type Valve Size
Area(s) Served Leak Test
PASS
Zone Valve Box Verification
Not behind doors or hidden
PASSBioMed
Cover plate Accessible
PASS PASS
Intervening wall exist between zone valve and the outlets served
PASS
1"Med Air
COMPANY Confidential Page: 79
Stephen BishopJob Contact Bryan TeasleyInspector BasementFloor MGZVB-08Label
Room Numbers Medical Gas SystemsManufacturerF11, F13, F17,F19, B08A-B08F
Environmental & Medical Gas Services 218 W Lorenz Blvd.
Jackson, MS 39213
Phone: (601)981-1861 | Fax: (601)981-1869 www.emgsi.com
Gas Type Valve Size
Area(s) Served Leak Test
PASS
Zone Valve Box Verification
Not behind doors or hidden
PASSCAT SCAN
Cover plate Accessible
PASS PASS
Intervening wall exist between zone valve and the outlets served
PASS
1"Oxygen 1"Med Air
COMPANY Confidential Page: 80
Stephen BishopJob Contact Bryan TeasleyInspector BasementFloor MGZVB-01Label
Room Numbers MedaesManufacturerE-5
Environmental & Medical Gas Services 218 W Lorenz Blvd.
Jackson, MS 39213
Phone: (601)981-1861 | Fax: (601)981-1869 www.emgsi.com
Gas Type Valve Size
Area(s) Served Leak Test
PASS
Zone Valve Box Verification
Not behind doors or hidden
PASSE-5
Cover plate Accessible
PASS PASS
Intervening wall exist between zone valve and the outlets served
PASS
1/2"Oxygen 1/2"Med Air 1/2"Med Vac
COMPANY Confidential Page: 81
Stephen BishopJob Contact Bryan TeasleyInspector BasementFloor MGZVB-02Label
Room Numbers MedaesManufacturerE-5A
Environmental & Medical Gas Services 218 W Lorenz Blvd.
Jackson, MS 39213
Phone: (601)981-1861 | Fax: (601)981-1869 www.emgsi.com
Gas Type Valve Size
Area(s) Served Leak Test
PASS
Zone Valve Box Verification
Not behind doors or hidden
PASSE-5
Cover plate Accessible
PASS PASS
Intervening wall exist between zone valve and the outlets served
PASS
1/2"Oxygen 1/2"Med Air 3/4"Med Vac
COMPANY Confidential Page: 82
Stephen BishopJob Contact Bryan TeasleyInspector BasementFloor MGZVB-12Label
Room Numbers OhmedaManufacturerK-3
Environmental & Medical Gas Services 218 W Lorenz Blvd.
Jackson, MS 39213
Phone: (601)981-1861 | Fax: (601)981-1869 www.emgsi.com
Gas Type Valve Size
Area(s) Served Leak Test
PASS
Zone Valve Box Verification
Not behind doors or hidden
PASSEKG/LAB
Cover plate Accessible
PASS PASS
Intervening wall exist between zone valve and the outlets served
PASS
3/4"Oxygen 3/4"Med Air
COMPANY Confidential Page: 83
Stephen BishopJob…
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