Previous Inspection Report.pdf

PDF 3 MB Posted Jul 30, 2024

Attached to: Tucson SAVAHCS Medical Gas Inspection Once Annually
Solicitation number: 36C26224Q1499
Issued by: Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 22

About this file

Written by GovTribe AI · Jul 30, 2024

This document is a Previous Inspection Report for a medical gas inspection of the Southern Arizona VA Health Care Systems in Tucson, Arizona. The report covers an inspection that occurred from December 4-6, 2023 and includes detailed information on the medical gas, vacuum, and air systems at the facility.

The key details are:

The inspection was conducted by Evergreen Medical Services, Inc. and evaluated the medical piping systems against applicable NFPA and CMS codes and standards.
The report provides an overview of the total number of master alarms (206 total, with 6 deficient), area alarms (117 total, with 6 deficient), and zone valves (200 total, with 13 deficient).
It also includes the results of testing for system dew point, particulate contaminants, gaseous contaminants, and source equipment, all of which passed inspection.
The report goes into detail on the specific deficiencies found, including master alarm, area alarm, and zone valve issues, and provides recommendations for corrective actions.

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Other files

File	Type	Posted
36C26224Q1499 0001- Contractor Q and A.pdf	PDF	Jul 30, 2024
S02. 36C26224Q1499 Tucson Medical Gas Inspection.pdf	PDF	Jul 26, 2024
S02. 36C26224Q1499 Tucson Medical Gas Inspection.pdf	PDF	Jul 18, 2024

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MEDICAL GAS

TESTING & INSPECTION

Southern Arizona VA Health Care Systems

Tuscon, Arizona

1-800-872-8992 www.evergreenmedical.com

12/04/2023-12/06/2023

MEDICAL GAS INSPECTION REPORT

Medical Gas and Vacuum Systems Inspection/Testing

Southern AZ VA Tucson, AZ

Medical Facility:

City, State:

Medical Gas Contact Name:

Medical Gas Contact Dept:

Inspection Dates(s):

Territory MGR Jason Cates ASSE 6030 CREDENTIAL: 42161

Lead Technician(s) William Sigler ASSE 6030 CREDENTIAL: 12544604

Brandon Scott ASSE 6030 CREDENTIAL: 12615654

Section 7 - Contaminants

REPORT CONTENTS

Section 1 - Systems Overview

Section 2 - Deficiencies

- Master Alarm Deficiencies

- Area Alarm Deficiencies

- Zone Valves Deficiencies . . .

- Outlets & Inlets Deficiencies . . .

Section 3 - Master Alarms

- Master Alarm Inventory

Section 4 - Area Alarms

- Area Alarm Inventory

Evergreen Medical Services, Inc. in accordance with applicable NFPA & 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 NFPA 99.

Conflicts may occur when different editions of NFPA 99 have been adopted by different AHJs, and compliance occurs with one edition but not the other. Changes made to newer editions of NFPA 99 are done so to improve the system's quality, integrity, fire resistance, effectiveness, durability, and safety. Dependent on the opinion of the AHJ(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 be used as long as it is not a distinct hazard to safety. Fire/Explosion hazards, labeling, manifold enclosures, medical air usage, & maintenance codes apply to new & existing facilities.

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.

- System Dew Point

- Particulate Contaminants

- Gaseous Contaminants

Section 8 - Source EQPT Summary

- Source Equipment

Section 5 - Zone Valves

- Zone Valve Inventory

Tom Underwood

Engineering

12/04/2023-12/06/2023

Southern Arizona VA Health Care Systems

Tuscon, Arizona

Section 6 - Outlets & Inlets

GAS SYSTEMS OVERVIEW

Medical Gas and Vacuum Systems Inspection/Testing

Southern AZ VA Tucson, AZ

MASTER ALARMS/SIGNALS (EACH SIGNAL COUNTED INDIVIDUALLY)

AREA ALARMS (EACH SYSTEM GAS COUNTED AS SEPARATE ALARM)

ZONE VALVES (EACH SYSTEM GAS COUNTED INDIVIDUALLY)

Total Master Alarm Signals

Quantity of Passing Master Alarm Signals

Quantity of Deficient Master Alarm Signals

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

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

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

Total Area Alarms

Quantity of Passing Area Alarms

Quantity of Deficient Area Alarms

Total Zone Valves

Quantity of Passing Zone Valves

Quantity of Deficient Zone Valves

94.9%

5.1% Quantity of Passing Area Alarms

Quantity of Deficient Area Alarms

93.5%

6.5% Quantity of Passing Zone Valves

Quantity of Deficient Zone Valves

97.1%

2.9% Quantity of Passing Master Alarm Signals

GAS SYSTEMS OVERVIEW

Medical Gas and Vacuum Systems Inspection/Testing

Southern AZ VA Tucson, AZ

OUTLETS, INLETS & MANUFACTURED ASSEMBLIES

SYSTEM DEW POINT

PARTICULATE CONTAMINANTS

Total Dew Point Test Sites

Quantity of Passing Test Sites

Quantity of Deficient Test Sites

Total Particulate Contaminant Test Sites

Quantity of Passing Test Sites

Quantity of Deficient Test Sites

The Test Sites are selected in order to represent System Dew Point in both high-use and low-use areas for the systems tested.

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

Total Quantity of Outlets, Inlets and Manufactured Assemblies has remained the same from previous medical gas systems inspection.

Total Outlets & Inlets

Quantity of Passing Outlets/Inlets

Quantity of Deficient Outlets/Inlets

99.0%

1.0% Quantity of Passing Outlets/Inlets

Quantity of Deficient Outlets/Inlets

85%

15% Quantity of Passing Test Sites

Quantity of Deficient Test Sites

100%

0% Quantity of Passing Test Sites

GAS SYSTEMS OVERVIEW

Medical Gas and Vacuum Systems Inspection/Testing

Southern AZ VA Tucson, AZ

GASEOUS CONTAMINANTS

SOURCE EQUIPMENT

Total Source Systems

Quantity of Passing Source Systems

Quantity of Deficient Source Systems

Total Quantity of Source Equipment has remained the same from previous medical gas systems inspection.

Quantity of Deficient Test Sites

Total Gaseous Contaminants Test Sites

Quantity of Passing Test Sites

The Test Sites are selected in order to represent Gaseous Contaminants in all separate distribution and source systems. 100%

0% Quantity of Passing Test Sites

Quantity of Deficient Test Sites

100%

0% Quantity of Passing Source Systems

MASTER ALARM DEFICIENCIES

Medical Gas and Vacuum Systems Inspection/Testing

Southern AZ VA Tucson, AZ

QTY

DEFICIENT

QTY

CORRECTED

0 0

6 0

0 0

6 0

Rewire Panels Independently to Initiating Device

Rewire Panels Independently to Initiating Device With Correct Number of Conductors

Protect Master Alarm Wiring

Repair/Replace Annunciator Module/Alarm Panel

Repair/Replace Power Supply

O) Labeling: No Condition Monitored

P) Other:

Verify and Relabel Condition Monitored

N/A

TOTALS:

MASTER ALARM DEFICIENCIES OVERVIEW

DEFICIENCY DESCRIPTION

A) Initiating Device: Incorrect Location

B) Initiating Device: Improper Set Point

C) Initiating Device: None in Place

CORRECTIVE ACTION NEEDED

Move Initiating Device to Proper Location and/or Install Demand Check

Adjust Alarm Set Point

Install Initiating Device

D) Wiring: Not Independent to at Least (2) Master Panels

E) Wiring: Shared Common Conductors

F) Wiring: Not Protected

G) Panel: Visual and/or Audible Function Failed

H) Panel: Power Failure

N) Labeling: No Source Location

I) Panel: Incorrect Power Source

J) Panel: Incorrect Location

K) Panel: No Signal in Place (Local Alarm Only)

L) Panel: No Signal in Place (No Initiating Device/Wiring)

M) Labeling: System Gas

Connect Alarm to Life Safety Branch

Move Alarm Panel to a Proper Location

Wire Initiating Device to Master Alarm Panel(s)

Add Signal/Signal Components to Master Alarm System

Verify and Relabel System Gas

MASTER ALARM DEFICIENCIES

Medical Gas and Vacuum Systems Inspection/Testing

Southern AZ VA Tucson, AZ

M aster A larm P an el

L ocation &

If M ultiple P anels

P er Location

(e.g. "E ngineering P anel #2")

S ystem

G as

M an u facturer

M od el

C on d ition

M on itored

S w itch or S ou rce L ocation

S et P oin t

U nit of M easu re

In itiatin g D evice

W irin g

P an el

L abelin g

O th er

26 Police O2 Beacon Total Alert 2 High Line Pressure Bldg. 57 Outside Mech Rm Across

O2 Bulk Pad

60 PSI ✓ ✓ ✓ O ✓

O) Labeling:

Condition

Monitored-Should be Line Pressure

Low

27 Police O2 Beacon Total Alert 2 Low Line Pressure Bldg. 57 Outside Mech Rm Across

O2 Bulk Pad

40 PSI ✓ ✓ ✓ O ✓

O) Labeling:

Condition

Monitored-Should be Line Pressure

High

87 Engineering O2 Beacon Total Alert 2 High Line Pressure Bldg. 57 Outside Mech Rm Across

O2 Bulk Pad

60 PSI ✓ ✓ ✓ O ✓

O) Labeling:

Condition

Monitored-Should be Line Pressure

Low

88 Engineering O2 Beacon Total Alert 2 Low Line Pressure Bldg. 57 Outside Mech Rm Across

O2 Bulk Pad

40 PSI ✓ ✓ ✓ O ✓

O) Labeling:

Condition

Monitored-Should be Line Pressure

High

Old Switchboard B57

B102A O2 Beacon Total Alert 2 High Line Pressure

Bldg. 57 Outside Mech Rm Across

O2 Bulk Pad

60 PSI ✓ ✓ ✓ O ✓

O) Labeling:

Condition

Monitored-Should be Line Pressure

Low

DEFICIENT MASTER ALARM LOCATION

DEFICIENCY

CODE

D E

C Y

D E

T A

N D

/O R

O R

R E

C T

A C

*P lease D ate, D escribe A ction T aken, & R efer to W ork

O rder if A pplicable

MASTER ALARM DEFICIENCIES BREAKDOWN (BY ITEM NUMBER)

MASTER ALARM DEFICIENCIES

Medical Gas and Vacuum Systems Inspection/Testing

Southern AZ VA Tucson, AZ

M aster A larm P an el

L ocation &

If M ultiple P anels

P er Location

(e.g. "E ngineering P anel #2")

S ystem

G as

M an u facturer

M od el

C on d ition

M on itored

S w itch or S ou rce L ocation

S et P oin t

U nit of M easu re

In itiatin g D evice

W irin g

P an el

L abelin g

O th er

DEFICIENT MASTER ALARM LOCATION

DEFICIENCY

CODE

D E

C Y

D E

T A

N D

R E

C T

A C

*P lease D ate, D escribe A ction T aken, & R efer to W ork

O rder if A pplicable

MASTER ALARM DEFICIENCIES BREAKDOWN (BY ITEM NUMBER)

Old Switchboard B57

B102A O2 Beacon Total Alert 2 Low Line Pressure

Bldg. 57 Outside Mech Rm Across

O2 Bulk Pad

40 PSI ✓ ✓ ✓ O ✓

O) Labeling:

Condition

Monitored-Should be Line Pressure

AREA ALARM DEFICIENCIES

Medical Gas and Vacuum Systems Inspection/Testing

Southern AZ VA Tucson, AZ

L) Labeling: Gas System Monitored Not Labeled

M) Other: 0

J) Module Function: Module Display Blank or Error Message

K) Labeling: Area Monitored Labeling Missing/Incorrect

B) Transducer Location: Incorrect Transducer Location

C) Transducer Location: No Demand Check

D) Transducer Function: Incorrect Gas Pressure Displayed

E) Alarm Location: Improper Alarm Panel Location

F) Alarm Location: No Alarm in Place

G) Panel Function: Visual and/or Audible Alarm Function Failure

H) Panel Function: Power Failure

I) Panel Function: Incorrect Power Source

Install Demand Check

Repair/Recalibrate/Replace Transducer

Move Alarm to Appropriate Location

Install Area Alarm & Transducer

Repair/Replace Annunciator Module / Ribbon Cable / Alarm Panel

Repair/Replace Power Supply

Connect Alarm to Life Safety Branch

Repair/Replace Module or Defective Transducer

Label Area Monitored

Label Gas System Monitored

N/A

AREA ALARM DEFICIENCIES OVERVIEW

ACTION NEEDED

Adjust Set Points to +/-20% Operating Pressure

Move Transducers to Correct Side of Zone Valve

QTY

CORRECTED

DEFICIENCY DESCRIPTION

A) Alarm Set Points: Incorrect High and/or Low Alarm Set Point(s)

QTY

DEFICIENT

AREA ALARM DEFICIENCIES

Medical Gas and Vacuum Systems Inspection/Testing

Southern AZ VA Tucson, AZ

A larm

P h ysical L ocation

A rea/Z on e M on itored

S ystem

G as

M an u facturer

M od el

P ressu re R eading

(P ositive in P

SI/N

egative in In/H g)

H igh P ressu re A larm S etting (P ositive in P

SI/N

egative in In/H g)

L ow

P ressure A larm S etting (P ositive in P

SI/N

egative in In/H g)

A larm

S et P oin ts

T ransd u cer L ocation

T ransd u cer F un ction

P an el L ocation

P an el F u nction

M od u le F un ction

L abelin g

O th er

47 OPP Fast Track 10 A2

B38 Infusion Suite A153(Chairs 1-8), Fast

Track 1-10 (A154, A155, A156, A157, A158, A159, A163, A164, O2 Allied Impact 53 12 ✓ ✓ ✓ ✓ ✓ ✓ K ✓ K) Labeling: Area Monitored Labeling Missing/Incorrect

48 OPP Fast Track 10 A2 MA Allied Impact 48 60 40 ✓ ✓ ✓ ✓ ✓ ✓ K ✓ K) Labeling: Area Monitored Labeling Missing/Incorrect

49 OPP Fast Track 10 A2 VAC Allied Impact 18 60 40 ✓ ✓ ✓ ✓ ✓ ✓ K ✓ K) Labeling: Area Monitored Labeling Missing/Incorrect

O/S E3 Roadrrunner Rd Entrance Middle alarm

Panel

B60 Roadrunner Rd E146- 156+ SE102, Vac Only

O2 Amico A2A 54 60 40 ✓ ✓ ✓ ✓ ✓ ✓ K ✓ K) Labeling: Area Monitored Labeling Missing/Incorrect

D E

C Y

D E

T A

N D

R E

C T

A C

*P lease D ate, D escribe A ction T aken, & R efer to W ork

O rder if A pplicable

DEFICIENCY CODE

AREA ALARM DEFICIENCIES BREAKDOWN (BY ITEM NUMBER)

DEFICIENT AREA ALARM LOCATION

TOTALS: 9 0

AREA ALARM DEFICIENCIES

Medical Gas and Vacuum Systems Inspection/Testing

Southern AZ VA Tucson, AZ

A larm

P h ysical L ocation

A rea/Z on e M on itored

S ystem

G as

M an u facturer

M od el

P ressu re R eading

(P ositive in P

SI/N

egative in In/H g)

H igh P ressure A larm

S etting

(P ositive in P

SI/N

egative in In/H g)

L ow

P ressure A larm S etting (P ositive in P

SI/N

egative in In/H g)

A larm

S et P oin ts

T ransd u cer L ocation

T ran sd u cer F un ction

P an el L ocation

P an el F u n ction

M od u le F u n ction

L abelin g

O th er

D E

C Y

D E

T A

N D

R E

C T

A C

*P lease D ate, D escribe A ction T aken, & R efer to W ork

O rder if A pplicable

DEFICIENCY CODE

AREA ALARM DEFICIENCIES BREAKDOWN (BY ITEM NUMBER)

DEFICIENT AREA ALARM LOCATION

O/S E3 Roadrrunner Rd Entrance Middle alarm

Panel MA Amico A2A 47 12 ✓ ✓ ✓ ✓ ✓ ✓ K ✓ K) Labeling: Area Monitored

Labeling Missing/Incorrect

O/S E3 Roadrrunner Rd Entrance Middle alarm

Panel VAC Amico A2A 21 60 40 ✓ ✓ ✓ ✓ ✓ ✓ K ✓ K) Labeling: Area Monitored

Labeling Missing/Incorrect

O/S E3 Roadrrunner Rd Entrance Bottom alarm

Panel

B60 E2 Medicine E111- E122

O2 Amico A2A 54 60 40 ✓ ✓ ✓ ✓ ✓ ✓ K ✓ K) Labeling: Area Monitored Labeling Missing/Incorrect

O/S E3 Roadrrunner Rd Entrance Bottom alarm

Panel MA Amico A2A 48 12 ✓ ✓ ✓ ✓ ✓ ✓ K ✓ K) Labeling: Area Monitored

Labeling Missing/Incorrect

O/S E3 Roadrrunner Rd Entrance Bottom alarm

Panel VAC Amico A2A 22 60 40 ✓ ✓ ✓ ✓ ✓ ✓ K ✓ K) Labeling: Area Monitored

ZONE VALVE DEFICIENCIES

Medical Gas and Vacuum Systems Inspection/Testing

Southern AZ VA Tucson, AZ

Replace Handle

Replace Window

Verify Rooms/Area Served and Relabel

Verify Rooms/Area Served and Relabel (Repiping or Decommissioning Valve May Be Necessary)

E: General Condition: Missing/Broken Handle

F: General Condition: Missing/Broken Window

G: Labeling: Inaccurate Rooms/Area Served

H: Labeling: Labeled as if in Series

ACTION NEEDED

Replace Gauge

Install Gauge With Correct Scale Range

Install Gauge

Repipe Valve So Gauge is Downstream of Valve

Q: Location: Improper Location

DEFICIENCY DESCRIPTION

A: Gauge: Inaccurate Pressure Reading

B: Gauge: Incorrect Scale Range

C: Gauge: No Gauge in Port

D: Gauge: On Source Side of Valve

N: Leak: Gas Passes Through Valve When Closed

P: Location: Hidden or Not Accessible

M: Leak: External Leak

J: Labeling: Missing System Gas

K: Labeling: Missing Warning Verbiage

L: Labeling: Rooms/Area not Attributed a Zone Valve

O: Leak: Gauge Connection Leaks

I: Labeling: Missing Non-Standard Pressure Verbiage

R: Location: No Valve in Place

N/A

15 0TOTALS:

S: Other: 0

Label All Required Components with Non-Standard Pressure

Update Label to Include System Gas

Update Label to Include Warning Verbiage

Verify if Rooms/Area is Served by an Existing Zone Valve (Installation Necessary if Rooms/Area is not Currently Served by a Zone Valve)

Rebuild if Possible or Replace Leaking Valve

Re-install Gauge Using Oxygen-Safe Sealant (Replacement of Valve May be Necessary)

Move Valve to Visible and Accessible Location

Move Valve to Compliant Location

Install Zone Valve

QTY

DEFICIENT

ZONE VALVE DEFICIENCIES OVERVIEW

QTY

CORRECTED

ZONE VALVE DEFICIENCIES

Medical Gas and Vacuum Systems Inspection/Testing

Southern AZ VA Tucson, AZ

L ocation

(O /S = utside & pp = O pposite)

R oom s or A rea Served

System G as

M an ufacturer

B all

G ate/G lob e

G au ge P ressure R eading (P ositive in P

SI / N

egative in "H g)

G au ge

G eneral C ondition

L abeling

L eaks

L ocation

O ther

47 O/S A147 1st Floor B38 BIPAP/CPAP, A144, Pulm Testing A144-146, Home Oxy A148

O2 Allied ✓ 54 ✓ ✓ G ✓ ✓ ✓ G) Labeling: Inaccurate Rooms/Area Served: 1st Floor B38 BIPAP/CPAP, A144, Pulm Testing A144- 146, Home Oxy A148

48 O/S A147 MA Allied ✓ 51 ✓ ✓ G ✓ ✓ ✓ G) Labeling: Inaccurate Rooms/Area Served: 1st Floor B38 BIPAP/CPAP, A144, Pulm Testing A144- 146, Home Oxy A148

49 O/S A147 VAC Allied ✓ 20 ✓ ✓ G ✓ ✓ ✓ G) Labeling: Inaccurate Rooms/Area Served: 1st Floor B38 BIPAP/CPAP, A144, Pulm Testing A144- 146, Home Oxy A148

50 Opp Fast Track

B38 Infusion Suite A153(Chairs 1-8), Fast Track 1-10 (A154, A155, A156, A157, A158, A159, A163, A164, A165, A166)

O2 Allied ✓ 56 ✓ ✓ G ✓ ✓ ✓

G) Labeling: Inaccurate Rooms/Area Served: B38 Infusion Suite A153(Chairs 1-8), Fast Track 1-10 (A154, A155, A156, A157, A158, A159, A163, A164, A165, A166)

51 Opp Fast Track MA Allied ✓ 851 ✓ ✓ G ✓ ✓ ✓

G) Labeling: Inaccurate Rooms/Area Served: B38 Infusion Suite A153(Chairs 1-8), Fast Track 1-10 (A154, A155, A156, A157, A158, A159, A163, A164, A165, A166)

D E

C Y

D E

T A

N D

R E

C T

A C

*P lease D ate, D escribe A ction Taken, &

R efer to W ork O rder if A pplicable

DEFICIENT VALVE LOCATION

DEFICIENCY

CODE

ZONE VALVE DEFICIENCIES BREAKDOWN (BY ITEM NUMBER)

ZONE VALVE DEFICIENCIES

Medical Gas and Vacuum Systems Inspection/Testing

Southern AZ VA Tucson, AZ

L ocation

(O /S =

O pposite)

R oom s or A rea Served

System G as

M an ufacturer

B all

G ate/G lob e

G au ge P ressure R eading (P ositive in P

SI / N

egative in "H g)

G au ge

G eneral C ondition

L abeling

L eaks

L ocation

O ther

D E

C Y

D E

T A

N D

R E

C T

A C

*P lease D ate, D escribe A ction Taken, &

R efer to W ork O rder if A pplicable

DEFICIENT VALVE LOCATION

DEFICIENCY

CODE

ZONE VALVE DEFICIENCIES BREAKDOWN (BY ITEM NUMBER)

52 Opp Fast Track VAC Allied ✓ 19 ✓ ✓ G ✓ ✓ ✓

G) Labeling: Inaccurate Rooms/Area Served: B38 Infusion Suite A153(Chairs 1-8), Fast Track 1-10 (A154, A155, A156, A157, A158, A159, A163, A164, A165, A166)

83 O/S OR 3 VAC Beacon ✓ 14 A ✓ ✓ ✓ ✓ ✓ A) Gauge: Inaccurate Pressure Reading

Bldg 60 O/S E2 A4

Entry B60 E2 Medicine E111-E122 O2 Beacon ✓ 60 A ✓ G ✓ ✓ ✓ A) Gauge: Inaccurate Pressure Reading: G) Labeling:

Inaccurate Rooms/Area Served

Bldg 60 O/S E2 A4

Entry MA Beacon ✓ 42 A ✓ G ✓ ✓ ✓ A) Gauge: Inaccurate Pressure Reading: G) Labeling:

Inaccurate Rooms/Area Served

Bldg 60 O/S E2 A4

ZONE VALVE DEFICIENCIES

Medical Gas and Vacuum Systems Inspection/Testing

Southern AZ VA Tucson, AZ

L ocation

(O /S =

O pposite)

R oom s or A rea Served

System G as

M an ufacturer

B all

G ate/G lob e

G au ge P ressure R eading (P ositive in P

SI / N

egative in "H g)

G au ge

G eneral C ondition

L abeling

L eaks

L ocation

O ther

D E

C Y

D E

T A

N D

R E

C T

A C

*P lease D ate, D escribe A ction Taken, &

R efer to W ork O rder if A pplicable

DEFICIENT VALVE LOCATION

DEFICIENCY

CODE

ZONE VALVE DEFICIENCIES BREAKDOWN (BY ITEM NUMBER)

Bldg 60 O/S E2

A5 Entry B60 Roadrunner Rd E146-156+

SE102, Vac Only O2 Allied ✓ 56 ✓ ✓ G ✓ ✓ ✓ G) Labeling: Inaccurate Rooms/Area Served

Bldg 60 O/S E2

A5 Entry MA Allied ✓ 52 ✓ ✓ G ✓ ✓ ✓ G) Labeling: Inaccurate Rooms/Area Served

Bldg 60 O/S E2

OUTLET & INLET DEFICIENCIES

Medical Gas and Vacuum Systems Inspection/Testing

Southern AZ VA Tucson, AZ

QTY

DEFICIENT

QTY

CORRECTED

0 0

13 0

8 2

0 0

21 2

S: Static Pressure: Pressure Out of Required Range

T: Location: Insufficient Terminals per Bed

U: Location: Terminals in Non-Compliant Location

N: Leak: Outer Check

O: Low Flow: Depressurized or Disconnected from System

P: Low Flow: Pressure Gas

Q: Low Flow: Undersized Piping/Components

R: Low Flow: Vacuum

Install Outlets/Inlets to Meet Required Minimum

Rebuild Outer Check

Rebuild Outlet / Remove Obstruction

Replace or Convert to Compliant Outlet/Inlet Style

Rebuild Inlet and Flush with Enzyme

Reset System Pressure or Label as Nonstandard

Identify point of disconnection and repair

Replace Damaged Hose Assembly

Rebuild/Replace Damaged Faceplate

Replace with Correct Gas Specific Faceplate

Replace Missing Screws

Replace Damaged Faceplate

ACTION NEEDED

Identify point of cross-connection and separate

Purge system and/or remove contamination source

Purge system and/or service dryer (if Medical Air)

Replace Damaged Faceplate

V: Other

TOTALS:

M: Leak: Inner Check

Replace System Label

Replace or Convert to Compliant Outlet/Inlet Style

Rebuild Inner Check - Temporary Shutdown Required

OUTLET/INLET DEFICIENCIES OVERVIEW

Remove Outlets/Inlets from Non-Compliant Area

N/A

DEFICIENCY DESCRIPTION

A: Gas Concentration: Cross-Connection Found

B: Gas Concentration: Gas Concentration Contaminated

C: Gas Concentration: Water Present

D: General Condition: Damaged Faceplate

E: General Condition: Damaged Hose Assembly

F: General Condition: Failed Adapter Connect and Release

G: General Condition: Incorrect Gas Connection

H: General Condition: Missing Screws

I: Labeling: Missing 'Use No Oil'

J: Labeling: Missing System Label

K: Labeling: No 'Use No Oil'

OUTLET & INLET DEFICIENCIES

Medical Gas and Vacuum Systems Inspection/Testing

Southern AZ VA Tucson, AZ

A rea or Z one

R oom or B ed #

(Inventory taken clockw ise around room , from top to bottom and/or left to right)

S ystem

G as

M anufacturer

M odel

P osition

G as C oncentration

G eneral C ondition

L abeling

L eaks

M inim um F low

S tatic P ressure

S ufficient T erm inals/B ed

O ther

2nd Floor Step

Down 232 VAC Beacon DC-DISS Rail ✓ ✓ ✓ N✓ ✓ ✓ ✓ ✓ N) Leak: Outer Check:

Repaired on 12/04/2023

2nd Floor Step

Down 241 VAC Beacon DC-DISS Rail ✓ ✓ ✓ N✓ ✓ ✓ ✓ ✓ N) Leak: Outer Check:

Repaired on 12/04/2023

1219 B50 Procedure 4 350 VAC Allied 560 Recessed ✓ ✓ ✓ M ✓ ✓ ✓ ✓ M) Leak: Inner Check

1381 B57 OR Suite OR 3 Rm 293 VAC Allied 460 Wall

(Recessed)

✓ ✓ ✓ M ✓ ✓ ✓ ✓ M) Leak: Inner Check

1407 B57 OR Suite OR 4 Rm 299 VAC Allied 560 Recessed ✓ ✓ ✓ M ✓ ✓ ✓ ✓ M) Leak: Inner Check

1409 B57 OR Suite OR 4 Rm 299 VAC Allied HOSE-DISS Hose Drop ✓ ✓ ✓ M ✓ ✓ ✓ ✓ M) Leak: Inner Check

1410 B57 OR Suite OR 4 Rm 299 VAC Allied HOSE-DISS Hose Drop ✓ ✓ ✓ M ✓ ✓ ✓ ✓ M) Leak: Inner Check

D E

C Y

D E

T A

N D

R E

C T

A C

*P lease D ate, D escribe A ction T aken, & R efer to W ork

O rder if A pplicable

DEFICIENT OUTLET/INLET LOCATION DEFICIENCY CODE

OUTLET/INLET DEFICIENCIES BREAKDOWN (BY ITEM NUMBER)

OUTLET & INLET DEFICIENCIES

Medical Gas and Vacuum Systems Inspection/Testing

Southern AZ VA Tucson, AZ

A rea or Z one

R oom or B ed #

(Inventory taken clockw ise around room , from top to bottom and/or left to right)

S ystem

G as

M anufacturer

M odel

P osition

G as C oncentration

G eneral C ondition

L abeling

L eaks

M inim um F low

S tatic P ressure

S ufficient T erm inals/B ed

O ther

D E

C Y

D E

T A

N D

R E

C T

A C

*P lease D ate, D escribe A ction T aken, & R efer to W ork

O rder if A pplicable

DEFICIENT OUTLET/INLET LOCATION DEFICIENCY CODE

OUTLET/INLET DEFICIENCIES BREAKDOWN (BY ITEM NUMBER)

1426 B57 OR Suite OR 5 Rm 292 VAC Allied 560 Wall

(Recessed)

✓ ✓ ✓ M ✓ ✓ ✓ ✓ M) Leak: Inner Check

1427 B57 OR Suite OR 5 Rm 292 VAC Allied 560 Wall

(Recessed)

✓ ✓ ✓ M ✓ ✓ ✓ ✓ M) Leak: Inner Check

1429 B57 OR Suite OR 5 Rm 292 VAC Allied 560 Wall

(Recessed)

✓ ✓ ✓ M ✓ ✓ ✓ ✓ M) Leak: Inner Check

1500 B57 OR Suite OR 10 Rm 2209 VAC Allied HOSE-DISS Hose Drop ✓ ✓ ✓ M ✓ ✓ ✓ ✓ M) Leak: Inner Check

1501 B57 OR Suite OR 10 Rm 2209 VAC Allied 560 Wall

(Recessed)

✓ ✓ ✓ M ✓ ✓ ✓ ✓ M) Leak: Inner Check

1514 B57 OR Suite OR 11 Rm 2205 VAC Allied HOSE-DISS Hose Drop ✓ ✓ ✓ M ✓ ✓ ✓ ✓ M) Leak: Inner Check

1528 B57 OR Suite OR 12 Rm 2203 VAC Allied HOSE-DISS Hose Drop ✓ ✓ ✓ M ✓ ✓ ✓ ✓ M) Leak: Inner Check www.evergreenmedical.com © 2021 Evergreen Medical Services, Inc. - VER 1.3 Corporate Office: 1-800-872-8992

OUTLET & INLET DEFICIENCIES

Medical Gas and Vacuum Systems Inspection/Testing

Southern AZ VA Tucson, AZ

A rea or Z one

R oom or B ed #

(Inventory taken clockw ise around room , from top to bottom and/or left to right)

S ystem

G as

M anufacturer

M odel

P osition

G as C oncentration

G eneral C ondition

L abeling

L eaks

M inim um F low

S tatic P ressure

S ufficient T erm inals/B ed

O ther

D E

C Y

D E

T A

N D

R E

C T

A C

*P lease D ate, D escribe A ction T aken, & R efer to W ork

O rder if A pplicable

DEFICIENT OUTLET/INLET LOCATION DEFICIENCY CODE

OUTLET/INLET DEFICIENCIES BREAKDOWN (BY ITEM NUMBER)

1542 B57 OR Suite OR 13 Rm 2202 VAC Allied HOSE-DISS Hose Drop ✓ ✓ ✓ M ✓ ✓ ✓ ✓ M) Leak: Inner Check

1554 B57 PRE-OP Bay 2 O2 Allied 460 Wall

(Recessed)

✓ ✓ ✓ N ✓ ✓ ✓ ✓ N) Leak: Outer Check

1565 B57 PRE-OP Bay 4 MA Allied 460 Wall

(Recessed)

✓ ✓ ✓ N ✓ ✓ ✓ ✓ N) Leak: Outer Check

1569 B57 PRE-OP Bay 5 O2 Allied 460 Wall

(Recessed)

✓ ✓ ✓ N ✓ ✓ ✓ ✓ N) Leak: Outer Check

1574 B57 PRE-OP Bay 6 O2 Allied 460 Wall

(Recessed)

✓ ✓ ✓ N ✓ ✓ ✓ ✓ N) Leak: Outer Check

1580 B57 PRE-OP Bay 7 O2 Allied 460 Wall

(Recessed)

✓ ✓ ✓ N ✓ ✓ ✓ ✓ N) Leak: Outer Check

1585 B57 PRE-OP Bay 8 O2 Allied 460 Wall

(Recessed)

OUTLET & INLET DEFICIENCIES

Medical Gas and Vacuum Systems Inspection/Testing

Southern AZ VA Tucson, AZ

A rea or Z one

R oom or B ed #

(Inventory taken clockw ise around room , from top to bottom and/or left to right)

S ystem

G as

M anufacturer

M odel

P osition

G as C oncentration

G eneral C ondition

L abeling

L eaks

M inim um F low

S tatic P ressure

S ufficient T erm inals/B ed

O ther

D E

C Y

D E

T A

N D

R E

C T

A C

*P lease D ate, D escribe A ction T aken, & R efer to W ork

O rder if A pplicable

DEFICIENT OUTLET/INLET LOCATION DEFICIENCY CODE

OUTLET/INLET DEFICIENCIES BREAKDOWN (BY ITEM NUMBER)

1606 B57 PACU Bay 2 MA Allied 460 Headwall

(Recessed)

✓ ✓ ✓ N ✓ ✓ ✓ ✓ N) Leak: Outer Check

1669 B57 PACU Bay 11 MA Allied 460 Headwall

(Recessed)

MASTER ALARMS

Medical Gas and Vacuum Systems Inspection/Testing

Southern AZ VA Tucson, AZ

M aster A larm P an el

L ocation

If M ultiple P anels

P er Location

(e.g. "E ngineering P anel #2")

S ystem

G as

M an u facturer

M od el

C on d ition

M on itored

S w itch or S ou rce L ocation

S et P oin t

U nit of M easu re

In itiatin g D evice

W irin g

P an el

L abelin g

O th er

C om p on en t C on d ition

1 Police MA Beacon Total Alert 2 Low Line Pressure Bldg. 57 Basement BA046 Mech Rm

40 PSI ✓ ✓ ✓ ✓ ✓ PASS

2 Police MA Beacon Total Alert 2 High Line Pressure Bldg. 57 Basement BA046 Mech Rm

60 PSI ✓ ✓ ✓ ✓ ✓ PASS

3 Police MA Beacon Total Alert 2 Inlet Filter Dirty Bldg. 57 Basement BA046 Mech Rm

N/A ✓ ✓ ✓ ✓ ✓ PASS

4 Police MA Beacon Total Alert 2 Dental-Dry Malfunction Bldg. 57 Basement BA046 Mech Rm

N/A ✓ ✓ ✓ ✓ ✓ PASS

5 Police MA Beacon Total Alert 2 Backup Compressor On Bldg. 57 Basement BA046 Mech Rm

75 PSI ✓ ✓ ✓ ✓ ✓ PASS

6 Police MA Beacon Total Alert 2 Aftercooler Hi Temp Bldg. 57 Basement BA046 Mech Rm

N/A ºF ✓ ✓ ✓ ✓ ✓ PASS

7 Police MA Beacon Total Alert 2 Dew Point High Bldg. 57 Basement BA046 Mech Rm

35 ºF ✓ ✓ ✓ ✓ ✓ PASS

8 Police MA Beacon Total Alert 2 Carbon Monoxide High Bldg. 57 Basement BA046 Mech Rm

10 PPM ✓ ✓ ✓ ✓ ✓ PASS

9 Police MA Beacon Total Alert 2 Dry Malfunction Bldg. 57 Basement BA046 Mech Rm

N/A ✓ ✓ ✓ ✓ ✓ PASS

10 Police MA Beacon Total Alert 2 Post Filter Dirty Bldg. 57 Basement BA046 Mech Rm

N/A ✓ ✓ ✓ ✓ ✓ PASS

11 Police VAC Beacon Total Alert 2 Filter Back Pressure Bldg. 57 Basement BA046 Mech Rm

N/A ✓ ✓ ✓ ✓ ✓ PASS

12 Police VAC Beacon Total Alert 2 Low Bldg. 57 Basement BA046 Mech Rm

12 inHg ✓ ✓ ✓ ✓ ✓ PASS

MASTER ALARMS: LOCATION & SPECIFICATION FUNCTION & CONDITION

MASTER ALARMS

Medical Gas and Vacuum Systems Inspection/Testing

Southern AZ VA Tucson, AZ

M aster A larm P an el

L ocation

If M ultiple P anels

P er Location

(e.g. "E ngineering P anel #2")

S ystem

G as

M an u facturer

M od el

C on d ition

M on itored

S w itch or S ou rce L ocation

S et P oin t

U nit of M easu re

In itiatin g D evice

W irin g

P an el

L abelin g

O th er

C om p on en t C on d ition

MASTER ALARMS: LOCATION & SPECIFICATION FUNCTION & CONDITION

13 Police VAC Beacon Total Alert 2 Backup Pump On Bldg. 57 Basement BA046 Mech Rm

18 inHg ✓ ✓ ✓ ✓ ✓ PASS

14 Police MA Beacon Total Alert 2 Dental-Low Line Pressure Bldg. 57 Basement BA046 Mech Rm

40 PSI ✓ ✓ ✓ ✓ ✓ PASS

15 Police MA Beacon Total Alert 2 Dental-High Line Pressure Bldg. 57 Basement BA046 Mech Rm

60 PSI ✓ ✓ ✓ ✓ ✓ PASS

16 Police MA Beacon Total Alert 2 Dental-Thermal Shut Down Bldg. 57 Basement BA046 Mech Rm

N/A ºF ✓ ✓ ✓ ✓ ✓ PASS

17 Police MA Beacon Total Alert 2 Dental-Dew Point High Bldg. 57 Basement BA046 Mech Rm

35 ºF ✓ ✓ ✓ ✓ ✓ PASS

18 Police MA Beacon Total Alert 2 Dental-Carbon Monoxide

High Bldg. 57 Basement BA046 Mech Rm

10 PPM ✓ ✓ ✓ ✓ ✓ PASS

19 Police CO2 Beacon Total Alert 2 Low Line Pressure Manifold Rm 40 PSI ✓ ✓ ✓ ✓ ✓ PASS

20 Police CO2 Beacon Total Alert 2 High Line Pressure Manifold Rm 60 PSI ✓ ✓ ✓ ✓ ✓ PASS

21 Police CO2 Beacon Total Alert 2 Reserve Supply In Use Manifold Rm 120 PSI ✓ ✓ ✓ ✓ ✓ PASS

22 Police O2 Beacon Total Alert 2 Reserve Supply Low Bulk Site 40 inH2O ✓ ✓ ✓ ✓ ✓ PASS

23 Police O2 Beacon Total Alert 2 Liquid Level Low Bulk Site 45 inH2O ✓ ✓ ✓ ✓ ✓ PASS

MASTER ALARMS

Medical Gas and Vacuum Systems Inspection/Testing

Southern AZ VA Tucson, AZ

M aster A larm P an el

L ocation

If M ultiple P anels

P er Location

(e.g. "E ngineering P anel #2")

S ystem

G as

M an u facturer

M od el

C on d ition

M on itored

S w itch or S ou rce L ocation

S et P oin t

U nit of M easu re

In itiatin g D evice

W irin g

P an el

L abelin g

O th er

C om p on en t C on d ition

MASTER ALARMS: LOCATION & SPECIFICATION FUNCTION & CONDITION

25 Police O2 Beacon Total Alert 2 Reserve Pressure Low Bulk Site 90 PSI ✓ ✓ ✓ ✓ ✓ PASS

26 Police O2 Beacon Total Alert 2 High Line Pressure Bldg. 57 Outside Mech Rm Across

O2 Bulk Pad

60 PSI ✓ ✓ ✓ O ✓ FAIL

27 Police O2 Beacon Total Alert 2 Low Line Pressure Bldg. 57 Outside Mech Rm Across

O2 Bulk Pad

40 PSI ✓ ✓ ✓ O ✓ FAIL

28 Police O2 Beacon Total Alert 2 High Line Pressure Bldg. 60 Mech Rm

Near Grill Patio

60 PSI ✓ ✓ ✓ ✓ ✓ PASS

29 Police O2 Beacon Total Alert 2 Low Line Pressure Bldg. 60 Mech Rm

Near Grill Patio

40 PSI ✓ ✓ ✓ ✓ ✓ PASS

30 Police N2O Beacon Total Alert 2 Low Line Pressure Bldg. 57 Outside Mech Rm Across

O2 Bulk Pad

40 PSI ✓ ✓ ✓ ✓ ✓ PASS

31 Police N2O Beacon Total Alert 2 High Line Pressure Bldg. 57 Outside Mech Rm Across

O2 Bulk Pad

60 PSI ✓ ✓ ✓ ✓ ✓ PASS

32 Police N2O Beacon Total Alert 2 Reserve Supply In Use Bldg. 57 Outside Mech Rm Across

O2 Bulk Pad

100 PSI ✓ ✓ ✓ ✓ ✓ PASS

33 Police N2 Beacon Total Alert 2 Reserve Supply In Use Bldg. 57 Outside Mech Rm Across

O2 Bulk Pad

250 PSI ✓ ✓ ✓ ✓ ✓ PASS

34 Police N2 Beacon Total Alert 2 High Line Pressure Bldg. 57 Outside Mech Rm Across

O2 Bulk Pad

190 PSI ✓ ✓ ✓ ✓ ✓ PASS

MASTER ALARMS

Medical Gas and Vacuum Systems Inspection/Testing

Southern AZ VA Tucson, AZ

M aster A larm P an el

L ocation

If M ultiple P anels

P er Location

(e.g. "E ngineering P anel #2")

S ystem

G as

M an u facturer

M od el

C on d ition

M on itored

S w itch or S ou rce L ocation

S et P oin t

U nit of M easu re

In itiatin g D evice

W irin g

P an el

L abelin g

O th er

C om p on en t C on d ition

MASTER ALARMS: LOCATION & SPECIFICATION FUNCTION & CONDITION

35 Police N2 Beacon Total Alert 2 Low Line Pressure Bldg. 57 Outside Mech Rm Across

O2 Bulk Pad

140 PSI ✓ ✓ ✓ ✓ ✓ PASS

36 Police MA Beacon Total Alert 2 Carbon Monoxide High Bldg. 38 Basement A41 Mech Room

10 PPM ✓ ✓ ✓ ✓ ✓ PASS

37 Police MA Beacon Total Alert 2 Dew Point High Bldg. 38 Basement A41 Mech Room

35 ºF ✓ ✓ ✓ ✓ ✓ PASS

38 Police MA Beacon Total Alert 2 Aftercooler Hi Temp Bldg. 38 Basement A41 Mech Room

N/A ✓ ✓ ✓ ✓ ✓ PASS

39 Police MA Beacon Total Alert 2 Backup Compressor On Bldg. 38 Basement A41 Mech Room

75 PSI ✓ ✓ ✓ ✓ ✓ PASS

40 Police MA Beacon Total Alert 2 High Line Pressure Bldg. 38 Basement A41 Mech Room

60 PSI ✓ ✓ ✓ ✓ ✓ PASS

41 Police MA Beacon Total Alert 2 Low Line Pressure Bldg. 38 Basement A41 Mech Room

40 PSI ✓ ✓ ✓ ✓ ✓ PASS

42 Police MA Beacon Total Alert 2 Post Filter Dirty Bldg. 38 Basement A41 Mech Room

N/A ✓ ✓ ✓ ✓ ✓ PASS

43 Police MA Beacon Total Alert 2 Dry Malfunction Bldg. 38 Basement A41 Mech Room

N/A ✓ ✓ ✓ ✓ ✓ PASS

44 Police MA Beacon Total Alert 2 Inlet Filter Dirty Bldg. 38 Basement A41 Mech Room

N/A ✓ ✓ ✓ ✓ ✓ PASS

45 Police MA Beacon Total Alert 2 Backup Compressor On Bldg. 60 Penthouse

Mech Room

75 PSI ✓ ✓ ✓ ✓ ✓ PASS

46 Police MA Beacon Total Alert 2 Dew Point High Bldg. 60 Penthouse

Mech Room

35 ºF ✓ ✓ ✓ ✓ ✓ PASS

MASTER ALARMS

Medical Gas and Vacuum Systems Inspection/Testing

Southern AZ VA Tucson, AZ

M aster A larm P an el

L ocation

If M ultiple P anels

P er Location

(e.g. "E ngineering P anel #2")

S ystem

G as

M an u facturer

M od el

C on d ition

M on itored

S w itch or S ou rce L ocation

S et P oin t

U nit of M easu re

In itiatin g D evice

W irin g

P an el

L abelin g

O th er

C om p on en t C on d ition

MASTER ALARMS: LOCATION & SPECIFICATION FUNCTION & CONDITION

47 Police MA Beacon Total Alert 2 Aftercooler Hi Temp Bldg. 60 Penthouse

Mech Room

N/A ºF ✓ ✓ ✓ ✓ ✓ PASS

48 Police MA Beacon Total Alert 2 Carbon Monoxide High Bldg. 60 Penthouse

Mech Room

10 PPM ✓ ✓ ✓ ✓ ✓ PASS

49 Police MA Beacon Total Alert 2 High Line Pressure Bldg. 60 Penthouse

Mech Room

60 PSI ✓ ✓ ✓ ✓ ✓ PASS

50 Police MA Beacon Total Alert 2 Low Line Pressure Bldg. 60 Penthouse

Mech Room

40 PSI ✓ ✓ ✓ ✓ ✓ PASS

51 Police MA Beacon Total Alert 2 Post Filter Dirty Bldg. 60 Penthouse

Mech Room

N/A ✓ ✓ ✓ ✓ ✓ PASS

52 Police MA Beacon Total Alert 2 Dry Malfunction Bldg. 60 Penthouse

Mech Room

N/A ✓ ✓ ✓ ✓ ✓ PASS

53 Police MA Beacon Total Alert 2 Inlet Filter Dirty Bldg. 60 Penthouse

Mech Room

N/A ✓ ✓ ✓ ✓ ✓ PASS

54 Police VAC Beacon Total Alert 2 Low Line Pressure Bldg. 38 Basement A41 Mech Room

12 inHg ✓ ✓ ✓ ✓ ✓ PASS

55 Police VAC Beacon Total Alert 2 Filter Back Pressure Bldg. 38 Basement A41 Mech Room

N/A ✓ ✓ ✓ ✓ ✓ PASS

56 Police VAC Beacon Total Alert 2 Backup Pump On Bldg. 60 Penthouse

Mech Room 18 inHg ✓ ✓ ✓ ✓ ✓ PASS

57 Police VAC Beacon Total Alert 2 Filter Back Pressure Bldg. 60 Penthouse

Mech Room

N/A ✓ ✓ ✓ ✓ ✓ PASS

58 Police VAC Beacon Total Alert 2 Low Line Pressure Bldg. 60 Penthouse

MASTER ALARMS

Medical Gas and Vacuum Systems Inspection/Testing

Southern AZ VA Tucson, AZ

M aster A larm P an el

L ocation

If M ultiple P anels

P er Location

(e.g. "E ngineering P anel #2")

S ystem

G as

M an u facturer

M od el

C on d ition

M on itored

S w itch or S ou rce L ocation

S et P oin t

U nit of M easu re

In itiatin g D evice

W irin g

P an el

L abelin g

O th er

C om p on en t C on d ition

MASTER ALARMS: LOCATION & SPECIFICATION FUNCTION & CONDITION

59 Police O2 Beacon Total Alert 2 High Line Pressure Bldg. 38 Basement A41 Mech Room

60 PSI ✓ ✓ ✓ ✓ ✓ PASS

60 Police O2 Beacon Total Alert 2 Low Line Pressure Bldg. 38 Basement A41 Mech Room

40 PSI ✓ ✓ ✓ ✓ ✓ PASS

61 Police VAC Beacon Total Alert 2 Backup Pump On Bldg. 38 Basement A41 Mech Room

18 inHg ✓ ✓ ✓ ✓ ✓ PASS

62 Engineering MA Beacon Total Alert 2 Low Line Pressure Bldg. 57 Basement BA046 Mech Rm

40 PSI ✓ ✓ ✓ ✓ ✓ PASS

63 Engineering MA Beacon Total Alert 2 High Line Pressure Bldg. 57 Basement BA046 Mech Rm

60 PSI ✓ ✓ ✓ ✓ ✓ PASS

64 Engineering MA Beacon Total Alert 2 Inlet Filter Dirty Bldg. 57 Basement BA046 Mech Rm

N/A ✓ ✓ ✓ ✓ ✓ PASS

65 Engineering MA Beacon Total Alert 2 Dental-Dryer Malfunction Bldg. 57 Basement BA046 Mech Rm

N/A ✓ ✓ ✓ ✓ ✓ PASS

66 Engineering MA Beacon Total Alert 2 Backup Compressor On Bldg. 57 Basement BA046 Mech Rm

75 PSI ✓ ✓ ✓ ✓ ✓ PASS

67 Engineering MA Beacon Total Alert 2 Aftercooler Hi Temp Bldg. 57 Basement BA046 Mech Rm

N/A ºF ✓ ✓ ✓ ✓ ✓ PASS

68 Engineering MA Beacon Total Alert 2 Dew Point High Bldg. 57 Basement BA046 Mech Rm

35 ºF ✓ ✓ ✓ ✓ ✓ PASS

69 Engineering MA Beacon Total Alert 2 Carbon Monoxide High Bldg. 57 Basement BA046 Mech Rm

10 PPM ✓ ✓ ✓ ✓ ✓ PASS

70 Engineering MA Beacon Total Alert 2 Dryer Malfunction Bldg. 57 Basement BA046 Mech Rm

N/A ✓ ✓ ✓ ✓ ✓ PASS

MASTER ALARMS

Medical Gas and Vacuum Systems Inspection/Testing

Southern AZ VA Tucson, AZ

M aster A larm P an el

L ocation

If M ultiple P anels

P er Location

(e.g. "E ngineering P anel #2")

S ystem

G as

M an u facturer

M od el

C on d ition

M on itored

S w itch or S ou rce L ocation

S et P oin t

U nit of M easu re

In itiatin g D evice

W irin g

P an el

L abelin g

O th er

C om p on en t C on d ition

MASTER ALARMS: LOCATION & SPECIFICATION FUNCTION & CONDITION

71 Engineering MA Beacon Total Alert 2 Post Filter Dirty Bldg. 57 Basement BA046 Mech Rm

N/A ✓ ✓ ✓ ✓ ✓ PASS

72 Engineering VAC Beacon Total Alert 2 Filter Back Pressure Bldg. 57 Basement BA046 Mech Rm

N/A ✓ ✓ ✓ ✓ ✓ PASS

73 Engineering VAC Beacon Total Alert 2 Low Bldg. 57 Basement BA046 Mech Rm

12 inHg ✓ ✓ ✓ ✓ ✓ PASS

74 Engineering VAC Beacon Total Alert 2 Backup Pump On Bldg. 57 Basement BA046 Mech Rm

18 inHg ✓ ✓ ✓ ✓ ✓ PASS

75 Engineering MA Beacon Total Alert 2 Dental-Low Line Pressure Bldg. 57 Basement BA046 Mech Rm

40 PSI ✓ ✓ ✓ ✓ ✓ PASS

76 Engineering MA Beacon Total Alert 2 Dental-High Line Pressure Bldg. 57 Basement BA046 Mech Rm

60 PSI ✓ ✓ ✓ ✓ ✓ PASS

77 Engineering MA Beacon Total Alert 2 Dental-Thermal Shut Down Bldg. 57 Basement BA046 Mech Rm

N/A ºF ✓ ✓ ✓ ✓ ✓ PASS

78 Engineering MA Beacon Total Alert 2 Dental-Dew Point High Bldg. 57 Basement BA046 Mech Rm

35 ºF ✓ ✓ ✓ ✓ ✓ PASS

79 Engineering MA Beacon Total Alert 2 Dental-Carbon Monoxide

High Bldg. 57 Basement BA046 Mech Rm

10 PPM ✓ ✓ ✓ ✓ ✓ PASS

80 Engineering CO2 Beacon Total Alert 2 Low Line Pressure Manifold Rm 40 PSI ✓ ✓ ✓ ✓ ✓ PASS

81 Engineering CO2 Beacon Total Alert 2 High Line Pressure Manifold Rm 60 PSI ✓ ✓ ✓ ✓ ✓ PASS

82 Engineering CO2 Beacon Total Alert 2 Reserve Supply In Use Manifold Rm 120 PSI ✓ ✓ ✓ ✓ ✓ PASS www.evergreenmedical.com © 2021 Evergreen Medical Services, Inc. - VER 1.3 Corporate Office: 1-800-872-8992

MASTER ALARMS

Medical Gas and Vacuum Systems Inspection/Testing

Southern AZ VA Tucson, AZ

M aster A larm P an el

L ocation

If M ultiple P anels

P er Location

(e.g. "E ngineering P anel #2")

S ystem

G as

M an u facturer

M od el

C on d ition

M on itored

S w itch or S ou rce L ocation

S et P oin t

U nit of M easu re

In itiatin g D evice

W irin g

P an el

L abelin g

O th er

C om p on en t C on d ition

MASTER ALARMS: LOCATION & SPECIFICATION FUNCTION & CONDITION

83 Engineering O2 Beacon Total Alert 2 Reserve Supply Low Bulk Site 40 inH2O ✓ ✓ ✓ ✓ ✓ PASS

84 Engineering O2 Beacon Total Alert 2 Liquid Level Low Bulk Site 45 inH2O ✓ ✓ ✓ ✓ ✓ PASS

85 Engineering O2 Beacon Total Alert 2 Reserve Supply In Use Bulk Site 90 PSI ✓ ✓ ✓ ✓ ✓ PASS

86 Engineering O2 Beacon Total Alert 2 Reserve Pressure Low Bulk Site 90 PSI ✓ ✓ ✓ ✓ ✓ PASS

87 Engineering O2 Beacon Total Alert 2 High Line Pressure Bldg. 57 Outside Mech Rm Across

O2 Bulk Pad

60 PSI ✓ ✓ ✓ O ✓ FAIL

88 Engineering O2 Beacon Total Alert 2 Low Line Pressure Bldg. 57 Outside Mech Rm Across

O2 Bulk Pad

40 PSI ✓ ✓ ✓ O ✓ FAIL

89 Engineering O2 Beacon Total Alert 2 High Line Pressure Bldg. 60 Penthouse

Mech Room

60 PSI ✓ ✓ ✓ ✓ ✓ PASS

90 Engineering O2 Beacon Total Alert 2 Low Line Pressure Bldg. 60 Penthouse

Mech Room

40 PSI ✓ ✓ ✓ ✓ ✓ PASS

91 Engineering N2O Beacon Total Alert 2 Low Line Pressure Bldg. 57 Outside Mech Rm Across

O2 Bulk Pad

40 PSI ✓ ✓ ✓ ✓ ✓ PASS

MASTER ALARMS

Medical Gas and Vacuum Systems Inspection/Testing

Southern AZ VA Tucson, AZ

M aster A larm P an el

L ocation

If M ultiple P anels

P er Location

(e.g. "E ngineering P anel #2")

S ystem

G as

M an u facturer

M od el

C on d ition

M on itored

S w itch or S ou rce L ocation

S et P oin t

U nit of M easu re

In itiatin g D evice

W irin g

P an el

L abelin g

O th er

C om p on en t C on d ition

MASTER ALARMS: LOCATION & SPECIFICATION FUNCTION & CONDITION

92 Engineering N2O Beacon Total Alert 2 High Line Pressure Bldg. 57 Outside Mech Rm Across

O2 Bulk Pad

60 PSI ✓ ✓ ✓ ✓ ✓ PASS

93 Engineering N2O Beacon Total Alert 2 Reserve Supply In Use Bldg. 57 Outside Mech Rm Across

O2 Bulk Pad

100 PSI ✓ ✓ ✓ ✓ ✓ PASS

94 Engineering N2 Beacon Total Alert 2 Reserve Supply In Use Bldg. 57 Outside Mech Rm Across

O2 Bulk Pad

250 PSI ✓ ✓ ✓ ✓ ✓ PASS

95 Engineering N2 Beacon Total Alert 2 High Line Pressure Bldg. 57 Outside Mech Rm Across

O2 Bulk Pad

190 PSI ✓ ✓ ✓ ✓ ✓ PASS

96 Engineering N2 Beacon Total Alert 2 Low Line Pressure Bldg. 57 Outside Mech Rm Across

O2 Bulk Pad

140 PSI ✓ ✓ ✓ ✓ ✓ PASS

97 Engineering MA Beacon Total Alert 2 Carbon Monoxide High Bldg. 38 Basement A41 Mech Room

10 PPM ✓ ✓ ✓ ✓ ✓ PASS

98 Engineering MA Beacon Total Alert 2 Dew Point High Bldg. 38 Basement A41 Mech Room

35 ºF ✓ ✓ ✓ ✓ ✓ PASS

99 Engineering MA Beacon Total Alert 2 Aftercooler Hi Temp Bldg. 38 Basement A41 Mech Room

N/A ºF ✓ ✓ ✓ ✓ ✓ PASS

100 Engineering MA Beacon Total Alert 2 Backup Compressor On Bldg. 38 Basement A41 Mech Room

75 PSI ✓ ✓ ✓ ✓ ✓ PASS

101 Engineering MA Beacon Total Alert 2 High Line Pressure Bldg. 38 Basement A41 Mech Room

60 PSI ✓ ✓ ✓ ✓ ✓ PASS

102 Engineering MA Beacon Total Alert 2 Low Line Pressure Bldg. 38 Basement A41 Mech Room

40 PSI ✓ ✓ ✓ ✓ ✓ PASS

MASTER ALARMS

Medical Gas and Vacuum Systems Inspection/Testing

Southern AZ VA Tucson, AZ

M aster A larm P an el

L ocation

If M ultiple P anels

P er Location

(e.g. "E ngineering P anel #2")

S ystem

G as

M an u facturer

M od el

C on d ition

M on itored

S w itch or S ou rce L ocation

S et P oin t

U nit of M easu re

In itiatin g D evice

W irin g

P an el

L abelin g

O th er

C om p on en t C on d ition

MASTER ALARMS: LOCATION & SPECIFICATION FUNCTION & CONDITION

104 Engineering MA Beacon Total Alert 2 Dry Malfunction Bldg. 38 Basement A41 Mech Room

N/A ✓ ✓ ✓ ✓ ✓ PASS

105 Engineering MA Beacon Total Alert 2 Inlet Filter Dirty Bldg. 38 Basement A41 Mech Room

N/A ✓ ✓ ✓ ✓ ✓ PASS

106 Engineering MA Beacon Total Alert 2 Backup Compressor On Bldg. 60 Penthouse

Mech Room

75 PSI ✓ ✓ ✓ ✓ ✓ PASS

107 Engineering MA Beacon Total Alert 2 Dew Point High Bldg. 60 Penthouse

Mech Room

35 ºF ✓ ✓ ✓ ✓ ✓ PASS

108 Engineering MA Beacon Total Alert 2 Aftercooler Hi Temp Bldg. 60 Penthouse

Mech Room

N/A ºF ✓ ✓ ✓ ✓ ✓ PASS

109 Engineering MA Beacon Total Alert 2 Carbon Monoxide High Bldg. 60 Penthouse

Mech Room

10 PPM ✓ ✓ ✓ ✓ ✓ PASS

110 Engineering MA Beacon Total Alert 2 High Line Pressure Bldg. 60 Penthouse

Mech Room

60 PSI ✓ ✓ ✓ ✓ ✓ PASS

111 Engineering MA Beacon Total Alert 2 Low Line Pressure Bldg. 60 Penthouse

Mech Room

40 PSI ✓ ✓ ✓ ✓ ✓ PASS

112 Engineering MA Beacon Total Alert 2 Post Filter Dirty Bldg. 60 Penthouse

Mech Room

N/A ✓ ✓ ✓ ✓ ✓ PASS

113 Engineering MA Beacon Total Alert 2 Dryer Malfunction Bldg. 60 Penthouse

Mech Room

N/A ✓ ✓ ✓ ✓ ✓ PASS

114 Engineering MA Beacon Total Alert 2 Inlet Filter Dirty Bldg. 60 Penthouse

Mech Room

N/A ✓ ✓ ✓ ✓ ✓ PASS

115 Engineering VAC Beacon Total Alert 2 Low Line Pressure Bldg. 38 Basement

MASTER ALARMS

Medical Gas and Vacuum Systems Inspection/Testing

Southern AZ VA Tucson, AZ

M aster A larm P an el

L ocation

If M ultiple P anels

P er Location

(e.g. "E ngineering P anel #2")

S ystem

G as

M an u facturer

M od el

C on d ition

M on itored

S w itch or S ou rce L ocation

S et P oin t

U nit of M easu re

In itiatin g D evice

W irin g

P an el

L abelin g

O th er

C om p on en t C on d ition

MASTER ALARMS: LOCATION & SPECIFICATION FUNCTION & CONDITION

116 Engineering VAC Beacon Total Alert 2 Filter Back Pressure Bldg. 38 Basement

Mech Room

N/A ✓ ✓ ✓ ✓ ✓ PASS

117 Engineering VAC Beacon Total Alert 2 Backup Pump On Bldg. 60 Penthouse

Mech Room 18 inHg ✓ ✓ ✓ ✓ ✓ PASS

118 Engineering VAC Beacon Total Alert 2 Filter Back Pressure Bldg. 60 Penthouse

Mech Room

N/A ✓ ✓ ✓ ✓ ✓ PASS

119 Engineering VAC Beacon Total Alert 2 Low Line Pressure Bldg. 60 Penthouse

Mech Room 12 inHg ✓ ✓ ✓ ✓ ✓ PASS

120 Engineering O2 Beacon Total Alert 2 High Line Pressure Bldg. 38 Basement A41 Mech Room

60 PSI ✓ ✓ ✓ ✓ ✓ PASS

121 Engineering O2 Beacon Total Alert 2 Low Line Pressure Bldg. 38 Basement A41 Mech Room

40 PSI ✓ ✓ ✓ ✓ ✓ PASS

122 Engineering VAC Beacon Total Alert 2 Backup Pump On Bldg. 38 Basement A41 Mech Room

18 inHg ✓ ✓ ✓ ✓ ✓ PASS

Old Switchboard B57

B102A MA Beacon Total Alert 2 Low Line Pressure

Bldg. 57 Basement BA046 Mech Rm

40 PSI ✓ ✓ ✓ ✓ ✓ PASS

Old Switchboard B57

B102A MA Beacon Total Alert 2 High Line Pressure

Bldg. 57 Basement BA046 Mech Rm

60 PSI ✓ ✓ ✓ ✓ ✓ PASS

Old Switchboard B57

B102A MA Beacon Total Alert 2 Inlet Filter Dirty

Bldg. 57 Basement BA046 Mech Rm

N/A ✓ ✓ ✓ ✓ ✓ PASS

Old Switchboard B57

B102A MA Beacon Total Alert 2 Dental-Dry Malfunction

Bldg. 57 Basement BA046 Mech Rm

N/A ✓ ✓ ✓ ✓ ✓ PASS

Old Switchboard B57

B102A MA Beacon Total Alert 2 Backup Compressor On

Bldg. 57 Basement BA046 Mech Rm

75 PSI ✓ ✓ ✓ ✓ ✓ PASS

MASTER ALARMS

Medical Gas and Vacuum Systems Inspection/Testing

Southern AZ VA Tucson, AZ

M aster A larm P an el

L ocation

If M ultiple P anels

P er Location

(e.g. "E ngineering P anel #2")

S ystem

G as

M an u facturer

M od el

C on d ition

M on itored

S w itch or S ou rce L ocation

S et P oin t

U nit of M easu re

In itiatin g D evice

W irin g

P an el

L abelin g

O th er

C om p on en t C on d ition

MASTER ALARMS: LOCATION & SPECIFICATION FUNCTION & CONDITION

Old Switchboard B57

B102A MA Beacon Total Alert 2 Aftercooler Hi Temp

Bldg. 57 Basement BA046 Mech Rm

ºF ✓ ✓ ✓ ✓ ✓ PASS

Old Switchboard B57

B102A MA Beacon Total Alert 2 Dew Point High

Bldg. 57 Basement BA046 Mech Rm

35 ºF ✓ ✓ ✓ ✓ ✓ PASS

Old Switchboard B57

B102A MA Beacon Total Alert 2 Carbon Monoxide High

Bldg. 57 Basement BA046 Mech Rm

10 PPM ✓ ✓ ✓ ✓ ✓ PASS

Old Switchboard B57

B102A MA Beacon Total Alert 2 Dry Malfunction

Bldg. 57 Basement BA046 Mech Rm

N/A ✓ ✓ ✓ ✓ ✓ PASS

Old Switchboard B57

B102A MA Beacon Total Alert 2 Post Filter Dirty

Bldg. 57 Basement BA046 Mech Rm

N/A ✓ ✓ ✓ ✓ ✓ PASS

Old Switchboard B57

B102A VAC Beacon Total Alert 2 Filter Back Pressure

Bldg. 57 Basement BA046 Mech Rm

N/A ✓ ✓ ✓ ✓ ✓ PASS

Old Switchboard B57

B102A VAC Beacon Total Alert 2 Low Line Pressure

Bldg. 57 Basement BA046 Mech Rm

12 inHg ✓ ✓ ✓ ✓ ✓ PASS

Old Switchboard B57

B102A VAC Beacon Total Alert 2 Backup Pump On

Bldg. 57 Basement BA046 Mech Rm

18 inHg ✓ ✓ ✓ ✓ ✓ PASS

Old Switchboard B57

B102A MA Beacon Total Alert 2 Dental-Low Line Pressure

Bldg. 57 Basement BA046 Mech Rm

40 PSI ✓ ✓ ✓ ✓ ✓ PASS

Old Switchboard B57

B102A MA Beacon Total Alert 2 Dental-High Line Pressure

Bldg. 57 Basement BA046 Mech Rm

60 PSI ✓ ✓ ✓ ✓ ✓ PASS

Old Switchboard B57

B102A MA Beacon Total Alert 2 Dental-Thermal Shut Down

Bldg. 57 Basement BA046 Mech Rm

N/A ºF ✓ ✓ ✓ ✓ ✓ PASS

Old Switchboard B57

B102A MA Beacon Total Alert 2 Dental-Dew Point High

Bldg. 57 Basement BA046 Mech Rm

35 ºF ✓ ✓ ✓ ✓ ✓ PASS

MASTER ALARMS

Medical Gas and Vacuum Systems Inspection/Testing

Southern AZ VA Tucson, AZ

M aster A larm P an el

L ocation

If M ultiple P anels

P er Location

(e.g. "E ngineering P anel #2")

S ystem

G as

M an u facturer

M od el

C on d ition

M on itored

S w itch or S ou rce L ocation

S et P oin t

U nit of M easu re

In itiatin g D evice

W irin g

P an el

L abelin g

O th er

C om p on en t C on d ition

MASTER ALARMS: LOCATION & SPECIFICATION FUNCTION & CONDITION

Old Switchboard B57

B102A MA Beacon Total Alert 2

Dental-Carbon Monoxide High

Bldg. 57 Basement BA046 Mech Rm

10 PPM ✓ ✓ ✓ ✓ ✓ PASS

Old Switchboard B57

B102A CO2 Beacon Total Alert 2 Low Line Pressure Manifold Rm 40 PSI ✓ ✓ ✓ ✓ ✓ PASS

Old Switchboard B57

B102A CO2 Beacon Total Alert 2 High Line Pressure Manifold Rm 60 PSI ✓ ✓ ✓ ✓ ✓ PASS

Old Switchboard B57

B102A CO2 Beacon Total Alert 2 Reserve Supply In Use Manifold Rm 120 PSI ✓ ✓ ✓ ✓ ✓ PASS

Old Switchboard B57

B102A O2 Beacon Total Alert 2 Reserve Supply Low Bulk Site 40 inH2O ✓ ✓ ✓ ✓ ✓ PASS

Old Switchboard B57

B102A O2 Beacon Total Alert 2 Liquid Level Low Bulk Site 45 inH2O ✓ ✓ ✓ ✓ ✓ PASS

Old Switchboard B57

B102A O2 Beacon Total Alert 2 Reserve Supply In Use Bulk Site 90 PSI ✓ ✓ ✓ ✓ ✓ PASS

Old Switchboard B57

B102A O2 Beacon Total Alert 2 Reserve Pressure Low Bulk Site 90 PSI ✓ ✓ ✓ ✓ ✓ PASS

Old Switchboard B57

B102A O2 Beacon Total Alert 2 High Line Pressure

Bldg. 57 Outside Mech Rm Across

O2 Bulk Pad

60 PSI ✓ ✓ ✓ O ✓ FAIL

Old Switchboard B57

B102A O2 Beacon Total Alert 2 Low Line Pressure

Bldg. 57 Outside Mech Rm Across

O2 Bulk Pad

40 PSI ✓ ✓ ✓ O ✓ FAIL

MASTER ALARMS

Medical Gas and Vacuum Systems Inspection/Testing

Southern AZ VA Tucson, AZ

M aster A larm P an el

L ocation

If M ultiple P anels

P er Location

(e.g. "E ngineering P anel #2")

S ystem

G as

M an u facturer

M od el

C on d ition

M on itored

S w itch…

This is the start of the file's text. The full file is on GovTribe.

File details come from the government source that posted it. Updated Jul 30, 2024.