Attachment III - Med Gas System Maintenance Inspection.pdf
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- Solicitation number
- 36C25026Q0452
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Medical Gas Systems Maintenance Inspection Report
This is a comprehensive inspection report for the VA Medical Center in Fort Wayne, Indiana detailing the testing and inspection results of the facility's medical gas systems as of January 5, 2026. The inspection was conducted by Evergreen Medical Services in compliance with NFPA 99: 2018 standards and covers all Category 1-3 medical gas, vacuum, WAGD (waste anesthetic gas disposal), and medical support gas systems. The facility achieved an overall medical gas systems health rating of 96.8%, with 505 compliant components and 13 deficient components across master alarm signals (48 total, 0 deficient), area alarm signals (27 total, 1 deficient), valves (56 total, 8 deficient), and outlets/inlets (374 total, 4 deficient). The inspection included detailed testing of source equipment including oxygen cryogenic fluid systems, nitrogen and nitrous oxide cylinder manifolds, medical air compressor systems, and vacuum/WAGD systems, all of which passed their respective inspection checklists.
Key deficiencies identified include one missing area alarm panel serving 3204 Recovery; six zone valves in Rooms 3315 and 3304 (Pre-Op) lacking intervening walls between valves and outlets; nitrogen valves not installed serving operating rooms 3232 and 3235; and four WAGD inlets required but not installed in anesthetizing locations (3rd Floor rooms 3210, 3218, 3232, and 3235). Additionally, 18 pressure indicators on NCG zone valves in multiple operating rooms and recovery areas were noted as requiring verification of installation year and risk assessment determination for corrective action. Gas contaminant testing showed no deficiencies with all particulate, dew point, and odor tests passing. The report includes recommendations for flexible connection inspections every 18 months, utility system distribution mapping updates, personnel training compliance, and pigtail replacement on manifold flexible connectors per manufacturer specifications every five years.
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Text version
Project ID(s): Annual Medical Gas Inspection
Project Date(s): 1/05/2026 www.EvergreenMedical.com
2121 Lake Ave
02152407
123456789
11225
Erick Siela ASSE Credential #:
ASSE Credential #:
ASSE Credential #:
ASSE Credential #:
michael.foster7@va.gov
Fort Wayne, IN 46805
Project Contact:
Michael Foster
Facilities
(260) 421-1062
Project Site:
123546
123456
VA Medical Center - Fort Wayne
Report Authored By:
Technician 2:
Technician 3:
Technician 4:
Technician 6: ASSE Credential #:
Technician 5: ASSE Credential #:
Evergreen Medical Services
Corporate Headquarters
8047 Castleton Road
Indianapolis, IN 46250
800-727-8321
MEDICAL GAS SYSTEMS MAINTENANCE INSPECTION
Project ID(s): Annual Medical Gas Inspection
Tested to NFPA 99: 2018
2Project ID(s): Annual Medical Gas Inspection
TESTING & INSPECTION PROCEDURES
EMS has designed its testing & inspection scope and procedure around applicable NFPA 99 codes and pertinent inspection and accreditation requirements, and manufacturer recommendations following industry best practices. However, your facility's risk assessment committee has the ultimate responsibility in deciding the scope and frequency of scheduled inspections for medical gas components and the associated procedures. These inspections are to be developed with consideration of the original equipment manufacturer recommendations and other recommendations as required by the authority having jurisdiction.
The testing & inspection procedures represented in this report are as follows unless otherwise directed and document by the facility's risk assessment team:
MASTER ALARMS :
Master alarm panel location is recorded along with manufacturer and model of alarm and location of initiating device. Master alarm panels are tested for proper audible and visual alarm activation & deactivation, each signal is inspected for proper labeling and wiring is inspected for independence to initiating device.
All master alarm signals* are tested by simulating each alarm condition and/or actuating the signal at the initiating device wherever possible.
If it is not possible to simulate an alarm condition or actuate the signal by changing system conditions then the alarm's wiring will be tested for continuity from the initiating to the master alarm panels.
* Cryogenic liquid central supply system master alarm signals that terminate within the supplier-owned equipment are not tested per the EMS maintenance inspection SOP as such signals are required to be tested by the supplier/equipment owner annually and EMS views this testing as sufficient in satisfying the NFPA 99 inspection requirement. EMS can test these signals per request, however the facility will have to direct the method used to perform this testing.
AREA ALARMS :
Area alarm panel location and area monitored is recorded along with manufacturer and model of alarm. Area alarm panels are tested for proper audible and visual alarm activation and deactivation through use of the alarm "test" function. Condition of area alarm and components are inspected.
System gas, high & low alarm setpoints are recorded and pressure reading is recorded and tested for accuracy.
Area monitored labeling and transducer location can only be verified by tracing piping and/or altering zone pressure. Actual alarm function under alarm conditions (high or low pressure) can only be verified by altering zone pressure. These tests can be performed by request but are not included in EMS's maintenance inspection SOP.
VALVES :
Valve location and labeling (including area(s) served, system gas and other required verbiage), manufacturer, valve type and pressure reading are inspected and recorded. Gauge pressure is recorded and tested for accuracy. Condition of valve assembly and enclosure are inspected and valves are checked for leaks.
Area served labeling can only be verified by tracing piping and/or altering zone pressure. This test can be performed by request but is not included in EMS's maintenance inspection SOP.
Per NFPA 99, the maintenance, inspection and testing operations of medical gas systems apply to all facilities—new and existing—with Category 1-3 Medical Gas, Vacuum, WAGD, and Medical Support Gas systems.
MEDICAL GAS SYSTEMS MAINTENANCE INSPECTION
PURPOSE
The inspection and testing documented in this report is designed around satisfying the medical gas systems maintenance program requirements laid out in NFPA 99 section 5.1.14. The purpose driving these maintenance program requirements is to ensure that medical gas system components are compliant with applicable NFPA 99 codes and standards, remain in good repair, and are operating within manufacturer specifications or recommendations.
SCOPE AND APPLICATION
OUTLETS & INLETS :
Outlet or inlet location, manufacturer, model, position and labeling is inspected and recorded. Outlets/inlets are tested for proper connect & release, leaks and general condition.
One outlet/inlet per zone is tested for static pressure and compared with zone valve gauge reading and/or area alarm pressure reading.
All outlets/inlets are tested for dynamic pressure/operational flow pressure drop.
All positive pressure medical gases are tested for oxygen concentration as a way of determining if existing cross-connections between two medical gases exist.
Facility testing and system evaluation performed to be in compliance with NFPA 99 2018 Edition.
3Project ID(s): Annual Medical Gas Inspection
MEDICAL GAS SYSTEMS MAINTENANCE INSPECTION
1)
2)
3)
TECHNICIAN CREDENTIALS
EMS service technicians are qualified to perform medical gas systems inspections and maintenance to one or more of the following qualification requirements per NFPA 99 5.1.14:
Documented training by which such persons are qualified to work with specific equipment as installed in that facility.
Credentialing to the requirements of ASSE 6040, Professional Qualification Standard for Medical Gas Maintenance Personnel.
Credentialing to the requirements of ASSE 6030, Professional Qualification Standard for Medical Gas Systems Verifiers.
QUALIFICATIONS
SOURCE EQUIPMENT :
All source systems' manufacturer, model number and specifications are recorded. Proper functioning of each system is observed and recorded. Each source type is inspected based on the associated inspection checklist visible on the page(s) of this report specific to that source system.
GAS CONTAMINANTS :
Particulate Contaminants - A representative sampling of each gas system pipeline is tested for particulate contaminants using a 0.45 micron filter membrane connected to an outlet of each gas. Results of this test are then recorded.
Dew Point - A representative sampling of medical air and instrument air pipeline is tested for dew point using a portable dew point monitor connected to an outlet of each gas. Results of this test are then recorded.
Odor - All positive pressure outlets are tested for objectionable or pronounced odor and the results are then recorded.
Gaseous Contaminants - Testing each gas system pipeline and source for total nonmethane hydrocarbons and halogenated hydrocarbons can be performed by request but is not included in EMS's maintenance inspection SOP.
4Project ID(s): Annual Medical Gas Inspection
TABLE OF CONTENTS
■ Summary of Findings
■ Master Alarms
■ Area Alarms
■ Valves
■ Outlets & Inlets
■ Contaminants
■ Source Equipment
■ Annex
Evergreen Medical Services has evaluated the medical piping systems indicated in this report in accordance with applicable NFPA 99 Health Care Facilities Code and ASSE 6000 Standards. These systems have been found to be within applicable guidelines except as noted within this report. Any deficiencies cited are based on the most applicable edition of NFPA 99. See coversheet for relevent NFPA 99 edition.
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.
The information recorded in this report represents the state of the medical gas systems for the indicated inspection 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 its entirety.
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Master Alarm
Signals (48)
Area Alarm Signals (27)
Valves (56) Outlets & Inlets (374)
Contaminant Test Sites
(6)
Source Systems (5)
Deficient 0 1 8 4 0 0
Compliant 48 26 48 370 6 5
48 26 48 370 6 5
1 8
MEDICAL GAS SYSTEMS HEALTH BY COMPONENT
96.8%
OVERALL MEDICAL
GAS SYSTEMS HEALTH
5Project ID(s): Annual Medical Gas Inspection
MASTER ALARMS
No deficiencies at time of test
No corrective action reported
AREA ALARMS
DEFICIENCY DETAIL - AREA ALARMS ALARM PANEL LOCATION(S) QTY
No Alarm Panel Installed Serving 3204 Recovery 0 1
CORRECTIVE ACTION DETAIL - AREA ALARMS ALARM PANEL LOCATION(S) QTY
No corrective action reported
VALVES
DEFICIENCY DETAIL - VALVES VALVE LOCATION(S) QTY
No Intervening Wall Between Zone Valves and Outlets / Inlets Served 3rd Floor: Rm 3315, 3rd Floor: Rm 3304 (Pre-Op) 6
No Nitrogen Valve Installed Serving OR 3232 0 1
No Nitrogen Valve Installed Serving OR 3235 0 1
CORRECTIVE ACTION DETAIL - VALVES VALVE LOCATION(S) QTY
No corrective action reported
OUTLET & INLETS
DEFICIENCY DETAIL - OUTLETS & INLETS OUTLET/INLET LOCATION(S) / ASSET # QTY
WAGD Inlet Required (Anesthetizing Location) 3rd Floor 3210, 3rd Floor 3218, 3rd Floor 3232, 3rd Floor
CORRECTIVE ACTION DETAIL - OUTLETS & INLETS OUTLET/INLET LOCATION(S) / ASSET # QTY
No corrective action reported
GAS CONTAMINANTS
No deficiencies at time of test
No corrective action reported
SOURCE EQUIPMENT
No deficiencies at time of testing
No corrective action reported
SUMMARY OF DEFICIENCIES
Individual deficiencies and corrective action notes can be found in the component sections ('Master Alarms', 'Area Alarms', 'Valves', 'Outlets & Inlets', 'Contaminants', 'Sources & Pipeline' ). This summary provides an overview of deficiency or corrective action type, location and quantity. For discussion regarding what constitutes a deficiency, please note the "Scope & Procedures" section of this report. For findings that have not been marked as deficient but instead EMS has provided a recommendation, please note the "Annex" section of this report.
6Project ID(s): Annual Medical Gas Inspection
MASTER ALARM SIGNALS
BY SYSTEM GAS:
18 12 6 6 0 6 0 0 0
48TOTAL MASTER
ALARM SIGNALS
TOTAL MASTER ALARM PANELS:
MANUFACTURER MODEL MASTER ALARM PANEL DESCRIPTION
O
M A
N
O
N
C O
V A
C
W A
G D
IA
O th e r
Amico A2M Gray Cover with Red LED Indicators 18 12 6 6 6
48ALARM SIGNALS
MASTER ALARMS BREAKDOWN (*EACH MASTER ALARM SIGNAL COUNTED AS SEPARATE ALARM BY SYSTEM GAS BELOW)
7Project ID(s): Annual Medical Gas Inspection
Master Alarm Panel
Location/#* *If multiple panels per location
(e.g. "Engineering Panel 1")
System MFR Model Condition
Monitored
Switch or
Source
Location S e t
P o in t
U n it o f
M e a s u re Component
Condition / Test
Results
Deficiency Detail or
Corrective Action
Needed/Taken
1 ER N2O Amico A2M Line Pressure
Low Manifold Room PASS
2 ER N2O Amico A2M Line Pressure
High Manifold Room PASS
3 ER N2O Amico A2M Reserve In Use Manifold Room PASS
4 ER N2 Amico A2M Line Pressure
Low Manifold Room PASS
5 ER N2 Amico A2M Line Pressure
High Manifold Room PASS
6 ER N2 Amico A2M Reserve In Use Manifold Room PASS
7 ER O2 Amico A2M Liquid Level
Low
Outside Mailroom - In
Basement Ceiling
SEE ANNEX Tested by Bulk Supplier
8 ER O2 Amico A2M Reserve
Cylinder In Use
Outside Mailroom - In
Basement Ceiling
SEE ANNEX Tested by Bulk Supplier
9 ER O2 Amico A2M Emergency
Cylinder Low
Outside Mailroom - In
Basement Ceiling
SEE ANNEX Alarm Not Required (Liq x Gas)
10 ER O2 Amico A2M Reserve Gas Pressure Low
Outside Mailroom - In
Basement Ceiling
SEE ANNEX Tested by Bulk Supplier
11 ER O2 Amico A2M Line Pressure
Low
Outside Mailroom - In
Basement Ceiling
PASS Tested At Panel
12 ER O2 Amico A2M Line Pressure
High
Outside Mailroom - In
Basement Ceiling
PASS Tested At Panel
13 ER MA Amico A2M Compressor Maintenance
Required
Mechanical Room
Penthouse
PASS
14 ER MA Amico A2M High Dew Point Mechanical
Room Penthouse
PASS
15 ER MA Amico A2M Line Pressure
Low
Mechanical Room
Penthouse
PASS
16 ER MA Amico A2M Line Pressure
High
Mechanical Room
Penthouse
PASS
17 ER VAC Amico A2M Low Mechanical
Room Penthouse
PASS
18 ER VAC Amico A2M Pumps
Maintenance Required
Mechanical Room
Penthouse
PASS
MASTER ALARMS: LOCATION & SPECIFICATION FUNCTION & CONDITION
8Project ID(s): Annual Medical Gas Inspection
Master Alarm Panel
Location/#* *If multiple panels per location
(e.g. "Engineering Panel 1")
System MFR Model Condition
Monitored
Switch or
Source
Location S e t
P o in t
U n it o f
M e a s u re Component
Condition / Test
Results
Deficiency Detail or
Corrective Action
Needed/Taken
MASTER ALARMS: LOCATION & SPECIFICATION FUNCTION & CONDITION
19 Maintenance N2O Amico A2M Line Pressure
Low Manifold Room PASS
20 Maintenance N2O Amico A2M Line Pressure
High Manifold Room PASS
21 Maintenance N2O Amico A2M Reserve In Use Manifold Room PASS PASS
22 Maintenance N2 Amico A2M Line Pressure
Low Manifold Room PASS
23 Maintenance N2 Amico A2M Line Pressure
High Manifold Room PASS
24 Maintenance N2 Amico A2M Reserve In Use Manifold Room PASS
25 Maintenance O2 Amico A2M Liquid Level
Low
Outside Mailroom - In
Basement Ceiling
SEE ANNEX Tested by Bulk Supplier
26 Maintenance O2 Amico A2M Reserve
Cylinder In Use
Outside Mailroom - In
Basement Ceiling
SEE ANNEX Tested by Bulk Supplier
27 Maintenance O2 Amico A2M Emergency
Cylinder Low
Outside Mailroom - In
Basement Ceiling
SEE ANNEX Alarm Not Required (Liq x Gas)
28 Maintenance O2 Amico A2M Reserve Gas Pressure Low
Outside Mailroom - In
Basement Ceiling
SEE ANNEX Tested by Bulk Supplier
29 Maintenance O2 Amico A2M Line Pressure
Low
Outside Mailroom - In
Basement Ceiling
PASS Tested At Panel
30 Maintenance O2 Amico A2M Line Pressure
High
Outside Mailroom - In
Basement Ceiling
PASS Tested At Panel
31 Maintenance MA Amico A2M Compressor Maintenance
Required
Mechanical Room
Penthouse
PASS
32 Maintenance MA Amico A2M High Dew Point Mechanical
Room Penthouse
PASS
33 Maintenance MA Amico A2M Line Pressure
Low
Mechanical Room
Penthouse
PASS
34 Maintenance MA Amico A2M Line Pressure
High
Mechanical Room
Penthouse
PASS
35 Maintenance VAC Amico A2M Low Mechanical
Room Penthouse
PASS
36 Maintenance VAC Amico A2M Pumps
Maintenance Required
Mechanical Room
Penthouse
9Project ID(s): Annual Medical Gas Inspection
Master Alarm Panel
Location/#* *If multiple panels per location
(e.g. "Engineering Panel 1")
System MFR Model Condition
Monitored
Switch or
Source
Location S e t
P o in t
U n it o f
M e a s u re Component
Condition / Test
Results
Deficiency Detail or
Corrective Action
Needed/Taken
MASTER ALARMS: LOCATION & SPECIFICATION FUNCTION & CONDITION
37 4th Floor O2 Amico A2M Liquid Level
Low
Outside Mailroom - In
Basement Ceiling
SEE ANNEX Tested By Bulk Supplier
38 4th Floor O2 Amico A2M Reserve
Cylinder In Use
Outside Mailroom - In
Basement Ceiling
SEE ANNEX Tested By Bulk Supplier
39 4th Floor O2 Amico A2M Emergency
Cylinder Low
Outside Mailroom - In
Basement Ceiling
SEE ANNEX Alarm Not Required (Liq x Gas)
40 4th Floor O2 Amico A2M Reserve Gas Pressure Low
Outside Mailroom - In
Basement Ceiling
SEE ANNEX Tested By Bulk Supplier
41 4th Floor O2 Amico A2M Line Pressure
Low
Outside Mailroom - In
Basement Ceiling
PASS Tested At Pane
42 4th Floor O2 Amico A2M Line Pressure
High
Outside Mailroom - In
Basement Ceiling
PASS Tested At Panel
43 4th Floor MA Amico A2M Compressor Maintenance
Required
Mechanical Room
Penthouse
PASS
44 4th Floor MA Amico A2M High Dew Point Mechanical
Room Penthouse
PASS
45 4th Floor MA Amico A2M Line Pressure
Low
Mechanical Room
Penthouse
PASS
46 4th Floor MA Amico A2M Line Pressure
High
Mechanical Room
Penthouse
PASS
47 4th Floor VAC Amico A2M Low Mechanical
Room Penthouse
PASS
48 4th Floor VAC Amico A2M Pumps
Maintenance Required
Mechanical Room
Penthouse
10Project ID(s): Annual Medical Gas Inspection
TOTAL AREA ALARM SIGNALS
BY SYSTEM GAS:
9 7 1 1 0 9 0 0 0
27TOTAL AREA
ALARM SIGNALS
TOTAL AREA ALARM PANELS:
MANUFACTURER
(Or Current Parent
Company )
MODEL AREA ALARM DESCRIPTION
O
M A
N
O
N
C O
V A
C
W A
G D
IA
O th e r
Amico 1 1 1 1
Amico Alert 1 1 1
Amico LCD 6 6 6
Puritan Bennett Mega 1 1
AREA ALARMS BREAKDOWN (EACH AREA ALARM SIGNAL COUNTED AS SEPARATE ALARM BY SYSTEM GAS BELOW)
ALARM SIGNALS
11Project ID(s): Annual Medical Gas Inspection
# Physical Location Area/Rooms
Monitored System MFR Model
P re s s u re
R e a d in g
(A ll G a s e s P
S I/
V A
C
W A
G D
H g
H ig h P re s s
S tt in g
(A ll
G a s e s P
S I/
V A
C
W A g
L o w P re s s tt in g
(A ll
G a s e s P
S I/
V A
C
W A g
Component
Condition /
Test Results
Deficiency Detail or
Corrective Action
Needed/Taken
1st Floor: ER A
139, A 141 - A 153, A 103 - A 136
ER A 139, A 141 -
A 153, A 103 - A
O2
Puritan Bennett
Mega PASS Recommend Verifying Areas
Served and Relabel
1st Floor: ER A
139, A 141 - A 153, A 103 - A 136
ER A 139, A 141 -
A 153, A 103 - A
VAC
Puritan Bennett
Mega PASS Recommend Verifying Areas
Served and Relabel
2nd Floor: Room
203 & 207 (Located In Office)
Room 203 & 207 O2 Amico Alert PASS
2nd Floor: Room
203 & 207 (Located In Office)
Room 203 & 207 MA Amico Alert PASS
2nd Floor: Room
203 & 207 (Located In Office)
Room 203 & 207 VAC Amico Alert PASS
6 3rd Floor: 3315 3315 O2 Amico LCD PASS
7 3rd Floor: 3315 3315 MA Amico LCD PASS
8 3rd Floor: 3315 3315 VAC Amico LCD PASS
3rd Floor: ORs /
Surgery (Located In Room 3213)
ORs / Surgery O2 Amico PASS
3rd Floor: ORs /
Surgery (Located In Room 3213)
ORs / Surgery VAC Amico PASS
3rd Floor: ORs /
Surgery (Located In Room 3213)
ORs / Surgery N2O Amico PASS
3rd Floor: ORs /
Surgery (Located In Room 3213)
ORs / Surgery N2 Amico PASS
3rd Floor: 3315B -
3315D 3315B - 3315D O2 Amico LCD PASS
3rd Floor: 3315B -
3315D 3315B - 3315D MA Amico LCD PASS
3rd Floor: 3315B -
3315D 3315B - 3315D VAC Amico LCD PASS
3rd Floor: Rm 3304
(Pre-Op) Rm 3304 (Pre-Op) O2 Amico LCD PASS
3rd Floor: Rm 3304
(Pre-Op) Rm 3304 (Pre-Op) MA Amico LCD PASS
3rd Floor: Rm 3304
(Pre-Op) Rm 3304 (Pre-Op) VAC Amico LCD PASS
3rd Floor: 3204 Recovery
FAIL
No Alarm Panel Installed Serving
3204 Recovery
4th Floor: 4312, 4316, 4320, 4324, 4326, 4333, 4332, 4346, 4348
4312, 4316, 4320, 4324, 4326, 4333, 4332, 4346, 4348
O2 Amico LCD PASS
4th Floor: 4312, 4316, 4320, 4324, 4326, 4333, 4332, 4346, 4348
4312, 4316, 4320, 4324, 4326, 4333, 4332, 4346, 4348
MA Amico LCD PASS
4th Floor: 4312, 4316, 4320, 4324, 4326, 4333, 4332, 4346, 4348
4312, 4316, 4320, 4324, 4326, 4333, 4332, 4346, 4348
VAC Amico LCD PASS
AREA ALARMS: LOCATION & SPECIFICATION FUNCTION AND CONDITION
12Project ID(s): Annual Medical Gas Inspection
# Physical Location Area/Rooms
Monitored System MFR Model
P re s s
R a d g
(A ll G a s e s P
S I/
V A
C
W A g
H ig h P re s s tt in g
(A ll
G a s e s P
S I/
V A
C
W A g
L o w P re s s tt in g
(A ll
G a s e s P
S I/
V A
C
W A g
Component
Condition /
Test Results
Deficiency Detail or
Corrective Action
Needed/Taken
AREA ALARMS: LOCATION & SPECIFICATION FUNCTION AND CONDITION
4th Floor: (ICU)
4353, 4352, 4364, (ICU) 4353, 4352,
4364, 4365
O2 Amico LCD PASS
4th Floor: (ICU)
4353, 4352, 4364, (ICU) 4353, 4352,
4364, 4365
MA Amico LCD PASS
4th Floor: (ICU)
4353, 4352, 4364, (ICU) 4353, 4352,
4364, 4365
VAC Amico LCD PASS
4th Floor: 4102 -
4102 - 4160 O2 Amico LCD PASS
4th Floor: 4102 -
4102 - 4160 MA Amico LCD PASS
4th Floor: 4102 -
4102 - 4160 VAC Amico LCD PASS
13Project ID(s): Annual Medical Gas Inspection
TOTAL VALVES
BY SYSTEM GAS:
22 8 5 1 0 20 0 0 0
56TOTAL
VALVES
TOTAL ZONE VALVE BOXES
MANUFACTURER VALVE TYPE VALVE DESCRIPTION
O
M A
N
O
N
C O
V A
C
W A
G D
IA
O th e r
Amico Zone - 1/4 Turn Accessible valve through which all station outlets/inlets are served 6 5 6
Beacon Zone - 1/4 Turn Accessible valve through which all station outlets/inlets are served 1 1 1
NCG Zone - 1/4 Turn Accessible valve through which all station outlets/inlets are served 12 1 5 1 9
Ohmeda Zone - 1/4 Turn Accessible valve through which all station outlets/inlets are served 1 1
Puritan Bennett Service - 1/4 Turn For servicing or modification of lateral branch piping 1
Puritan Bennett Zone - 1/4 Turn Accessible valve through which all station outlets/inlets are served 2 3
VALVES BREAKDOWN (EACH SYSTEM GAS COUNTED AS SEPARATE ZONE VALVE)
56VALVES
14Project ID(s): Annual Medical Gas Inspection
# Physical Location Area/Rooms Served System MFR Valve Type
Gauge
Reading (All Gases PSI/
VAC & WAGD
inHg)
Component
Condition / Test
Results
Deficiency Detail or
Corrective Action
Needed/Taken
1 1st Floor: A 103 - A
A 103 - A 136 VAC
Puritan Bennett
Zone - 1/4 Turn PASS
2 1st Floor: A 153, A 141 - A 143, A 148 -
A 153 A 153 O2
Puritan Bennett
Zone - 1/4 Turn PASS
3 1st Floor: A 153, A 141 - A 143, A 148 -
A 153
A 141 - A 143, A 148
- A 153
VAC
Puritan Bennett
Zone - 1/4 Turn PASS Recommend Verifying Areas Served and Relabel
4 1st Floor: Room A
Room A 139 O2 Puritan Bennett
Zone - 1/4 Turn PASS
5 1st Floor: Room A
Room A 139 VAC Puritan Bennett
Zone - 1/4 Turn PASS
6 1st Floor: Room 167 Room 167 O2 Beacon Zone - 1/4 Turn PASS
7 1st Floor: Room 167 Room 167 MA Beacon Zone - 1/4 Turn PASS
8 1st Floor: Room 167 Room 167 VAC Beacon Zone - 1/4 Turn PASS
9 2nd Floor: Room 203 & 207 (In Hallway Near Restrooms)
Room 203 & 207 O2 NCG Zone - 1/4 Turn PASS
10 2nd Floor: Room 203 & 207 (In Hallway Near Restrooms)
Room 203 & 207 MA NCG Zone - 1/4 Turn PASS
11 2nd Floor: Room 203 & 207 (In Hallway Near Restrooms)
Room 203 & 207 VAC NCG Zone - 1/4 Turn PASS
3rd Floor: OR 3218 OR 3218 O2 NCG Zone - 1/4 Turn SEE ANNEX
No Pressure Indicator: Verify Year Of
Install & Determine By Risk
Assessment If Corrections Are
Required To Meet Current Standard
3rd Floor: OR 3218 OR 3218 VAC NCG Zone - 1/4 Turn SEE ANNEX
No Pressure Indicator: Verify Year Of
Install & Determine By Risk
Assessment If Corrections Are
Required To Meet Current Standard
3rd Floor: OR 3218 OR 3218 N2O NCG Zone - 1/4 Turn SEE ANNEX
No Pressure Indicator: Verify Year Of
Install & Determine By Risk
Assessment If Corrections Are
Required To Meet Current Standard
OR 3218 SEE ANNEX
No Nitrogen Valve Installed Serving
OR 3218; N2 Outlets Not In Service
3rd Floor: OR 3232 OR 3232 O2 NCG Zone - 1/4 Turn SEE ANNEX
No Pressure Indicator: Verify Year Of
Install & Determine By Risk
Assessment If Corrections Are
Required To Meet Current Standard
3rd Floor: OR 3232 OR 3232 VAC NCG Zone - 1/4 Turn SEE ANNEX
No Pressure Indicator: Verify Year Of
Install & Determine By Risk
Assessment If Corrections Are
Required To Meet Current Standard
3rd Floor: OR 3232 OR 3232 N2O NCG Zone - 1/4 Turn SEE ANNEX
No Pressure Indicator: Verify Year Of
Install & Determine By Risk
Assessment If Corrections Are
Required To Meet Current Standard
OR 3232 FAIL
No Nitrogen Valve Installed Serving
OR 3232
3rd Floor: OR 3235 OR 3235 O2 NCG Zone - 1/4 Turn SEE ANNEX
No Pressure Indicator: Verify Year Of
Install & Determine By Risk
Assessment If Corrections Are
Required To Meet Current Standard
3rd Floor: OR 3235 OR 3235 VAC NCG Zone - 1/4 Turn SEE ANNEX
No Pressure Indicator: Verify Year Of
Install & Determine By Risk
Assessment If Corrections Are
Required To Meet Current Standard
3rd Floor: OR 3235 OR 3235 N2O NCG Zone - 1/4 Turn SEE ANNEX
No Pressure Indicator: Verify Year Of
Install & Determine By Risk
Assessment If Corrections Are
Required To Meet Current Standard
OR 3235 FAIL
No Nitrogen Valve Installed Serving
OR 3235
VALVES: LOCATION & SPECIFICATION FUNCTION AND CONDITION
15Project ID(s): Annual Medical Gas Inspection
# Physical Location Area/Rooms Served System MFR Valve Type
Gauge
Reading (All Gases PSI/
VAC & WAGD
inHg)
Component
Condition / Test
Results
Deficiency Detail or
Corrective Action
Needed/Taken
VALVES: LOCATION & SPECIFICATION FUNCTION AND CONDITION
21 3rd Floor: 3 West Service Valve
3 West Service Valve O2 Puritan Bennett
Service - 1/4 Turn UNAVAILABLE Under Construction
22 3rd Floor: 3133, 3134, 3135, 3137, 3138, 3139 (Box 1)
3133, 3134, 3135, 3137, 3138, 3139
O2 NCG Zone - 1/4 Turn UNAVAILABLE Under Construction
23 3rd Floor: 3133, 3134, 3135, 3137, 3138, 3139 (Box 2)
3133, 3134, 3135, 3137, 3138, 3139
MA Ohmeda Zone - 1/4 Turn UNAVAILABLE Under Construction
24 3rd Floor: 3133, 3134, 3135, 3137, 3138, 3139 (Box 2)
3133, 3134, 3135, 3137, 3138, 3139
VAC Ohmeda Zone - 1/4 Turn UNAVAILABLE Under Construction
25 3rd Floor: 335 - 340 335 - 340 O2 NCG Zone - 1/4 Turn UNAVAILABLE Under Construction
26 3rd Floor: 331 - 332 331 - 332 O2 NCG Zone - 1/4 Turn UNAVAILABLE Under Construction
27 3rd Floor: 3315 D 3315 D O2 NCG Zone - 1/4 Turn PASS
28 3rd Floor: 3315 D 3315 D VAC NCG Zone - 1/4 Turn PASS
29 3rd Floor: 302 - 313 (Master Shut Off -
Box 1)
302 - 313 (Master Shut Off)
O2 NCG Zone - 1/4 Turn SEE ANNEX
No Pressure Indicator: Verify Year Of
Install & Determine By Risk
Assessment If Corrections Are
Required To Meet Current Standard
30 3rd Floor: 302 - 313 (Master Shut Off -
Box 2)
302 - 313 (Master Shut Off)
VAC NCG Zone - 1/4 Turn SEE ANNEX
No Pressure Indicator: Verify Year Of
Install & Determine By Risk
Assessment If Corrections Are
Required To Meet Current Standard
3rd Floor: 3204
(Recovery) 3204 (Recovery) O2 NCG Zone - 1/4 Turn SEE ANNEX
No Pressure Indicator: Verify Year Of
Install & Determine By Risk
Assessment If Corrections Are
Required To Meet Current Standard
3rd Floor: 3204
(Recovery) 3204 (Recovery) VAC NCG Zone - 1/4 Turn SEE ANNEX
No Pressure Indicator: Verify Year Of
Install & Determine By Risk
Assessment If Corrections Are
Required To Meet Current Standard
3rd Floor: OR 3208 OR 3208 O2 NCG Zone - 1/4 Turn SEE ANNEX
No Pressure Indicator: Verify Year Of
Install & Determine By Risk
Assessment If Corrections Are
Required To Meet Current Standard
3rd Floor: OR 3208 OR 3208 VAC NCG Zone - 1/4 Turn SEE ANNEX
No Pressure Indicator: Verify Year Of
Install & Determine By Risk
Assessment If Corrections Are
Required To Meet Current Standard
35 3rd Floor: OR 3208 OR 3208 N2O NCG Zone - 1/4 Turn NOT IN USE
36 3rd Floor: OR 3208 OR 3208 N2 NCG Zone - 1/4 Turn NOT IN USE
3rd Floor: OR 3210 OR 3210 O2 NCG Zone - 1/4 Turn SEE ANNEX
No Pressure Indicator: Verify Year Of
Install & Determine By Risk
Assessment If Corrections Are
Required To Meet Current Standard
3rd Floor: OR 3210 OR 3210 VAC NCG Zone - 1/4 Turn SEE ANNEX
No Pressure Indicator: Verify Year Of
Install & Determine By Risk
Assessment If Corrections Are
Required To Meet Current Standard
3rd Floor: OR 3210 OR 3210 N2O NCG Zone - 1/4 Turn SEE ANNEX
No Pressure Indicator: Verify Year Of
Install & Determine By Risk
Assessment If Corrections Are
Required To Meet Current Standard
OR 3210 SEE ANNEX
No Nitrogen Valve Installed Serving
OR 3210; N2 Outlets Not In Service
40 3rd Floor: Rm 3315 Rm 3315 O2 Amico Zone - 1/4 Turn FAIL No Intervening Wall Between Zone
Valves and Outlets / Inlets Served
41 3rd Floor: Rm 3315 Rm 3315 MA Amico Zone - 1/4 Turn FAIL No Intervening Wall Between Zone
Valves and Outlets / Inlets Served
42 3rd Floor: Rm 3315 Rm 3315 VAC Amico Zone - 1/4 Turn FAIL No Intervening Wall Between Zone
Valves and Outlets / Inlets Served
43 3rd Floor: 3315B 3315B O2 Amico Zone - 1/4 Turn PASS
44 3rd Floor: 3315B 3315B VAC Amico Zone - 1/4 Turn PASS
16Project ID(s): Annual Medical Gas Inspection
# Physical Location Area/Rooms Served System MFR Valve Type
Gauge
Reading (All Gases PSI/
VAC & WAGD
inHg)
Component
Condition / Test
Results
Deficiency Detail or
Corrective Action
Needed/Taken
VALVES: LOCATION & SPECIFICATION FUNCTION AND CONDITION
45 3rd Floor: Rm 3304 (Pre-Op)
Rm 3304 (Pre-Op) O2 Amico Zone - 1/4 Turn FAIL No Intervening Wall Between Zone
Valves and Outlets / Inlets Served
46 3rd Floor: Rm 3304 (Pre-Op)
Rm 3304 (Pre-Op) MA Amico Zone - 1/4 Turn FAIL No Intervening Wall Between Zone
Valves and Outlets / Inlets Served
47 3rd Floor: Rm 3304 (Pre-Op)
Rm 3304 (Pre-Op) VAC Amico Zone - 1/4 Turn FAIL No Intervening Wall Between Zone
Valves and Outlets / Inlets Served
48 4th Floor: 4352, 4353, 4364, 4365
4352, 4353, 4364, O2 Amico Zone - 1/4 Turn PASS
49 4th Floor: 4352, 4353, 4364, 4365
4352, 4353, 4364, MA Amico Zone - 1/4 Turn PASS
50 4th Floor: 4352, 4353, 4364, 4365
4352, 4353, 4364, VAC Amico Zone - 1/4 Turn PASS
51 4th Floor: 4102, 4106, 4114, 4116, 4118, 4120, 4124, 4130, 4144, 4143, 4140, 4154, 4160
4102, 4106, 4114, 4116, 4118, 4120, 4124, 4130, 4144, 4143, 4140, 4154, O2 Amico Zone - 1/4 Turn PASS
52 4th Floor: 4102, 4106, 4114, 4116, 4118, 4120, 4124, 4130, 4144, 4143, 4140, 4154, 4160
4102, 4106, 4114, 4116, 4118, 4120, 4124, 4130, 4144, 4143, 4140, 4154, MA Amico Zone - 1/4 Turn PASS
53 4th Floor: 4102, 4106, 4114, 4116, 4118, 4120, 4124, 4130, 4144, 4143, 4140, 4154, 4160
4102, 4106, 4114, 4116, 4118, 4120, 4124, 4130, 4144, 4143, 4140, 4154, VAC Amico Zone - 1/4 Turn PASS
54 4th Floor: 4312, 4316, 4320, 4324, 4326, 4333, 4332, 4346, 4348
4312, 4316, 4320, 4324, 4326, 4333, 4332, 4346, 4348
O2 Amico Zone - 1/4 Turn PASS
55 4th Floor: 4312, 4316, 4320, 4324, 4326, 4333, 4332, 4346, 4348
4312, 4316, 4320, 4324, 4326, 4333, 4332, 4346, 4348
MA Amico Zone - 1/4 Turn PASS
56 4th Floor: 4312, 4316, 4320, 4324, 4326, 4333, 4332, 4346, 4348
4312, 4316, 4320, 4324, 4326, 4333, 4332, 4346, 4348
VAC Amico Zone - 1/4 Turn PASS
5th Floor NOT IN USE Rooms 530 - 546 & 507 - 527 Turned
Into Offices
17Project ID(s): Annual Medical Gas Inspection
TOTAL
OUTLETS/
INLETS:
TOTAL OUTLETS/INLETS
BY SYSTEM GAS:
77 7 7 0 160 0 0 0
MANUFACTURER MODEL OUTLET/INLET DESCRIPTION
O
M A
N
O
N
C O
V A
C
W A
G D
IA
O th e r
Allied 248 Push Pull Release (1 5/8" valve body)) - 1959 6 1 11
Allied 400 Upper Center Pull Down Release ID Tab - 1976 2 2 2
Allied 560 500 but DISS 7 7 7 14
Amico A1-CH 18 14 24
Amico A1-DISS 1 1
Amico DISS 48 24 48
Beacon B-GEO 1 1 1
Beacon D3-DISS 24 24 24
Hill-Rom D2-DI 5 6
Ohio
Ohio D2-DISS 11 11 11
Puritan Bennett B-DISS 18
OUTLETS, INLETS & MANUFACTURED ASSEMBLY INVENTORY BREAKDOWN:
18Project ID(s): Annual Medical Gas Inspection
OUTLETS & INLETS: LOCATION & SPECIFICATION
# Area or Zone Room, Bed or
Asset # System MFR Model Position/Style
Component
Condition /
Test Results
Deficiency Detail or
Corrective Action
Needed/Taken
1 1st Floor A 103 VAC Puritan Bennett
B-DISS PASS
2 1st Floor A 105 VAC Puritan Bennett
B-DISS PASS
3 1st Floor A 108 VAC Puritan Bennett
B-DISS PASS
4 1st Floor A 109 VAC Puritan Bennett
B-DISS PASS
5 1st Floor A 110 VAC Puritan Bennett
B-DISS PASS
6 1st Floor A 111 VAC Puritan Bennett
B-DISS PASS
7 1st Floor A 112 VAC Puritan Bennett
B-DISS PASS
8 1st Floor A 114 VAC Puritan Bennett
B-DISS PASS
9 1st Floor A 115 VAC Puritan Bennett
B-DISS PASS
10 1st Floor A 118 VAC Puritan Bennett
B-DISS PASS
11 1st Floor A 119 VAC Puritan Bennett
B-DISS PASS
12 1st Floor A 120 VAC Puritan Bennett
B-DISS PASS
13 1st Floor A 126 VAC Puritan Bennett
B-DISS PASS
14 1st Floor A 128 VAC Puritan Bennett
B-DISS PASS
15 1st Floor A 131 VAC Puritan Bennett
B-DISS PASS
16 1st Floor A 133 VAC Puritan Bennett
B-DISS PASS
17 1st Floor A 135 VAC Puritan Bennett
B-DISS PASS
18 1st Floor A 136 VAC Puritan Bennett
B-DISS PASS
19 1st Floor A 153 O2 Hill-Rom D2-DI PASS
20 1st Floor A 153 VAC Hill-Rom D2-DI PASS
21 1st Floor A 153 VAC Hill-Rom D2-DI PASS
22 1st Floor: ER A 139 - 1 O2 Hill-Rom D2-DI PASS
23 1st Floor: ER A 139 - 1 VAC Hill-Rom D2-DI PASS
24 1st Floor: ER A 139 - 2 O2 Hill-Rom D2-DI PASS
25 1st Floor: ER A 139 - 2 VAC Hill-Rom D2-DI PASS
26 1st Floor: ER A 139 - 3 O2 Hill-Rom D2-DI PASS
27 1st Floor: ER A 139 - 3 VAC Hill-Rom D2-DI PASS
28 1st Floor: ER A 139 - 4 O2 Hill-Rom D2-DI PASS
29 1st Floor: ER A 139 - 4 VAC Hill-Rom D2-DI PASS
30 1st Floor 167 O2 Beacon B-GEO PASS
31 1st Floor 167 MA Beacon B-GEO PASS
32 1st Floor 167 VAC Beacon B-GEO PASS
33 2nd Floor 203 O2 Allied 248 PASS
34 2nd Floor 203 MA Allied 248 PASS
35 2nd Floor 203 VAC Allied 248 PASS
FUNCTION & CONDITION
19Project ID(s): Annual Medical Gas Inspection
OUTLETS & INLETS: LOCATION & SPECIFICATION
# Area or Zone Room, Bed or
Asset # System MFR Model Position/Style
Component
Condition /
Test Results
Deficiency Detail or
Corrective Action
Needed/Taken
FUNCTION & CONDITION
36 2nd Floor 207 O2 Allied 400 PASS
37 2nd Floor 207 O2 Allied 400 PASS
38 2nd Floor 207 MA Allied 400 PASS
39 2nd Floor 207 MA Allied 400 PASS
40 2nd Floor 207 VAC Allied 400 PASS
41 2nd Floor 207 VAC Allied 400 PASS
42 3rd Floor 3315 O2 Amico A1-CH PASS
43 3rd Floor 3315 O2 Amico A1-CH PASS
44 3rd Floor 3315 O2 Amico A1-CH PASS
45 3rd Floor 3315 O2 Amico A1-CH PASS
46 3rd Floor 3315 O2 Amico A1-CH PASS
47 3rd Floor 3315 MA Amico A1-CH PASS
48 3rd Floor 3315 MA Amico A1-CH PASS
49 3rd Floor 3315 MA Amico A1-CH PASS
50 3rd Floor 3315 MA Amico A1-CH PASS
51 3rd Floor 3315 MA Amico A1-CH PASS
52 3rd Floor 3315 VAC Amico A1-CH PASS
53 3rd Floor 3315 VAC Amico A1-CH PASS
54 3rd Floor 3315 VAC Amico A1-CH PASS
55 3rd Floor 3315 VAC Amico A1-CH PASS
56 3rd Floor 3315 VAC Amico A1-CH PASS
57 3rd Floor 3315B O2 Amico A1-CH PASS
58 3rd Floor 3315B O2 Amico A1-CH PASS
59 3rd Floor 3315B VAC Amico A1-CH PASS
60 3rd Floor 3315B VAC Amico A1-CH PASS
61 3rd Floor 3315B VAC Amico A1-CH PASS
62 3rd Floor 3315B VAC Amico A1-CH PASS
63 3rd Floor 3315B VAC Amico A1-CH PASS
64 3rd Floor 3315D O2 Amico A1-CH PASS
65 3rd Floor 3315D O2 Amico A1-CH PASS
66 3rd Floor 3315D VAC Amico A1-CH PASS
67 3rd Floor 3315D VAC Amico A1-CH PASS
68 3rd Floor 3315D VAC Amico A1-CH PASS
69 3rd Floor 3315D VAC Amico A1-CH PASS
70 3rd Floor 3315D VAC Amico A1-CH PASS
20Project ID(s): Annual Medical Gas Inspection
OUTLETS & INLETS: LOCATION & SPECIFICATION
# Area or Zone Room, Bed or
Asset # System MFR Model Position/Style
Component
Condition /
Test Results
Deficiency Detail or
Corrective Action
Needed/Taken
FUNCTION & CONDITION
3rd Floor: Pre-Op / Recovery Phase II
3304 O2 Amico A1-CH PASS
3rd Floor: Pre-Op / Recovery Phase II
3304 O2 Amico A1-CH PASS
3rd Floor: Pre-Op / Recovery Phase II
3304 O2 Amico A1-CH PASS
3rd Floor: Pre-Op / Recovery Phase II
3304 O2 Amico A1-CH PASS
3rd Floor: Pre-Op / Recovery Phase II
3304 O2 Amico A1-CH PASS
3rd Floor: Pre-Op / Recovery Phase II
3304 O2 Amico A1-CH PASS
3rd Floor: Pre-Op / Recovery Phase II
3304 O2 Amico A1-CH PASS
3rd Floor: Pre-Op / Recovery Phase II
3304 O2 Amico A1-CH PASS
3rd Floor: Pre-Op / Recovery Phase II
3304 O2 Amico A1-CH PASS
3rd Floor: Pre-Op / Recovery Phase II
3304 MA Amico A1-CH PASS
3rd Floor: Pre-Op / Recovery Phase II
3304 MA Amico A1-CH PASS
3rd Floor: Pre-Op / Recovery Phase II
3304 MA Amico A1-CH PASS
3rd Floor: Pre-Op / Recovery Phase II
3304 MA Amico A1-CH PASS
3rd Floor: Pre-Op / Recovery Phase II
3304 MA Amico A1-CH PASS
3rd Floor: Pre-Op / Recovery Phase II
3304 MA Amico A1-CH PASS
3rd Floor: Pre-Op / Recovery Phase II
3304 MA Amico A1-CH PASS
3rd Floor: Pre-Op / Recovery Phase II
3304 MA Amico A1-CH PASS
3rd Floor: Pre-Op / Recovery Phase II
3304 MA Amico A1-CH PASS
3rd Floor: Pre-Op / Recovery Phase II
3304 VAC Amico A1-CH PASS
3rd Floor: Pre-Op / Recovery Phase II
3304 VAC Amico A1-CH PASS
3rd Floor: Pre-Op / Recovery Phase II
3304 VAC Amico A1-CH PASS
3rd Floor: Pre-Op / Recovery Phase II
3304 VAC Amico A1-CH PASS
3rd Floor: Pre-Op / Recovery Phase II
3304 VAC Amico A1-CH PASS
3rd Floor: Pre-Op / Recovery Phase II
3304 VAC Amico A1-CH PASS
3rd Floor: Pre-Op / Recovery Phase II
3304 VAC Amico A1-CH PASS
3rd Floor: Pre-Op / Recovery Phase II
3304 VAC Amico A1-CH PASS
3rd Floor: Pre-Op / Recovery Phase II
3304 VAC Amico A1-CH PASS
21Project ID(s): Annual Medical Gas Inspection
OUTLETS & INLETS: LOCATION & SPECIFICATION
# Area or Zone Room, Bed or
Asset # System MFR Model Position/Style
Component
Condition /
Test Results
Deficiency Detail or
Corrective Action
Needed/Taken
FUNCTION & CONDITION
98 3rd Floor: PACU 3204 O2 Allied 248 PASS
99 3rd Floor: PACU 3204 O2 Allied 248 PASS
100 3rd Floor: PACU 3204 O2 Allied 248 PASS
101 3rd Floor: PACU 3204 O2 Allied 248 PASS
102 3rd Floor: PACU 3204 O2 Allied 248 PASS
103 3rd Floor: PACU 3204 VAC Allied 248 PASS
104 3rd Floor: PACU 3204 VAC Allied 248 PASS
105 3rd Floor: PACU 3204 VAC Allied 248 PASS
106 3rd Floor: PACU 3204 VAC Allied 248 PASS
107 3rd Floor: PACU 3204 VAC Allied 248 PASS
108 3rd Floor: PACU 3204 VAC Allied 248 PASS
109 3rd Floor: PACU 3204 VAC Allied 248 PASS
110 3rd Floor: PACU 3204 VAC Allied 248 PASS
111 3rd Floor: PACU 3204 VAC Allied 248 PASS
112 3rd Floor: PACU 3204 VAC Allied 248 PASS
113 3rd Floor 3208 O2 Amico A1-DISS PASS
114 3rd Floor 3208 VAC Amico A1-DISS PASS
115 3rd Floor 3210 O2 Allied 560 PASS
116 3rd Floor 3210 VAC Allied 560 PASS
117 3rd Floor 3210 VAC Allied 560 PASS
118 3rd Floor 3210 N2O Allied 560 PASS
119 3rd Floor 3210 N2 Allied 560 NOT IN USE
3rd Floor 3210 FAIL WAGD Inlet Required (Anesthetizing
Location)
120 3rd Floor 3218 O2 Allied 560 PASS
121 3rd Floor 3218 O2 Allied 560 PASS
122 3rd Floor 3218 VAC Allied 560 PASS
123 3rd Floor 3218 VAC Allied 560 PASS
124 3rd Floor 3218 VAC Allied 560 PASS
125 3rd Floor 3218 VAC Allied 560 PASS
126 3rd Floor 3218 N2O Allied 560 PASS
127 3rd Floor 3218 N2O Allied 560 PASS
128 3rd Floor 3218 N2 Allied 560 NOT IN USE
129 3rd Floor 3218 N2 Allied 560 NOT IN USE
3rd Floor 3218 FAIL WAGD Inlet Required (Anesthetizing
Location)
130 3rd Floor 3232 O2 Allied 560 PASS
131 3rd Floor 3232 O2 Allied 560 PASS
132 3rd Floor 3232 VAC Allied 560 PASS
133 3rd Floor 3232 VAC Allied 560 PASS
134 3rd Floor 3232 VAC Allied 560 PASS
135 3rd Floor 3232 VAC Allied 560 PASS
136 3rd Floor 3232 N2O Allied 560 PASS
137 3rd Floor 3232 N2O Allied 560 PASS
138 3rd Floor 3232 N2 Allied 560 NOT IN USE
139 3rd Floor 3232 N2 Allied 560 NOT IN USE
3rd Floor 3232 FAIL WAGD Inlet Required (Anesthetizing
Location)
22Project ID(s): Annual Medical Gas Inspection
OUTLETS & INLETS: LOCATION & SPECIFICATION
# Area or Zone Room, Bed or
Asset # System MFR Model Position/Style
Component
Condition /
Test Results
Deficiency Detail or
Corrective Action
Needed/Taken
FUNCTION & CONDITION
140 3rd Floor 3235 O2 Allied 560 PASS
141 3rd Floor 3235 O2 Allied 560 PASS
142 3rd Floor 3235 VAC Allied 560 PASS
143 3rd Floor 3235 VAC Allied 560 PASS
144 3rd Floor 3235 VAC Allied 560 PASS
145 3rd Floor 3235 VAC Allied 560 PASS
146 3rd Floor 3235 N2O Allied 560 PASS
147 3rd Floor 3235 N2O Allied 560 PASS
148 3rd Floor 3235 N2 Allied 560 NOT IN USE
149 3rd Floor 3235 N2 Allied 560 NOT IN USE
3rd Floor 3235 FAIL WAGD Inlet Required (Anesthetizing
Location)
150 3rd Floor: Office 3133 O2 Ohio D2-DISS UNAVAILABLE Under Construction
151 3rd Floor: Office 3133 O2 Ohio D2-DISS UNAVAILABLE Under Construction
152 3rd Floor: Office 3133 MA Ohio D2-DISS UNAVAILABLE Under Construction
153 3rd Floor: Office 3133 MA Ohio D2-DISS UNAVAILABLE Under Construction
154 3rd Floor: Office 3133 VAC Ohio D2-DISS UNAVAILABLE Under Construction
155 3rd Floor: Office 3133 VAC Ohio D2-DISS UNAVAILABLE Under Construction
156 3rd Floor: Office 3134 O2 Ohio D2-DISS UNAVAILABLE Under Construction
157 3rd Floor: Office 3134 O2 Ohio D2-DISS UNAVAILABLE Under Construction
158 3rd Floor: Office 3134 MA Ohio D2-DISS UNAVAILABLE Under Construction
159 3rd Floor: Office 3134 MA Ohio D2-DISS UNAVAILABLE Under Construction
160 3rd Floor: Office 3134 VAC Ohio D2-DISS UNAVAILABLE Under Construction
161 3rd Floor: Office 3134 VAC Ohio D2-DISS UNAVAILABLE Under Construction
162 3rd Floor 3135 O2 Ohio D2-DISS UNAVAILABLE Under Construction
163 3rd Floor 3135 MA Ohio D2-DISS UNAVAILABLE Under Construction
164 3rd Floor 3135 VAC Ohio D2-DISS UNAVAILABLE Under Construction
165 3rd Floor 3137 O2 Ohio D2-DISS UNAVAILABLE Under Construction
166 3rd Floor 3137 O2 Ohio D2-DISS UNAVAILABLE Under Construction
167 3rd Floor 3137 MA Ohio D2-DISS UNAVAILABLE Under Construction
168 3rd Floor 3137 MA Ohio D2-DISS UNAVAILABLE Under Construction
169 3rd Floor 3137 VAC Ohio D2-DISS UNAVAILABLE Under Construction
170 3rd Floor 3137 VAC Ohio D2-DISS UNAVAILABLE Under Construction
171 3rd Floor 3138 O2 Ohio D2-DISS UNAVAILABLE Under Construction
172 3rd Floor 3138 O2 Ohio D2-DISS UNAVAILABLE Under Construction
173 3rd Floor 3138 MA Ohio D2-DISS UNAVAILABLE Under Construction
174 3rd Floor 3138 MA Ohio D2-DISS UNAVAILABLE Under Construction
175 3rd Floor 3138 VAC Ohio D2-DISS UNAVAILABLE Under Construction
176 3rd Floor 3138 VAC Ohio D2-DISS UNAVAILABLE Under Construction
177 3rd Floor 3139 O2 Ohio D2-DISS UNAVAILABLE Under Construction
178 3rd Floor 3139 O2 Ohio D2-DISS UNAVAILABLE Under Construction
179 3rd Floor 3139 MA Ohio D2-DISS UNAVAILABLE Under Construction
180 3rd Floor 3139 MA Ohio D2-DISS UNAVAILABLE Under Construction
181 3rd Floor 3139 VAC Ohio D2-DISS UNAVAILABLE Under Construction
182 3rd Floor 3139 VAC Ohio D2-DISS UNAVAILABLE Under Construction
183 4th Floor 4160 O2 Amico DISS PASS
184 4th Floor 4160 O2 Amico DISS PASS
185 4th Floor 4160 MA Amico DISS PASS
186 4th Floor 4160 VAC Amico DISS PASS
187 4th Floor 4160 VAC Amico DISS PASS
188 4th Floor 4154 O2 Amico DISS PASS
189 4th Floor 4154 O2 Amico DISS PASS
190 4th Floor 4154 MA Amico DISS PASS
191 4th Floor 4154 VAC Amico DISS PASS
192 4th Floor 4154 VAC Amico DISS PASS
23Project ID(s): Annual Medical Gas Inspection
OUTLETS & INLETS: LOCATION & SPECIFICATION
# Area or Zone Room, Bed or
Asset # System MFR Model Position/Style
Component
Condition /
Test Results
Deficiency Detail or
Corrective Action
Needed/Taken
FUNCTION & CONDITION
193 4th Floor 4150 O2 Amico DISS PASS
194 4th Floor 4150 O2 Amico DISS PASS
195 4th Floor 4150 MA Amico DISS PASS
196 4th Floor 4150 VAC Amico DISS PASS
197 4th Floor 4150 VAC Amico DISS PASS
198 4th Floor 4143 O2 Amico DISS PASS
199 4th Floor 4143 O2 Amico DISS PASS
200 4th Floor 4143 MA Amico DISS PASS
201 4th Floor 4143 VAC Amico DISS PASS
202 4th Floor 4143 VAC Amico DISS PASS
203 4th Floor 4144 O2 Amico DISS PASS
204 4th Floor 4144 O2 Amico DISS PASS
205 4th Floor 4144 MA Amico DISS PASS
206 4th Floor 4144 VAC Amico DISS PASS
207 4th Floor 4144 VAC Amico DISS PASS
208 4th Floor 4130 O2 Amico DISS PASS
209 4th Floor 4130 O2 Amico DISS PASS
210 4th Floor 4130 MA Amico DISS PASS
211 4th Floor 4130 VAC Amico DISS PASS
212 4th Floor 4130 VAC Amico DISS PASS
213 4th Floor 4124 O2 Amico DISS PASS
214 4th Floor 4124 O2 Amico DISS PASS
215 4th Floor 4124 MA Amico DISS PASS
216 4th Floor 4124 VAC Amico DISS PASS
217 4th Floor 4124 VAC Amico DISS PASS
218 4th Floor 4120 O2 Amico DISS PASS
219 4th Floor 4120 O2 Amico DISS PASS
220 4th Floor 4120 MA Amico DISS PASS
221 4th Floor 4120 VAC Amico DISS PASS
222 4th Floor 4120 VAC Amico DISS PASS
223 4th Floor 4118 O2 Amico DISS PASS
224 4th Floor 4118 O2 Amico DISS PASS
225 4th Floor 4118 MA Amico DISS PASS
226 4th Floor 4118 VAC Amico DISS PASS
227 4th Floor 4118 VAC Amico DISS PASS
228 4th Floor 4116 O2 Amico DISS PASS
229 4th Floor 4116 O2 Amico DISS PASS
230 4th Floor 4116 O2 Amico DISS PASS
231 4th Floor 4116 O2 Amico DISS PASS
232 4th Floor 4116 MA Amico DISS PASS
233 4th Floor 4116 MA Amico DISS PASS
234 4th Floor 4116 VAC Amico DISS PASS
235 4th Floor 4116 VAC Amico DISS PASS
236 4th Floor 4116 VAC Amico DISS PASS
237 4th Floor 4116 VAC Amico DISS PASS
238 4th Floor 4114 O2 Amico DISS PASS
239 4th Floor 4114 O2 Amico DISS PASS
240 4th Floor 4114 O2 Amico DISS PASS
241 4th Floor 4114 O2 Amico DISS PASS
242 4th Floor 4114 MA Amico DISS PASS
243 4th Floor 4114 MA Amico DISS PASS
244 4th Floor 4114 VAC Amico DISS PASS
245 4th Floor 4114 VAC Amico DISS PASS
246 4th Floor 4114 VAC Amico DISS PASS
247 4th Floor 4114 VAC Amico DISS PASS
24Project ID(s): Annual Medical Gas Inspection
OUTLETS & INLETS: LOCATION & SPECIFICATION
# Area or Zone Room, Bed or
Asset # System MFR Model Position/Style
Component
Condition /
Test Results
Deficiency Detail or
Corrective Action
Needed/Taken
FUNCTION & CONDITION
248 4th Floor 4108 O2 Amico DISS PASS
249 4th Floor 4108 O2 Amico DISS PASS
250 4th Floor 4108 O2 Amico DISS PASS
251 4th Floor 4108 O2 Amico DISS PASS
252 4th Floor 4108 MA Amico DISS PASS
253 4th Floor 4108 MA Amico DISS PASS
254 4th Floor 4108 VAC Amico DISS PASS
255 4th Floor 4108 VAC Amico DISS PASS
256 4th Floor 4108 VAC Amico DISS PASS
257 4th Floor 4108 VAC Amico DISS PASS
258 4th Floor 4104 O2 Amico DISS PASS
259 4th Floor 4104 O2 Amico DISS PASS
260 4th Floor 4104 O2 Amico DISS PASS
261 4th Floor 4104 O2 Amico DISS PASS
262 4th Floor 4104 MA Amico DISS PASS
263 4th Floor 4104 MA Amico DISS PASS
264 4th Floor 4104 VAC Amico DISS PASS
265 4th Floor 4104 VAC Amico DISS PASS
266 4th Floor 4104 VAC Amico DISS PASS
267 4th Floor 4104 VAC Amico DISS PASS
268 4th Floor 4312 O2 Amico DISS PASS
269 4th Floor 4312 O2 Amico DISS PASS
270 4th Floor 4312 MA Amico DISS PASS
271 4th Floor 4312 VAC Amico DISS PASS
272 4th Floor 4312 VAC Amico DISS PASS
273 4th Floor 4316 O2 Amico DISS PASS
274 4th Floor 4316 O2 Amico DISS PASS
275 4th Floor 4316 MA Amico DISS PASS
276 4th Floor 4316 VAC Amico DISS PASS
277 4th Floor 4316 VAC Amico DISS PASS
278 4th Floor 4320 O2 Amico DISS PASS
279 4th Floor 4320 O2 Amico DISS PASS
280 4th Floor 4320 MA Amico DISS PASS
281 4th Floor 4320 VAC Amico DISS PASS
282 4th Floor 4320 VAC Amico DISS PASS
283 4th Floor 4332 O2 Amico DISS PASS
284 4th Floor 4332 O2 Amico DISS PASS
285 4th Floor 4332 MA Amico DISS PASS
286 4th Floor 4332 VAC Amico DISS PASS
287 4th Floor 4332 VAC Amico DISS PASS
288 4th Floor 4333 O2 Amico DISS PASS
289 4th Floor 4333 O2 Amico DISS PASS
290 4th Floor 4333 MA Amico DISS PASS
291 4th Floor 4333 VAC Amico DISS PASS
292 4th Floor 4333 VAC Amico DISS PASS
293 4th Floor 4324 O2 Amico DISS PASS
294 4th Floor 4324 O2 Amico DISS PASS
295 4th Floor 4324 MA Amico DISS PASS
296 4th Floor 4324 VAC Amico DISS PASS
297 4th Floor 4324 VAC Amico DISS PASS
298 4th Floor 4326 O2 Amico DISS PASS
299 4th Floor 4326 O2 Amico DISS PASS
300 4th Floor 4326 MA Amico DISS PASS
301 4th Floor 4326 VAC Amico DISS PASS
302 4th Floor 4326 VAC Amico DISS PASS
25Project ID(s): Annual Medical Gas Inspection
OUTLETS & INLETS: LOCATION & SPECIFICATION
# Area or Zone Room, Bed or
Asset # System MFR Model Position/Style
Component
Condition /
Test Results
Deficiency Detail or
Corrective Action
Needed/Taken
FUNCTION & CONDITION
303 4th Floor 4346 O2 Beacon D3-DISS Boom PASS
304 4th Floor 4346 O2 Beacon D3-DISS Boom PASS
305 4th Floor 4346 O2 Beacon D3-DISS Boom PASS
306 4th Floor 4346 O2 Beacon D3-DISS Boom PASS
307 4th Floor 4346 MA Beacon D3-DISS Boom PASS
308 4th Floor 4346 MA Beacon D3-DISS Boom PASS
309 4th Floor 4346 MA Beacon D3-DISS Boom PASS
310 4th Floor 4346 MA Beacon D3-DISS Boom PASS
311 4th Floor 4346 VAC Beacon D3-DISS Boom PASS
312 4th Floor 4346 VAC Beacon D3-DISS Boom PASS
313 4th Floor 4346 VAC Beacon D3-DISS Boom PASS
314 4th Floor 4346 VAC Beacon D3-DISS Boom PASS
315 4th Floor 4348 O2 Beacon D3-DISS Boom PASS
316 4th Floor 4348 O2 Beacon D3-DISS Boom PASS
317 4th Floor 4348 O2 Beacon D3-DISS Boom PASS
318 4th Floor 4348 O2 Beacon D3-DISS Boom PASS
319 4th Floor 4348 MA Beacon D3-DISS Boom PASS
320 4th Floor 4348 MA Beacon D3-DISS Boom PASS
321 4th Floor 4348 MA Beacon D3-DISS Boom PASS
322 4th Floor 4348 MA Beacon D3-DISS Boom PASS
323 4th Floor 4348 VAC Beacon D3-DISS Boom PASS
324 4th Floor 4348 VAC Beacon D3-DISS Boom PASS
325 4th Floor 4348 VAC Beacon D3-DISS Boom PASS
326 4th Floor 4348 VAC Beacon D3-DISS Boom PASS
327 4th Floor: ICU 4352 O2 Beacon D3-DISS Boom PASS
328 4th Floor: ICU 4352 O2 Beacon D3-DISS Boom PASS
329 4th Floor: ICU 4352 O2 Beacon D3-DISS Boom PASS
330 4th Floor: ICU 4352 O2 Beacon D3-DISS Boom PASS
331 4th Floor: ICU 4352 MA Beacon D3-DISS Boom PASS
332 4th Floor: ICU 4352 MA Beacon D3-DISS Boom PASS
333 4th Floor: ICU 4352 MA Beacon D3-DISS Boom PASS
334 4th Floor: ICU 4352 MA Beacon D3-DISS Boom PASS
335 4th Floor: ICU 4352 VAC Beacon D3-DISS Boom PASS
336 4th Floor: ICU 4352 VAC Beacon D3-DISS Boom PASS
337 4th Floor: ICU 4352 VAC Beacon D3-DISS Boom PASS
338 4th Floor: ICU 4352 VAC Beacon D3-DISS Boom PASS
339 4th Floor: ICU 4353 O2 Beacon D3-DISS Boom PASS
340 4th Floor: ICU 4353 O2 Beacon D3-DISS Boom PASS
341 4th Floor: ICU 4353 O2 Beacon D3-DISS Boom PASS
342 4th Floor: ICU 4353 O2 Beacon D3-DISS Boom PASS
343 4th Floor: ICU 4353 MA Beacon D3-DISS Boom PASS
344 4th Floor: ICU 4353 MA Beacon D3-DISS Boom PASS
345 4th Floor: ICU 4353 MA Beacon D3-DISS Boom PASS
346 4th Floor: ICU 4353 MA Beacon D3-DISS Boom PASS
347 4th Floor: ICU 4353 VAC Beacon D3-DISS Boom PASS
348 4th Floor: ICU 4353 VAC Beacon D3-DISS Boom PASS
349 4th Floor: ICU 4353 VAC Beacon D3-DISS Boom PASS
350 4th Floor: ICU 4353 VAC Beacon D3-DISS Boom PASS
26Project ID(s): Annual Medical Gas Inspection
OUTLETS & INLETS: LOCATION & SPECIFICATION
# Area or Zone Room, Bed or
Asset # System MFR Model Position/Style
Component
Condition /
Test Results
Deficiency Detail or
Corrective Action
Needed/Taken
FUNCTION & CONDITION
351 4th Floor: ICU 4364 O2 Beacon D3-DISS Boom PASS
352 4th Floor: ICU 4364 O2 Beacon D3-DISS Boom PASS
353 4th Floor: ICU 4364 O2 Beacon D3-DISS Boom PASS
354 4th Floor: ICU 4364 O2 Beacon D3-DISS Boom PASS
355 4th Floor: ICU 4364 MA Beacon D3-DISS Boom PASS
356 4th Floor: ICU 4364 MA Beacon D3-DISS Boom PASS
357 4th Floor: ICU 4364 MA Beacon D3-DISS Boom PASS
358 4th Floor: ICU 4364 MA Beacon D3-DISS Boom PASS
359 4th Floor: ICU 4364 VAC Beacon D3-DISS Boom PASS
360 4th Floor: ICU 4364 VAC Beacon D3-DISS Boom PASS
361 4th Floor: ICU 4364 VAC Beacon D3-DISS Boom PASS
362 4th Floor: ICU 4364 VAC Beacon D3-DISS Boom PASS
363 4th Floor: ICU 4365 O2 Beacon D3-DISS Boom PASS
364 4th Floor: ICU 4365 O2 Beacon D3-DISS Boom PASS
365 4th Floor: ICU 4365 O2 Beacon D3-DISS Boom PASS
366 4th Floor: ICU 4365 O2 Beacon D3-DISS Boom PASS
367 4th Floor: ICU 4365 MA Beacon D3-DISS Boom PASS
368 4th Floor: ICU 4365 MA Beacon D3-DISS Boom PASS
369 4th Floor: ICU 4365 MA Beacon D3-DISS Boom PASS
370 4th Floor: ICU 4365 MA Beacon D3-DISS Boom PASS
371 4th Floor: ICU 4365 VAC Beacon D3-DISS Boom PASS
372 4th Floor: ICU 4365 VAC Beacon D3-DISS Boom PASS
373 4th Floor: ICU 4365 VAC Beacon D3-DISS Boom PASS
374 4th Floor: ICU 4365 VAC Beacon D3-DISS Boom PASS
5th Floor NOT IN USE Offices - Outlets / Inlets Removed
From Service. Dental Clinic Does Not
Have Outlets / Inlets.
27Project ID(s): Annual Medical Gas Inspection
Position
C e ilin g C o n n e c tio n s
O u tle t C o n n e c tio n
H o se C o n d itio n
1 4th Floor 4365 O₂ BOOM Steris
HarmonyCare
✓ ✓ ✓ PASS 1/5/2026 Shared Zone Valve
2 4th Floor 4365 Med Air BOOM Steris
HarmonyCare
✓ ✓ ✓ PASS 1/5/2026 Shared Zone Valve
3 4th Floor 4365 Vac BOOM Steris
HarmonyCare
✓ ✓ ✓ PASS 1/5/2026 Shared Zone Valve
4 4th Floor 4364 O₂ BOOM Steris
HarmonyCare
✓ ✓ ✓ PASS 1/5/2026 Shared Zone Valve
5 4th Floor 4364 Med Air BOOM Steris
HarmonyCare
✓ ✓ ✓ PASS 1/5/2026 Shared Zone Valve
6 4th Floor 4364 Vac BOOM Steris
HarmonyCare
✓ ✓ ✓ PASS 1/5/2026 Shared Zone Valve
7 4th Floor 4346 O₂ BOOM Steris
HarmonyCare Shared Zone Valve - Unable To Test
8 4th Floor 4346 Med Air BOOM Steris
HarmonyCare Shared Zone Valve - Unable To Test
9 4th Floor 4346 Vac BOOM Steris
HarmonyCare Shared Zone Valve - Unable To Test
10 4th Floor 4353 O₂ BOOM Steris
HarmonyCare
✓ ✓ ✓ PASS 1/5/2026 Shared Zone Valve
11 4th Floor 4353 Med Air BOOM Steris
HarmonyCare
✓ ✓ ✓ PASS 1/5/2026 Shared Zone Valve
12 4th Floor 4353 Vac BOOM Steris
HarmonyCare
✓ ✓ ✓ PASS…
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