Med Gas Annual Inspection Report.pdf

Annual Medical Gas Inspection Report

VA Medical Center Erie 135 East 38th Street

Erie, PA 16504

Contact: Ken Watkins

Inspection Performed On: July 29, 2025

Medpipe Project #: 624943 On-Site Medpipe Representative(s): Austin Conroy, Josh Jones

Performed by: Medpipe Maintenance Corp.

P.O. Box 541 Lawrence, PA 15055 Phone: (724) 745-1854 Fax: (724) 745-2184

Medpipe Maintenance Corp. P.O. Box 541 Lawrence, PA 15055 724-745 1854 Fax: 724-745-2184

Acknowledgment, Terms of Verification, and Limitation of Liability

The verification provided applies only to the equipment and systems listed on the attached log as of the actual date of the inspection and shall not apply in the event of any modification of any element of the equipment or system subsequent to the date of inspection. MEDPIPE MAINTENANCE CORP. shall not be liable for claims, demands, liabilities, costs, attorney fees or damages resulting from incorrect or incomplete information supplied to MEDPIPE MAINTENANCE CORP., pertaining to the new or existing equipment and systems upon which verification is requested. By accepting the verification offered at the completion of the inspection, the purchaser/customer acknowledges the foregoing statement of the scope and limitations of the verification and agrees to hold harmless, indemnify and defend MEDPIPE MAINTENANCE CORP. as well as those engaged by MEDPIPE MAINTENANCE CORP. in the performance of the inspection/work, and any successors, assigns, subsidiaries of each, from any and all claims, demands, liabilities, costs attorneys fees or legal actions of any kind brought by third parties, regardless of the basis upon which such claim, demand, alleged liability or legal action is asserted, including the alleged negligence of MEDPIPE MAINTENANCE

CORP.

Further, by accepting the verification offered herein, the purchaser/customer, agrees that UNDER NO

CIRCUMSTANCES SHALL MEDPIPE MAINTENANCE CORP., ITS AGENTS, SUBCONTRACTORS,

SUPPLIERS AND THE EMPLOYEES OF EACH BE LIABLE FOR ANY SPECIAL, INCIDENTAL,

INDIRECT, OR CONSEQUENTIAL DAMAGES, (OR EQUIVALENTS THEREOF NO MATTER HOW

CLAIMED, COMPUTED OR CHARACTERIZED) ARISING OUT OF OR IN CONNECTION WITH THIS

VERIFICATION, ITS PERFORMANCE OR ALLEGED BREACH OF PERFORMANCE BY MEDPIPE

MAINTENANCE CORP. REGARDLESS OF WHETHER ANY SUCH LIABILITY SHALL BE CLAIMED IN

CONTRACT, EQUITY, TORT (INCLUDING NEGLIGENCE) OR OTHERWISE.

By way of example of the foregoing limitation of liability, but without limiting in any manner its scope or application, MEDPIPE MAINTENANCE CORP. shall not be liable for all or any part of the following no matter how claimed, computed, or characterized; loss of profit or revenue, loss of return on investment, cost of capital, loss of operating time or production, loss or reduction of use or value of any facilities (including existing facilities) or any portions of facilities, expense of replacement products or power, or increased costs of operations or maintenance. The limitation of liability contained in this Article shall be effective without regard to MEDPIPE MAINTENANCE CORP.’s performance, or failure or delay of performance or under any other term or condition of this verification and shall not be affected by any alleged oral agreement or other writing, including those contained in any Warranty or alleged warranty.

VA Medical Center Erie 2025 Annual Medical Gas & Vacuum System Inspection

Medpipe Maintenance Corp. P.O. Box 541 Lawrence, PA 15055 724-745 1854 Fax: 724-745-2184

Executive Summary Survey and testing of the piped medical gas and vacuum systems was conducted as part of the facility preventive maintenance program and to verify compliance with applicable regulations. This inspection is in conformity with NFPA 99, sections 5.1.14 & 5.1.15 and TJC Standard EC.02.05.09, which states:

“…the organization inspects, tests, and maintains critical components of piped medical gas systems, including master signal panels, area alarms, automatic pressure switches, shutoff valves, flexible connectors, and outlets.”

Tested systems and components are in compliance with NFPA, TJC, CGA, ASSE and other applicable agencies unless they are listed in the Deficiency Tables. Compliance is based primarily on the National Fire Protection Association document NFPA 99, Health Care Facilities Code, with specific reference to Chapter 5, Gas and Vacuum Systems. Complete Master Alarm testing results are presented in the table on page 7.

This report contains several sections. The first section contains the Executive Summary and Deficiency Summary Tables; the remaining sections contain complete listings of assets with test results, separated according to type.

Thank you for the opportunity to provide medical gas inspection services to your facility. Please contact us at your convenience with questions, comments or to order parts/service.

Larry Hall General Manager

Medpipe Maintenance Corp. P.O. Box 541 Lawrence, PA 15055 724-745 1854 Fax: 724-745-2184

Executive Summary (cont.)

Description of the testing program for this facility:

All area alarm panels, zone shutoff valves, accessible gas outlets/vacuum inlets, master alarms and central supply systems are tested each year.

Equipment tested/evaluated this visit:

Source Systems

Oxygen ✓ Vacuum ✓ Medical Air ✓ Nitrous Oxide ✓ Nitrogen ✓ WAGD (Evacuation) Carbon Dioxide ✓ HeliOx

Components Total

Bulk Liquid *Oxygen 1

Medical Vacuum System 1 Medical Air Compressor 1 Gas Manifold

*Carbon Dioxide 1 *Nitrogen 1 *Nitrous Oxide 1

Master Alarm 2 Area Alarm 11 Zone Valve Box 20 Outlet 269

*Carbon Dioxide 4 *Medical Air 31 *Medical Vacuum 114 *Nitrogen 2 *Nitrous Oxide 4 *Oxygen 110

*WAGD 4

Medpipe Maintenance Corp. P.O. Box 541 Lawrence, PA 15055 724-745 1854 Fax: 724-745-2184

Executive Summary (cont.)

Brief Summary of Test Procedures

Master Alarms-- Presence of required signals, location, labeling, function* Area Alarms-- Presence of required signals, location, labeling, function, set points, accuracy

Zone Shutoff Valves-- Presence of required valves, location, labeling, leakage, gauge accuracy Gas Outlets/Vacuum Inlets-- Pressure, flow, leakage, labeling, general condition

Gas/Piping Purity-- Particulates, moisture, contaminant gases Central Supply Systems-- NFPA 99 compliance

*The source equipment alarms (e.g. pressure switches, monitors) are triggered to verify function.

Line pressure switches are tested by pressure increase/decrease with a hand pump.

Acceptance Criteria for Medical Gas & Vacuum System Testing

Oxygen Medical Air Vacuum Nitrous Oxide Nitrogen WAGD Carbon Dioxide

Outlet/Inlet Testing

Pressure 50-55 psi 50-55 psi >12" Hg 50-55 psi 160-185 psi >12" Hg 50-55 psi Flow >3.5 scfm1 >3.5 scfm1 >3.0 scfm >3.5 scfm >5.0 scfm >3.0 scfm >3.5 scfm Concentration >99% 19.5-23.5% O2 n/a >99% >99% (<1% O2) n/a >99%

Alarm Testing

Alarm Setpoints +/- 20% +/- 20% 12" Hg +/- 20% +/- 20% 12" Hg +/- 20% of normal line of normal line of normal line of normal line of normal line pressure pressure pressure pressure pressure

Zone Valve Testing

Gauge Readings +/- 5% +/- 5% +/- 10% +/- 5% +/- 5% +/- 10% +/- 5% of normal line of normal line of normal line of normal line of normal line of normal line of normal line pressure pressure vacuum pressure pressure vacuum pressure

Labeling (colors)

Label/Text Green/white Yellow/black White/black Blue/white Black/white Purple/white Grey/white

Source Gas Contaminants/Purity

Particulates <1 mg <1 mg n/a <1 mg <1 mg n/a <1 mg Hydrocarbons n/a <25 ppm n/a n/a n/a n/a n/a Halocarbons n/a <2 ppm n/a <1 ppm n/a n/a n/a Carbon Monoxide <10 ppm <10 ppm n/a <10 ppm <10 ppm n/a <10 ppm Carbon Dioxide <300 ppm <500 ppm n/a <300 ppm n/a n/a n/a Dew Point n/a <2°C (35°F) n/a n/a n/a n/a n/a Visible Moisture None None n/a None None n/a None Odor None None n/a None None n/a None Oil None None n/a None None n/a None

1Transient flow of 6 scfm for 3 seconds in Critical Care Areas References: NFPA 99 (2024), USP, NF, CGA, ASSE, TJC

Medpipe Maintenance Corp. P.O. Box 541 Lawrence, PA 15055 724-745 1854 Fax: 724-745-2184

Executive Summary (cont.)

Deficiency Summary:

Master Alarms Deficiencies Identified. Refer to page 7 for complete master alarm testing results.

Area Alarms No Deficiencies Identified.

Zone Shutoff Valves Deficiencies Identified. Refer to the table on page 13.

Outlets/Inlets Deficiencies Identified. Refer to the table on page 14.

Gas/Piping Purity No Deficiencies Identified.

Central Supply Systems

Deficiencies identified for the Medical Air Compressor. Refer to the table on page 9.

Deficiencies identified for the Medical Vacuum Pump System. Refer to the table on page 10.

Deficiencies identified for the Manifold Systems. Refer to the table on page 11.

Medpipe Maintenance Corp. P.O. Box 541 Lawrence, PA 15055 724-745 1854 Fax: 724-745-2184

Master Alarms

Reference NFPA 99 2024 sections 5.1.9.1, 5.1.9.2

Codes:

P Pass

NP1 Signal Not Present, but the equipment local alarm/relay necessary to send the signal to the master alarms is present NP2 Signal Not Present, the equipment local alarm/relay necessary to send the signal to the master alarms is not present NT1 Signal Not Tested- possible risk of service interruption NT2 Signal Not Tested- sending device could not be triggered NT3 Signal Not Tested- sending device could not be located/accessed NT4 Signal Not Tested- system is not in service at this time NT5 Signal Not Tested – system is tested by Supplier

Comments:

Required Alarm Signals Panel Location Boiler Room Switchboard

Carbon Dioxide Gas Manifold (Manifold Room) Main Line Pressure High P P Main Line Pressure Low P P Changeover to Secondary P P Medical Air Compressor System (Mech Room BW035) Main Line Pressure High P P Main Line Pressure Low P P Lag Compressor Running P P Dew Point High P P Carbon Monoxide High P P Nitrogen Manifold (G) (Manifold Room) Main Line Pressure High P P Main Line Pressure Low P P Changeover to Secondary P P Nitrous Oxide Manifold (G) (Manifold Room) Main Line Pressure High P P Main Line Pressure Low P P Changeover to Secondary P P Oxygen Bulk Liquid System (Outdoor Bulk Pad) Main Liquid Level Low NT5 NT5 Reserve In Use NT5 NT5 Reserve Pressure Low NT5 NT5 Main Line Pressure High P P Main Line Pressure Low P P Vacuum Pump System (Mech Room PH) Lag Pump Running NP1 NP1 Vacuum Low P P

Medpipe Maintenance Corp. P.O. Box 541 Lawrence, PA 15055 724-745 1854 Fax: 724-745-2184

Deficiency Summary

Central Supply Systems – Bulk Liquid

Comments/Further Explanations:

System Type Codes O- Oxygen N2O- Nitrous Oxide N2- Nitrogen CO2- Carbon Dioxide

Deficiency Codes S1 Site not compliant (2 exits, bollards, lighting, signage) S12 Main line pressure gauge not present/accurate, location S2 Site condition issue (pad, fence, debris, foliage, icing) S13 Emergency O2 connection not present/correctly configured S3 Reserve supply not present/correctly configured S14 Alarms/switches not connected to master alarm panels S4 Piping not compliant (materials, protection, painted) S15 System main line pressure not within NFPA required range S5 System does not have all required alarms/sending devices S16 Leakage detected (see Comments section below for location) S6 Line pressure regulation not duplexed or bypass-able S17 Labeling not present/compliant S7 Pressure relief valves not present/functional, location, type S18 Demand check valves for pressure switch/gauge not present S8 Source shutoff valve not present, location, type S19 Cylinder lead (pigtails) not compliant (materials/expired) S9 Check valves not present/functional, location, type S20 See Comments section below S10 Main line valve not present, location, type S21 Emergency O2 connection box not locked/secured S11 Main line pressure switch not present/functional, location S22 Vessels/cylinders not properly secured/chained

Reference NFPA 99 2024 section 5.1.3.10

System Deficiency Codes Corrections Location Type Action Taken Date

No Deficiencies Identified.

Medpipe Maintenance Corp. P.O. Box 541 Lawrence, PA 15055 724-745 1854 Fax: 724-745-2184

Deficiency Summary

Central Supply Systems – Medical Air Compressors

Comments/Further Explanations:

Deficiency Codes S1 System not dedicated to human respiration S19 Dew Point monitor not present/functional, location S2 Intake location/configuration incorrect S20 CO monitor not present/functional, location S3 System not oil free S21 Source supply shutoff valve not present, location S4 Compressors not duplexed S22 Main line pressure switch not present/functional, location S5 Isolation, check or relief valves not present S23 Main line pressure gauge not present/functional, location S6 Flexible connectors not present S24 Lead/Lag pressure settings incorrect S7 Compressor alternation is not automatic S25 Lead or lag compressor operation incorrect S8 System not connected to emergency power circuits S26 System main line pressure incorrect S9 Local receiver flooded alarm not present/functional S27 Dew Point above 35F (2C) S10 Local separator(s) flooded alarm not present/functional S28 Alarms/sensors not connected to master alarm panels S11 Local lag compressor alarm not present/functional S29 Leakage detected S12 Local high air temperature alarm not present/functional S30 Labeling incorrect S13 Receiver – no relief valve, auto drain, sight glass, or gauge S31 Demand check valves for pressure switch/gauge not present S14 Receiver three-valve bypass, manual drain not present S32 Dryer auto-drain not present S15 Dryers, filters, or aftercoolers not present/functional S33 Sample port not present, location S16 Dryers, filters, or aftercoolers not duplexed/bypassable S34 Other, see worksheets for further detail S17 Line pressure regulation not duplexed/bypassable S35 See Comments section below S18 Line pressure relief valve not present/incorrect location, type

Reference NFPA 99 2024 section 5.1.3.6

System Deficiency Codes Corrections Location Action Taken Date

Mech Room BW035 S20

Mech Room BW035 S20- Carbon Monoxide monitor display is blank. (Note: Local and Master CO High alarms rang when tested)

Medpipe Maintenance Corp. P.O. Box 541 Lawrence, PA 15055 724-745 1854 Fax: 724-745-2184

Deficiency Summary

Central Supply Systems – Vacuum Pumps

Comments/Further Explanations:

System Type Codes MV- Medical Vacuum WAGD – Waste Anesthetic Gas Disposal

Deficiency Codes S1 Discharge location/configuration incorrect S13 Lead or lag pump operation incorrect S2 Pumps not duplexed S14 Lab Vacuum – no separate line, valve and/or trap S3 Isolation or check valves not present S15 System main line Vacuum level incorrect S4 Flexible couplings not present S16 Leakage detected S5 Pump alternation not automatic S17 Labeling incorrect S6 System not connected to emergency power circuits S18 Alarms/switches not connected to master alarm panels S7 Receiver bypass and/or drain not present S19 Demand check valves for vacuum switch/gauge not present S8 Local lag pump running alarm not present/functional S20 Other, see worksheets for further detail S9 Source supply shutoff valve not present, location S21 See Comments section below S10 Main line vacuum switch not present/functional, location S22 System location not compliant S11 Main line vacuum gauge not present/functional, location S23 Incorrect piping/valve materials S12 Lead/Lag pressure settings incorrect

Reference NFPA 99 2024 section 5.1.3.7

System Deficiency Codes Corrections Location Action Taken Date

Mech Room PH (MV) S18

Mech Room PH (MV) S18 - Lag Pump Running (Master).

Medpipe Maintenance Corp. P.O. Box 541 Lawrence, PA 15055 724-745 1854 Fax: 724-745-2184

Deficiency Summary

Central Supply Systems – Manifolds

Comments/Further Explanations:

System Type Codes O- Oxygen MA- Medical Air N2O- Nitrous Oxide N2- Nitrogen CO2- Carbon Dioxide H- HeliOx

Deficiency Codes S1 Storage configuration not compliant S17 Pressure relief not vented outside of building S2 Automatic changeover not present/functional S18 Alarms/switches not connected to master alarm panels S3 Normal/Changeover lights not present/burned out S19 System not connected to emergency power circuits S4 Minimum number of cylinders not present S20 System main line pressure incorrect S5 Cylinder lead check valves not present S21 Leakage detected S6 Header valves not present/functional S22 Labeling incorrect S7 Line pressure regulation not duplexed or bypassable S23 In use/reserve cylinders not secured by safety chains, brackets S8 Pressure relief valve(s) not present/incorrect location, type S24 Demand check valves for pressure switch/gauge not present S9 Source supply shutoff valve not present/incorrect location S25 Room ventilation not compliant S10 Main line pressure switch not present/functional, location S26 Electrical devices not >5 feet AFF or protected S11 Main line pressure gauge not present/functional, location S27 Other, see worksheets for further detail S12 Liquid system does not have a reserve supply S28 See Comments section below S13 Reserve supply incorrect size or type S29 Cylinder lead (pigtail) material not compliant S14 Emergency Reserve In Use pressure switch not present S30 Cylinder lead (pigtail) time in service > 5 year mfr recomm S15 Emergency Reserve Low pressure switch not present S31 Check valve on reserve header not present/location S16 Emergency O2 connection not present/incorrect configuration S32 Manifold line pressure reading inaccurate

Reference NFPA 99 2024 sections 5.1.3.5.(9,10,11)

System Deficiency Codes Corrections Location Type Action Taken Date

Manifold Room CO2 S30

Manifold Room N2 S30 Manifold Room N2O S30

CO2 (Manifold Room) S30- Pigtails 2020 (3x3).

N2 (Manifold Room) S30- Pigtails 2020 (2x2).

N2O (Manifold Room) S30- Pigtails 2020 (3x3).

Medpipe Maintenance Corp. P.O. Box 541 Lawrence, PA 15055 724-745 1854 Fax: 724-745-2184

Deficiency Summary

Alarm Panels

Comments/Further Explanations:

System Type Codes O- Oxygen MA- Medical Air MV- Medical Vacuum N2O- Nitrous Oxide N2- Nitrogen W- WAGD (Evacuation) CO2- Carbon Dioxide VW – Combined Vac/WAGD H - HeliOx

Deficiency Codes A1 Area monitored labeling not present, incorrect or unclear A10 Digital or analog pressure displays not accurate A2 Gas/Signal labeling not present, incorrect or incomplete A11 Panel/module malfunctioning A3 Audible indicator malfunctioning A12 Panel/module physically damaged A4 Normal (Green) indicator malfunctioning A13 Panel location non-compliant/undesirable A5 Abnormal (Red or Yellow) indicator malfunctioning A14 Panel not on emergency power circuits A6 Alarm did not activate when triggered A15 Required signals or panel not present A7 Alarm did not return to normal after cleared A16 Sensors in non-compliant location for area type A8 Test button sequence malfunctioning A17 No electrical power to panel A9 Set points incorrect A18 See Comments section below

Reference NFPA 99 2024 section 5.1.9.1 & 5.1.9.4

System Deficiency Codes Corrections

No Deficiencies Identified.

Medpipe Maintenance Corp. P.O. Box 541 Lawrence, PA 15055 724-745 1854 Fax: 724-745-2184

Deficiency Summary

Shutoff Valves

Comments/Further Explanations:

System Type Codes O- Oxygen MA- Medical Air MV- Medical Vacuum N2O- Nitrous Oxide N2- Nitrogen W- WAGD (Evacuation) CO2- Carbon Dioxide VW – Combined Vac/WAGD H - HeliOx

Deficiency Codes V1 Area controlled labeling not present, incorrect or unclear V8 Cover/frame damaged or missing V2 Gas labeling not present or incorrect V9 Valve location non-compliant/undesirable V3 Leakage detected V10 Valve configuration non-compliant V4 Gauge(s) defective V11 Valve type non-compliant V5 No gauge(s) present - port available V12 Valve not locked, latched, or in secure area as required V6 No gauge(s) present - no port available V13 No valve(s) present as required V7 Handle difficult to move V14 See Comments section below

Reference NFPA 99 2024 section 5.1.4

System Deficiency Codes Corrections

Floor 1-In Sterile Process Room O V4

Medpipe Maintenance Corp. P.O. Box 541 Lawrence, PA 15055 724-745 1854 Fax: 724-745-2184

Deficiency Summary

Outlets/Inlets

Reference NFPA 99 2024 section 5.1.5

System Type Codes O- Oxygen MA- Medical Air MV- Medical Vacuum N2O- Nitrous Oxide N2- Nitrogen W- WAGD (Evacuation) CO2- Carbon Dioxide H - HeliOx

Mounting Codes CE-Ceiling CB-Ceiling Boom CO - Console FC-Fixed Column FP-Floor Pedestal W-Wall

Legend 1 Difficult to insert / extract connector 6 Defective / missing parts 11 Incorrect labeling / color-coding 2 Leak with connector in 7 Patient using outlet / inlet 12 Visible water detected 3 Leak with connector out 8 Unable to test at this time 13 Latch cover missing / broken 4 Reduced flow / no flow 9 Facility’s connector broken 14 Ceiling outlets without hoses (#) 5 Abnormal pressure 10 Hoses need replacement 15 Contamination detected

Location Type Code Comments Corrections Floor:1-Bio Med MV 3 W#4 Floor:1-ER 2 O 2 CO#1 Floor:6-625J O 2 CO#2 Floor:5-519 O 2 W#2 Floor:5-520 O 2 W#2 Floor:5-521 O 2,3 W#1 Floor:5-522 O 2 W#1 Floor:5-531 O 2 W#1

Medpipe Maintenance Corp. P.O. Box 541 Lawrence, PA 15055 724-745 1854 Fax: 724-745-2184

Deficiency Summary

Gas/Piping Purity

Particulates

Outlets at random representative locations were tested to check particulate content.

Reference NFPA 99 2024 section 5.1.12.4.8

Contaminants

Tests were performed at the Source Equipment and at random outlet locations to check for contamination.

Reference NFPA 99 2024 section 5.1.12.4.8,12

Location Type Level Comments No Deficiencies Identified

Location Type Comments No Deficiencies Identified

Annual Medical Gas Inspection

COMPLETE MEDICAL GAS INSPECTION SERVICES

P.O. Box 541 Lawrence, PA 15055 Ph: (724) 745-1854 Fax: (724) 745-2184

Facility: VA Medical Center Erie

Project #: 624943

Manuf/Model: Amico Alert 2

Master Alarm - Boiler Room

Date Inspected: July 29, 2025

Labeling - P Test Button - P Green Light - P Red/Yellow Light - P Audible - P

Comments:Carbon Dioxide Gas Manifold (Manifold Room) - Main Line Pressure High Pass

Carbon Dioxide Gas Manifold (Manifold Room) - Main Line Pressure Low Pass

Carbon Dioxide Gas Manifold (Manifold Room) - Changeover to Secondary Pass

Medical Air Compressor System (Mech Room BW035) - Main Line Pressure High Pass

Medical Air Compressor System (Mech Room BW035) - Main Line Pressure Low Pass

Medical Air Compressor System (Mech Room BW035) - Lag Compressor Running Pass

Medical Air Compressor System (Mech Room BW035) - Dew Point High Pass

Medical Air Compressor System (Mech Room BW035) - Carbon Monoxide High Pass

Nitrogen Manifold (G) (Manifold Room) - Main Line Pressure High Pass

Nitrogen Manifold (G) (Manifold Room) - Main Line Pressure Low Pass

Nitrogen Manifold (G) (Manifold Room) - Changeover to Secondary Pass

Nitrous Oxide Manifold (G) (Manifold Room) - Main Line Pressure High Pass

Nitrous Oxide Manifold (G) (Manifold Room) - Main Line Pressure Low Pass

Nitrous Oxide Manifold (G) (Manifold Room) - Changeover to Secondary Pass

Oxygen Bulk Liquid System (Outdoor Bulk Pad) - Main Liquid Level Low NT5

Oxygen Bulk Liquid System (Outdoor Bulk Pad) - Reserve In Use NT5

Oxygen Bulk Liquid System (Outdoor Bulk Pad) - Reserve Pressure Low NT5

Oxygen Bulk Liquid System (Outdoor Bulk Pad) - Main Line Pressure High Pass

Oxygen Bulk Liquid System (Outdoor Bulk Pad) - Main Line Pressure Low Pass

Vacuum Pump System (Mech Room PH) - Lag Pump Running NP1

Vacuum Pump System (Mech Room PH) - Vacuum Low Pass

Codes

P - Pass NP1- Signal Not Present, but the equipment local alarm/relay necessary to send the signal to the master alarms is present

NP2 - Signal Not Present, the equipment local alarm/relay necessary to send the signal to the master alarms is not present

NT1 - Signal Not Tested- possible risk of service interruption

NT2 - Signal Not Tested- sending device could not be triggered

NT3 - Signal Not Tested- sending device could not be located/accessed

NT4 - Signal Not Tested- system is not in service at this time

NT5 - Signal Not Tested – system is tested by Supplier F - Fail

P.O. Box 541 Lawrence, PA 15055 Ph: (724) 745-1854 Fax: (724) 745-2184

Facility: VA Medical Center Erie

Project #: 624943

Manuf/Model: Amico Alert 2

Master Alarm - Switchboard

Date Inspected: July 29, 2025

Labeling - P Test Button - P Green Light - P Red/Yellow Light - P Audible - P

Comments:Carbon Dioxide Gas Manifold (Manifold Room) - Main Line Pressure High Pass

Carbon Dioxide Gas Manifold (Manifold Room) - Main Line Pressure Low Pass

Carbon Dioxide Gas Manifold (Manifold Room) - Changeover to Secondary Pass

Medical Air Compressor System (Mech Room BW035) - Main Line Pressure High Pass

Medical Air Compressor System (Mech Room BW035) - Main Line Pressure Low Pass

Medical Air Compressor System (Mech Room BW035) - Lag Compressor Running Pass

Medical Air Compressor System (Mech Room BW035) - Dew Point High Pass

Medical Air Compressor System (Mech Room BW035) - Carbon Monoxide High Pass

Nitrogen Manifold (G) (Manifold Room) - Main Line Pressure High Pass

Nitrogen Manifold (G) (Manifold Room) - Main Line Pressure Low Pass

Nitrogen Manifold (G) (Manifold Room) - Changeover to Secondary Pass

Nitrous Oxide Manifold (G) (Manifold Room) - Main Line Pressure High Pass

Nitrous Oxide Manifold (G) (Manifold Room) - Main Line Pressure Low Pass

Nitrous Oxide Manifold (G) (Manifold Room) - Changeover to Secondary Pass

Oxygen Bulk Liquid System (Outdoor Bulk Pad) - Main Liquid Level Low NT5

Oxygen Bulk Liquid System (Outdoor Bulk Pad) - Reserve In Use NT5

Oxygen Bulk Liquid System (Outdoor Bulk Pad) - Reserve Pressure Low NT5

Oxygen Bulk Liquid System (Outdoor Bulk Pad) - Main Line Pressure High Pass

Oxygen Bulk Liquid System (Outdoor Bulk Pad) - Main Line Pressure Low Pass

Vacuum Pump System (Mech Room PH) - Lag Pump Running NP1

Vacuum Pump System (Mech Room PH) - Vacuum Low Pass

Codes

P - Pass NP1- Signal Not Present, but the equipment local alarm/relay necessary to send the signal to the master alarms is present

NP2 - Signal Not Present, the equipment local alarm/relay necessary to send the signal to the master alarms is not present

NT1 - Signal Not Tested- possible risk of service interruption

NT2 - Signal Not Tested- sending device could not be triggered

NT3 - Signal Not Tested- sending device could not be located/accessed

NT4 - Signal Not Tested- system is not in service at this time

NT5 - Signal Not Tested – system is tested by Supplier F - Fail

P.O. Box 541 Lawrence, PA 15055 Ph: (724) 745-1854 Fax: (724) 745-2184

Facility: VA Medical Center Erie

Project #: 624943

Area Alarms

Date Inspected: July 29, 2025

Building: 1

Floor: 1

Location Outside Pulmonary

Area Monitored

Pulmonary/Secretary Primary Care

Manufacturer P-B

Model MEGA

Asset #: 1-AA-1-1 Result Pass

40 60

Def. Code(s)

High Set

Low Set

MA1

Reading

Gas

O1

Comments

Building: 1

Floor: 1

Location Blue Clinic Nurses Desk

Area Monitored

(Blue Clinic) Exam A-F

Manufacturer Amico

Model Alert 3

Asset #: 1-AA-1-2 Result Pass

12 30

Def. Code(s)

High Set

Low Set

MV1

Reading

Gas

O1

Comments

Building: 1

Floor: 1

Location ED Nurses Desk

Area Monitored

Emergency Department

Manufacturer Allied

Model DA2

Asset #: 1-AA-1-3 Result Pass

Def. Code(s)

High Set

Low Set

11.9

O1

MA1

Reading

Gas

MV1

Comments

A1 - Area monitored labeling not present, incorrect

A5 - Abnormal (Red or Yellow) indicator malfunctioning

A9 - Set points incorrect

A13 - Panel Location non-compliant/undesirable

A17 - No electrical power to panel

A2 - Gas/Signal labeling not present, incorrect or incomplete

A6 - Alarm did not activate when triggered

A10 - Digital or analog pressure displays not accurate

A14 - Panel not on emergency power circuits

A18 - See Comments

A3 - Audible indicator malfunctioning

A7 - Alarm did not return to normal after cleared

A11 - Panel/module malfunctioning

A15 - Required signals or panel not present

A4 - Normal (Green) indicator malfunctioning

A8 - Test button sequence malfunctioning

A12 - Panel/module physically damaged

A16 - Sensors in non-compliant location for area type

Deficiency Codes NT (Not Tested), NA (Not Applicable), NP (Not Present)

Gas Codes: O - Oxygen MA - Medical Air MV - Medical Vacuum N2O - Nitrous Oxide N2 - Nitrogen W - WAGD (Evacuation) CO2 - Carbon Dioxide VW - Vac/WAGD H - HeliOx

P.O. Box 541 Lawrence, PA 15055 Ph: (724) 745-1854 Fax: (724) 745-2184

Facility: VA Medical Center Erie

Project #: 624943

Area Alarms

Date Inspected: July 29, 2025

Building: 1

Floor: 1

Location Hallway Outside 1W224

Area Monitored

Xray 1W221, Sonography 1W222 & 1W223, CT 1W224

Manufacturer Amico

Model Alert 2

Asset #: 1-AA-1-4 Result Pass

12 30

Def. Code(s)

High Set

Low Set

MV1

Reading

Gas

O1

Comments

Building: 1

Floor: 1

Location Outside 1W221

Area Monitored

RFI 1 & 2

Manufacturer Amico

Model Alert 3

Asset #: 1-AA-1-5 Result Pass

12 30

Def. Code(s)

High Set

Low Set

MV1

Reading

Gas

O1

Comments

Building: 1

Floor: 2

Location Across from Pre Post 4 (Endo)

Area Monitored

Endo Rooms

Manufacturer Amico

Model Alert 3

Asset #: 1-AA-2-1 Result Pass

Def. Code(s)

High Set

Low Set

N2O1

O1

VW1

Reading

Gas

MA1

Comments

A1 - Area monitored labeling not present, incorrect

A5 - Abnormal (Red or Yellow) indicator malfunctioning

A9 - Set points incorrect

A13 - Panel Location non-compliant/undesirable

A17 - No electrical power to panel

A2 - Gas/Signal labeling not present, incorrect or incomplete

A6 - Alarm did not activate when triggered

A10 - Digital or analog pressure displays not accurate

A14 - Panel not on emergency power circuits

A18 - See Comments

A3 - Audible indicator malfunctioning

A7 - Alarm did not return to normal after cleared

A11 - Panel/module malfunctioning

A15 - Required signals or panel not present

A4 - Normal (Green) indicator malfunctioning

A8 - Test button sequence malfunctioning

A12 - Panel/module physically damaged

A16 - Sensors in non-compliant location for area type

Gas Codes: O - Oxygen MA - Medical Air MV - Medical Vacuum N2O - Nitrous Oxide N2 - Nitrogen W - WAGD (Evacuation) CO2 - Carbon Dioxide VW - Vac/WAGD H - HeliOx

P.O. Box 541 Lawrence, PA 15055 Ph: (724) 745-1854 Fax: (724) 745-2184

Facility: VA Medical Center Erie

Project #: 624943

Area Alarms

Date Inspected: July 29, 2025

Building: 1

Floor: 2

Location Across from Pre Post 4 (OR)

Area Monitored

OR Rooms

Manufacturer Amico

Model Alert 3

Asset #: 1-AA-2-2 Result Pass

Def. Code(s)

High Set

Low Set

MA1

VW1

N2O1

CO21

N21

Reading

Gas

O1

Comments

Building: 1

Floor: 2

Location Right of Pre Post 4

Area Monitored

PACU Rooms 1-3, Pre OP 1-7, Air Only in PACU 1-3

Manufacturer Amico

Model Alert 3

Asset #: 1-AA-2-3 Result Pass

Def. Code(s)

High Set

Low Set

MA1

MV1

Reading

Gas

O1

Comments

Building: 1

Floor: 3

Location Infusion Nurses Station

Area Monitored

Infusion Bays 1-9, Private Exam (Bay10)

Manufacturer Amico

Model Alert 3

Asset #: 1-AA-3-1 Result Pass

Def. Code(s)

High Set

Low Set

Reading

Gas

O1

Comments

A1 - Area monitored labeling not present, incorrect

A5 - Abnormal (Red or Yellow) indicator malfunctioning

A9 - Set points incorrect

A13 - Panel Location non-compliant/undesirable

A17 - No electrical power to panel

A2 - Gas/Signal labeling not present, incorrect or incomplete

A6 - Alarm did not activate when triggered

A10 - Digital or analog pressure displays not accurate

A14 - Panel not on emergency power circuits

A18 - See Comments

A3 - Audible indicator malfunctioning

A7 - Alarm did not return to normal after cleared

A11 - Panel/module malfunctioning

A15 - Required signals or panel not present

A4 - Normal (Green) indicator malfunctioning

A8 - Test button sequence malfunctioning

A12 - Panel/module physically damaged

A16 - Sensors in non-compliant location for area type

Gas Codes: O - Oxygen MA - Medical Air MV - Medical Vacuum N2O - Nitrous Oxide N2 - Nitrogen W - WAGD (Evacuation) CO2 - Carbon Dioxide VW - Vac/WAGD H - HeliOx

P.O. Box 541 Lawrence, PA 15055 Ph: (724) 745-1854 Fax: (724) 745-2184

Facility: VA Medical Center Erie

Project #: 624943

Area Alarms

Date Inspected: July 29, 2025

Building: 1

Floor: 6

Location Right of 625J

Area Monitored

625G, 625H, 625J, 625M

Manufacturer Amico

Model Alert 3

Asset #: 1-AA-6-1 Result Pass

40 60

Def. Code(s)

High Set

Low Set

O1

Reading

Gas

MV1

Comments

Building: 1

Floor: 6

Location Nurse Station (617-619...)

Area Monitored

617-619, 628-631

Manufacturer P-B

Model MEGA

Asset #: 1-AA-6-2 Result Pass

40 60

Def. Code(s)

High Set

Low Set

O1

Reading

Gas

MV1

Comments

A1 - Area monitored labeling not present, incorrect

A5 - Abnormal (Red or Yellow) indicator malfunctioning

A9 - Set points incorrect

A13 - Panel Location non-compliant/undesirable

A17 - No electrical power to panel

A2 - Gas/Signal labeling not present, incorrect or incomplete

A6 - Alarm did not activate when triggered

A10 - Digital or analog pressure displays not accurate

A14 - Panel not on emergency power circuits

A18 - See Comments

A3 - Audible indicator malfunctioning

A7 - Alarm did not return to normal after cleared

A11 - Panel/module malfunctioning

A15 - Required signals or panel not present

A4 - Normal (Green) indicator malfunctioning

A8 - Test button sequence malfunctioning

A12 - Panel/module physically damaged

A16 - Sensors in non-compliant location for area type

Gas Codes: O - Oxygen MA - Medical Air MV - Medical Vacuum N2O - Nitrous Oxide N2 - Nitrogen W - WAGD (Evacuation) CO2 - Carbon Dioxide VW - Vac/WAGD H - HeliOx

P.O. Box 541 Lawrence, PA 15055 Ph: (724) 745-1854 Fax: (724) 745-2184

Facility: VA Medical Center Erie

MP Project # 624943

Zone Shutoff Valves

Date Inspected: July 29, 2025

Building: 1

Floor: 1

Location Outside Pulmonary

Area Controlled

Pulmonary Lab / Secretary Primary Care

Manufacturer P-B

Asset #: 1-ZVB-1-1 Result Pass

Def. Code(s)

Comments

Gas O

MA

Pressure Reading

Building: 1

Floor: 1

Location Outside Blue Clinic

Area Controlled

Blue Clinic A-F (342,344,346,352,354,356)

Manufacturer Allied

Asset #: 1-ZVB-1-2 Result Pass

Def. Code(s)

Comments

Gas O

MV

Pressure Reading

Building: 1

Floor: 1

Location Outside Rad Clinic

Area Controlled

Red Clinic Exams 1-5

Manufacturer Amico

Asset #: 1-ZVB-1-3 Result Pass

Def. Code(s)

Comments

Gas O

MV

Pressure Reading

V1 - Area controlled labeling not present, incorrect

V5 - No gauge(s) present - port available

V9 - Valve location non-compliant/undesirable

V13 - No valve(s) present as required

V2 - Gas labeling not present or incorrect

V6 - No gauge(s) present - no port available

V10 - Valve configuration non-compliant

V14 - See Comments Section

V3 - Leakage detected

V7 - Handle difficult to move

V11 - Valve type non-compliant

V4 - Gauge(s) defective

V8 - Cover/Frame damaged or missing

V12 - Valve not locked, latched or in secure area as required

Deficiency Codes

Gas Codes: O - Oxygen MA - Medical Air MV - Medical Vacuum N2O - Nitrous Oxide N2 - Nitrogen W - WAGD (Evacuation) CO2 - Carbon Dioxide VW - Vac/WAGD H - HeliOx

NT (Not Tested), NA (Not Applicable), NP (Not Present)

P.O. Box 541 Lawrence, PA 15055 Ph: (724) 745-1854 Fax: (724) 745-2184

Facility: VA Medical Center Erie

MP Project # 624943

Zone Shutoff Valves

Date Inspected: July 29, 2025

Building: 1

Floor: 1

Location Left of ED 8

Area Controlled

Emergency Department

Manufacturer Allied

Asset #: 1-ZVB-1-4 Result Pass

Def. Code(s)

Comments

Gas O

MA

MV

Pressure Reading

Building: 1

Floor: 1

Location Outside CT

Area Controlled

CT 64 Slice

Manufacturer Amico

Asset #: 1-ZVB-1-5 Result Pass

Def. Code(s)

Comments

Gas O

MV

Pressure Reading

Building: 1

Floor: 1

Location Outside Bone Density

Area Controlled

Bone Density / Dexascan

Manufacturer Amico

Asset #: 1-ZVB-1-6 Result Pass

Def. Code(s)

Comments

Gas O

MV

Pressure Reading

V1 - Area controlled labeling not present, incorrect

V5 - No gauge(s) present - port available

V9 - Valve location non-compliant/undesirable

V13 - No valve(s) present as required

V2 - Gas labeling not present or incorrect

V6 - No gauge(s) present - no port available

V10 - Valve configuration non-compliant

V14 - See Comments Section

V3 - Leakage detected

V7 - Handle difficult to move

V11 - Valve type non-compliant

V4 - Gauge(s) defective

V8 - Cover/Frame damaged or missing

V12 - Valve not locked, latched or in secure area as required

Deficiency Codes

Gas Codes: O - Oxygen MA - Medical Air MV - Medical Vacuum N2O - Nitrous Oxide N2 - Nitrogen W - WAGD (Evacuation) CO2 - Carbon Dioxide VW - Vac/WAGD H - HeliOx

P.O. Box 541 Lawrence, PA 15055 Ph: (724) 745-1854 Fax: (724) 745-2184

Facility: VA Medical Center Erie

MP Project # 624943

Zone Shutoff Valves

Date Inspected: July 29, 2025

Building: 1

Floor: 1

Location In Sterile Process Room

Area Controlled

Bio Med 15216

Manufacturer Amico

Asset #: 1-ZVB-1-7 Result FAIL

Def. Code(s) V4

Comments Medical Air is Not in Use/Not in Service V4 - O

Gas O

MA

MV

Pressure Reading

NA

Building: 1

Floor: 1

Location Outside 1W222

Area Controlled

Sonography 1W222 & 1W223, CT 1W224, X Ray 1W221

Manufacturer Amico

Asset #: 1-ZVB-1-8 Result Pass

Def. Code(s)

Comments

Gas O

MV

Pressure Reading

Building: 1

Floor: 1

Location Outside RF 2

Area Controlled

RF 1 & 2

Manufacturer Amico

Asset #: 1-ZVB-1-9 Result Pass

Def. Code(s)

Comments

Gas O

MV

Pressure Reading

V1 - Area controlled labeling not present, incorrect

V5 - No gauge(s) present - port available

V9 - Valve location non-compliant/undesirable

V13 - No valve(s) present as required

V2 - Gas labeling not present or incorrect

V6 - No gauge(s) present - no port available

V10 - Valve configuration non-compliant

V14 - See Comments Section

V3 - Leakage detected

V7 - Handle difficult to move

V11 - Valve type non-compliant

V4 - Gauge(s) defective

V8 - Cover/Frame damaged or missing

V12 - Valve not locked, latched or in secure area as required

Deficiency Codes

Gas Codes: O - Oxygen MA - Medical Air MV - Medical Vacuum N2O - Nitrous Oxide N2 - Nitrogen W - WAGD (Evacuation) CO2 - Carbon Dioxide VW - Vac/WAGD H - HeliOx

P.O. Box 541 Lawrence, PA 15055 Ph: (724) 745-1854 Fax: (724) 745-2184

Facility: VA Medical Center Erie

MP Project # 624943

Zone Shutoff Valves

Date Inspected: July 29, 2025

Building: 1

Floor: 2

Location Left of Endo 1

Area Controlled

Endo 1

Manufacturer Amico

Asset #: 1-ZVB-2-1 Result Pass

Def. Code(s)

Comments

Gas O

MA

MV

N2O

CO2

WAGD

Pressure Reading

Building: 1

Floor: 2

Location Right of Endo 2

Area Controlled

Endo 2

Manufacturer Amico

Asset #: 1-ZVB-2-2 Result Pass

Def. Code(s)

Comments

Gas O

MA

MV

N2O

CO2

WAGD

Pressure Reading

Building: 1

Floor: 2

Location Right of OR 1

Area Controlled

OR Room 1

Manufacturer Amico

Asset #: 1-ZVB-2-3 Result Pass

Def. Code(s)

Comments

Gas O

MA

MV

N2O

N2

CO2

Pressure Reading

WAGD 21

V1 - Area controlled labeling not present, incorrect

V5 - No gauge(s) present - port available

V9 - Valve location non-compliant/undesirable

V13 - No valve(s) present as required

V2 - Gas labeling not present or incorrect

V6 - No gauge(s) present - no port available

V10 - Valve configuration non-compliant

V14 - See Comments Section

V3 - Leakage detected

V7 - Handle difficult to move

V11 - Valve type non-compliant

V4 - Gauge(s) defective

V8 - Cover/Frame damaged or missing

V12 - Valve not locked, latched or in secure area as required

Deficiency Codes

Gas Codes: O - Oxygen MA - Medical Air MV - Medical Vacuum N2O - Nitrous Oxide N2 - Nitrogen W - WAGD (Evacuation) CO2 - Carbon Dioxide VW - Vac/WAGD H - HeliOx

P.O. Box 541 Lawrence, PA 15055 Ph: (724) 745-1854 Fax: (724) 745-2184

Facility: VA Medical Center Erie

MP Project # 624943

Zone Shutoff Valves

Date Inspected: July 29, 2025

Building: 1

Floor: 2

Location Left of OR 2

Area Controlled

OR Room 2

Manufacturer Amico

Asset #: 1-ZVB-2-4 Result Pass

Def. Code(s)

Comments

Gas O

MA

MV

N2O

N2

CO2

Pressure Reading

WAGD 22

Building: 1

Floor: 2

Location Hallway Outside of Pre/Post & PACU

Area Controlled

Pre/Post 1-7, PACU 1-3 (Air in PACU only)

Manufacturer Amico

Asset #: 1-ZVB-2-5 Result Pass

Def. Code(s)

Comments

Gas O

MA

MV

Pressure Reading

Building: 1

Floor: 3

Location Outside Small Procedure

Area Controlled

Small Procedures

Manufacturer Beacon

Asset #: 1-ZVB-3-2 Result Pass

Def. Code(s)

Comments

Gas O

MV

Pressure Reading

V1 - Area controlled labeling not present, incorrect

V5 - No gauge(s) present - port available

V9 - Valve location non-compliant/undesirable

V13 - No valve(s) present as required

V2 - Gas labeling not present or incorrect

V6 - No gauge(s) present - no port available

V10 - Valve configuration non-compliant

V14 - See Comments Section

V3 - Leakage detected

V7 - Handle difficult to move

V11 - Valve type non-compliant

V4 - Gauge(s) defective

V8 - Cover/Frame damaged or missing

V12 - Valve not locked, latched or in secure area as required

Deficiency Codes

Gas Codes: O - Oxygen MA - Medical Air MV - Medical Vacuum N2O - Nitrous Oxide N2 - Nitrogen W - WAGD (Evacuation) CO2 - Carbon Dioxide VW - Vac/WAGD H - HeliOx

P.O. Box 541 Lawrence, PA 15055 Ph: (724) 745-1854 Fax: (724) 745-2184

Facility: VA Medical Center Erie

MP Project # 624943

Zone Shutoff Valves

Date Inspected: July 29, 2025

Building: 1

Floor: 3

Location Outside of Infusion Suite

Area Controlled

Infusion Bays 1-9, Private Exam Bay

Manufacturer Beacon

Asset #: 1-ZVB-3-3 Result Pass

Def. Code(s)

Comments Medical Air and Vacuum are Futures, Valved Off and Handles Removed

Gas O

MA

MV

Pressure Reading

Building: 1

Floor: 5

Location Right of 518

Area Controlled

519-522, 529-533

Manufacturer P-B

Asset #: 1-ZVB-5-1 Result Pass

Def. Code(s)

Comments

Gas O

MV

Pressure Reading

Building: 1

Floor: 5

Location Right of 515

Area Controlled

504-508, 510-513

Manufacturer P-B

Asset #: 1-ZVB-5-2 Result Pass

Def. Code(s)

Comments

Gas O

MV

Pressure Reading

V1 - Area controlled labeling not present, incorrect

V5 - No gauge(s) present - port available

V9 - Valve location non-compliant/undesirable

V13 - No valve(s) present as required

V2 - Gas labeling not present or incorrect

V6 - No gauge(s) present - no port available

V10 - Valve configuration non-compliant

V14 - See Comments Section

V3 - Leakage detected

V7 - Handle difficult to move

V11 - Valve type non-compliant

V4 - Gauge(s) defective

V8 - Cover/Frame damaged or missing

V12 - Valve not locked, latched or in secure area as required

Deficiency Codes

Gas Codes: O - Oxygen MA - Medical Air MV - Medical Vacuum N2O - Nitrous Oxide N2 - Nitrogen W - WAGD (Evacuation) CO2 - Carbon Dioxide VW - Vac/WAGD H - HeliOx

P.O. Box 541 Lawrence, PA 15055 Ph: (724) 745-1854 Fax: (724) 745-2184

Facility: VA Medical Center Erie

MP Project # 624943

Zone Shutoff Valves

Date Inspected: July 29, 2025

Building: 1

Floor: 6

Location Left of 625M

Area Controlled

625G, 625H, 625J, 625M

Manufacturer Beacon

Asset #: 1-ZVB-6-1 Result Pass

Def. Code(s)

Comments Air Not in Service. Valved Off; Handle Removed

Gas O

MV

Pressure Reading

Building: 1

Floor: 6

Location Right of 616

Area Controlled

617-619, 628-631

Manufacturer Beacon

Asset #: 1-ZVB-6-2 Result Pass

Def. Code(s)

Comments Medical Air is Not in Service. Valved Off; Handle Removed.

Gas O

MA

MV

Pressure Reading

NA

V1 - Area controlled labeling not present, incorrect

V5 - No gauge(s) present - port available

V9 - Valve location non-compliant/undesirable

V13 - No valve(s) present as required

V2 - Gas labeling not present or incorrect

V6 - No gauge(s) present - no port available

V10 - Valve configuration non-compliant

V14 - See Comments Section

V3 - Leakage detected

V7 - Handle difficult to move

V11 - Valve type non-compliant

V4 - Gauge(s) defective

V8 - Cover/Frame damaged or missing

V12 - Valve not locked, latched or in secure area as required

Deficiency Codes

Gas Codes: O - Oxygen MA - Medical Air MV - Medical Vacuum N2O - Nitrous Oxide N2 - Nitrogen W - WAGD (Evacuation) CO2 - Carbon Dioxide VW - Vac/WAGD H - HeliOx

P.O. Box 541 Lawrence, PA 15055 Ph: (724) 745-1854 Fax: (724) 745-2184

Facility: VA Medical Center Erie

MP Project # 624943

GAS OUTLETS/SUCTION INLETS

Bldg Floor Area/Dept Room Gas # Result Def. Code(s)Pres Mfr Model

Date Inspected: July 29, 2025

Mounting Connector Adapter Comments

1 Bio Med1 Bio Med Not Tested O8 Beacon Series BMA 1 QCWall Puritan-BennettNot in Service

1 Bio Med1 Bio Med Not Tested O8 Beacon Series BMA 2 QCWall Puritan-BennettNot in Service

1 Bio Med1 Bio Med Not Tested O8 Beacon Series BMA 3 QCWall Puritan-BennettNot in Service

1 Bio Med1 Bio Med Not Tested O8 Beacon Series BMA 4 QCWall Puritan-BennettNot in Service

1 Bio Med1 Bio Med Not Tested O8 Beacon Series BMA 5 QCWall Puritan-BennettNot in Service

1 Bio Med1 Bio Med Pass Beacon Series BMV 1 27 QCWall Puritan-Bennett

1 Bio Med1 Bio Med Pass Beacon Series BMV 2 27 QCWall Puritan-Bennett

1 Bio Med1 Bio Med Pass Beacon Series BMV 3 27 QCWall Puritan-Bennett

1 Bio Med1 Bio Med Fail O3 Beacon Series BMV 4 27 QCWall Puritan-Bennett

1 Bio Med1 Bio Med Pass Beacon Series BMV 5 27 QCWall Puritan-Bennett

1 Bio Med1 Bio Med Pass Beacon Series BO 1 51 QCWall Puritan-Bennett

1 Bio Med1 Bio Med Pass Beacon Series BO 2 51 QCWall Puritan-Bennett

1 Bio Med1 Bio Med Pass Beacon Series BO 3 51 QCWall Puritan-Bennett

1 Bio Med1 Bio Med Pass Beacon Series BO 4 51 QCWall Puritan-Bennett

1 Blue Clinic1 Blue Clinic Exam A (1W342) Pass Amico Alert 1MV 1 27 QCWall Puritan-Bennett

1 Blue Clinic1 Blue Clinic Exam A (1W342) Pass Amico Alert 1O 1 51 QCWall Puritan-Bennett

1 Blue Clinic1 Blue Clinic Exam B (1W344) Pass Amico Alert 1MV 1 27 QCWall Puritan-Bennett

1 Blue Clinic1 Blue Clinic Exam B (1W344) Pass Amico Alert 1O 1 51 QCWall Puritan-Bennett

1 Blue Clinic1 Blue Clinic Exam C (1W346) Pass Amico Alert 1MV 1 27 QCWall Puritan-Bennett

1 Blue Clinic1 Blue Clinic Exam C (1W346) Pass Amico Alert 1O 1 51 QCWall Puritan-Bennett

1 Blue Clinic1 Blue Clinic Exam D (1W352) Pass Amico Alert 1MV 1 27 QCWall Puritan-Bennett

1 Blue Clinic1 Blue Clinic Exam D (1W352) Pass Amico Alert 1O 1 51 QCWall Puritan-Bennett

1 Blue Clinic1 Blue Clinic Exam E (1W354) Pass Amico Alert 1MV 1 27 QCWall Puritan-Bennett

1 Blue Clinic1 Blue Clinic Exam E (1W354) Pass Amico Alert 1O 1 51 QCWall Puritan-Bennett

1 Blue Clinic1 Blue Clinic Exam F (1W356) Pass Amico Alert 1MV 1 27 QCWall Puritan-Bennett

1 Blue Clinic1 Blue Clinic Exam F (1W356) Pass Amico Alert 1O 1 51 QCWall Puritan-Bennett

1 ED1 1W452 (Left) Pass Amico Alert 1MV 1 27 QCWall Puritan-Bennett

1 ED1 1W452 (Left) Pass Amico Alert 1O 1 51 QCWall Puritan-Bennett

1 ED1 ER 1 Pass Amico Alert 1MA 1 50 QCWall Puritan-Bennett

1 ED1 ER 1 Pass Amico Alert 1MV 1 27 QCWall Puritan-Bennett

1 ED1 ER 1 Pass Beacon Series BO 1 51 QCConsole Puritan-Bennett

1 ED1 ER 2 Pass Beacon Series BMA 1 50 QCConsole Puritan-Bennett

1 ED1 ER 2 Pass Beacon Series BMV 1 27 QCConsole Puritan-Bennett

Gas Codes: O - Oxygen MA - Medical Air MV - Medical Vacuum N2O - Nitrous Oxide N2 - Nitrogen W - WAGD (Evacuation) CO2 - Carbon Dioxide VW - Vac/WAGD H - HeliOx

Deficiency Codes

O12 - Visible water detected

O8 - Unable to test at this time

O4 - Reduced flow/no flow

O15 - Contamination detected

O11 - Incorrect labeling/color-coding

O7 - Patient using outlet/inlet

O3 - Leak with connector out

O14 - Ceiling outlets without hoses

O10 - Hoses need replacement

O6 - Defective/Missing Parts

O2 - Leak with connector in

O13 - Latch cover missing/broken

O9 - Facility's connector broken

O5 - Abnormal Pressure

O1 - Difficult to insert/extract connector

P.O. Box 541 Lawrence, PA 15055 Ph: (724) 745-1854 Fax: (724) 745-2184

Facility: VA Medical Center Erie

MP Project # 624943

GAS OUTLETS/SUCTION INLETS

Bldg Floor Area/Dept Room Gas # Result Def. Code(s)Pres Mfr Model

Date Inspected: July 29, 2025

Mounting Connector Adapter Comments

1 ED1 ER 2 Fail O2 Beacon Series BO 1 51 QCConsole Puritan-Bennett

1 ED1 ER 3 Pass Beacon Series BMA 1 50 QCConsole Puritan-Bennett

1 ED1 ER 3 Pass Beacon Series BMV 1 27 QCConsole Puritan-Bennett

1 ED1 ER 3 Pass Beacon Series BO 1 51 QCConsole Puritan-Bennett

1 ED1 ER 4 Pass Beacon Series BMA 1 50 QCConsole Puritan-Bennett

1 ED1 ER 4 Pass Beacon Series BMV 1 27 QCConsole Puritan-Bennett

1 ED1 ER 4 Pass Beacon Series BO 1 51 QCConsole Puritan-Bennett

1 ED1 ER 5 Pass Beacon Series BMA 1 50 QCConsole Puritan-Bennett

1 ED1 ER 5 Pass Beacon Series BMV 1 27 QCConsole Puritan-Bennett

1 ED1 ER 5 Pass Beacon Series BO 1 51 QCConsole Puritan-Bennett

1 ED1 ER 6 Pass Beacon Series BMA 1 50 QCConsole Puritan-Bennett

1 ED1 ER 6 Pass Beacon Series BMV 1 27 QCConsole Puritan-Bennett

1 ED1 ER 6 Pass Beacon Series BO 1 51 QCConsole Puritan-Bennett

1 ED1 ER 7 Pass Amico Alert 1MA 1 50 QCWall Puritan-Bennett

1 ED1 ER 7 Pass Amico Alert 1MV 1 27 QCWall Puritan-Bennett

1 ED1 ER 7 Pass Amico Alert 1O 1 51 QCWall Puritan-Bennett

1 ED1 ER 8 Pass Amico Alert 1MA 1 50 QCWall Puritan-Bennett

1 ED1 ER 8 Pass Amico Alert 1MV 1 27 QCWall Puritan-Bennett

1 ED1 ER 8 Pass Amico Alert 1O 1 51 QCWall Puritan-Bennett

1 ED1 ER 9 Pass Amico Alert 1MA 1 50 QCWall Puritan-Bennett

1 ED1 ER 9 Pass Amico Alert 1MV 1 27 QCWall Puritan-Bennett

1 ED1 ER 9 Pass Amico Alert 1O 1 51 QCWall Puritan-Bennett

1 Pulm/Cardiac1 Pulm Lab (1N1170) Not Tested O8 P-B Series BMA 1 QCWall Puritan-BennettOutlet Access Obstructed

1 Pulm/Cardiac1 Pulm Lab (1N1170) Not Tested O8 P-B Series BO 1 QCWall Puritan-BennettOutlet Access Obstructed

1 Pulm/Cardiac1 Secretary Primary Care 1N1169

Not Tested O8 Beacon Series BO 1 QCWall Puritan-BennettOutlet Access Obstructed

1 Radiology1 1W222 Sonography Not Tested O8 Amico Alert 1MV 1 QCWall Puritan-BennettOutlet Access Obstructed

1 Radiology1 1W222 Sonography Pass Amico Alert 1O 1 51 QCWall Puritan-Bennett

1 Radiology1 1W223 Sonography Pass Amico Alert 1MV 1 27 QCWall Puritan-Bennett

1 Radiology1 1W223 Sonography Pass Amico Alert 1O 1 51 QCWall Puritan-Bennett

1 Radiology1 Bone Density Dexascan Pass Amico Alert 1MV 1 27 QCWall Puritan-Bennett

1 Radiology1 Bone Density Dexascan Pass Amico Alert 1O 1 51 QCWall Puritan-Bennett

1 Radiology1 CT 1W224 Pass Amico Alert 1MV 1 27 QCWall Puritan-Bennett

Gas Codes: O - Oxygen MA - Medical Air MV - Medical Vacuum N2O - Nitrous Oxide N2 - Nitrogen W - WAGD (Evacuation) CO2 - Carbon Dioxide VW - Vac/WAGD H - HeliOx

Deficiency Codes

O12 - Visible water detected

O8 - Unable to test at this time

O4 - Reduced flow/no flow

O15 - Contamination detected

O11 - Incorrect labeling/color-coding

O7 - Patient using outlet/inlet

O3 - Leak with connector out

O14 - Ceiling outlets without hoses

O10 - Hoses need replacement

O6 - Defective/Missing Parts

O2 - Leak with connector in

O13 - Latch cover missing/broken

O9 - Facility's connector broken

P.O. Box 541 Lawrence, PA 15055 Ph: (724) 745-1854 Fax: (724) 745-2184

Facility: VA Medical Center Erie

MP Project # 624943

GAS OUTLETS/SUCTION INLETS

Bldg Floor Area/Dept Room Gas # Result Def. Code(s)Pres Mfr Model

Date Inspected: July 29, 2025

Mounting Connector Adapter Comments

1 Radiology1 CT 1W224 Pass Amico Alert 1O 1 51 QCWall Puritan-Bennett

1 Radiology1 CT 64 Slice 1W225A Pass Amico Alert 1MV 1 27 QCWall Puritan-Bennett

1 Radiology1 CT 64 Slice 1W225A Pass Amico Alert 1O 1 51 QCWall Puritan-Bennett

1 Radiology1 RF1 Pass Amico Alert 1MV 1 27 QCWall Puritan-Bennett

1 Radiology1 RF1 Pass Amico Alert 1O 1 51 QCWall Puritan-Bennett

1 Radiology1 RF2 Pass Amico Alert 1MV 1 27 QCWall Puritan-Bennett

1 Radiology1 RF2 Pass Amico Alert 1O 1 51 QCWall Puritan-Bennett

1 Radiology1 X Ray 1W221 Pass Amico Alert 1MV 1 27 QCWall Puritan-Bennett

1 Radiology1 X Ray…