R_Boom Hose Inspections_2026_VA Charleston_4.pdf
PDF 255 KB Posted
- Attached to
- J065--FY26: REPAIR MEDICAL GAS LEAK
- Solicitation number
- 36C24726Q0868
About this file
This is a flexible connection testing report documenting the inspection and leak detection of medical gas delivery systems at Ralph H. Johnson VA Medical Center in Charleston, SC, performed on 6/3/2026. The testing was conducted by Evergreen Medical Services, Inc. (EMS), with Lead Technician Kevin (credential 6040) and Technician Tanner Moore (ASSE 6030 - 12454599) performing the work.
The report details testing of 69 boom and retractable hose assemblies across multiple facility areas including GI Suite (Endoscopy), Catheterization Lab, and Surgery. All tested systems passed inspection with checkmarks indicating successful ceiling connections, outlet connections, and hose condition evaluations. Testing covered systems supplied by Amico and Beacon manufacturers, with gases including oxygen (O₂), medical air, vacuum (Vac), nitrogen (N₂), nitrous oxide (N₂O), and WAGD. The inspection identified and repaired leaking outlet/inlet connections in nine units during testing (positions 9, 41, 42, 43, 55, and 58). All assemblies received passing ratings with a next inspection date of 6/3/2026. The testing protocol conforms to NFPA 99 5.1.14.2.3.1(A), which requires leak testing of nonstationary booms and articulating assemblies every 18 months or per facility risk assessment. Equipment used included oxygen-safe leak detectant, ultrasonic leak detector, borescope camera, and proprietary disassembly tools. The document notes that coordinate facility staff involvement may be required for future testing, particularly for ICU rooms, and terminal cleaning of tested spaces may be necessary.
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| PXL_20260526_124550763_1.jpg | JPG image | |
| 36C24726Q0868_2.docx | DOCX document | |
| PXL_20260526_124939323_3.jpg | JPG image | |
| R_SYS_2026_VA Charleston_6.pdf | ||
| PXL_20260526_124554514_2.jpg | JPG image | |
| R_PM_2026_VA Charleston_5.pdf |
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Text version
Page 1 FLEXIBLE CONNECTION TESTING McDowell
Marion, NC
2/22/2025
Facility: Contact:
City, ST: Title:
Date(s) of Testing: Email:
Phone:
Technician(s):
Contact Information
Technician(s) Performing Service
Some rooms such as ICU rooms may not be readily available for testing of the flexible connectors. Coordination from the staff and department contracting the testing will be required to hold rooms for testing and may incur additional charges for return trips.
Rooms may require terminal cleaning upon completion of testing prior to returning the space back to patient care. Dust and debris may be inside the ancilary space above the ceiling where the flexible connections are hooked to the distribution piping as well as inside the assemblies themselves. EMS
Technicians will make every attempt to clean up after testing however, the facility should evaluate if further cleaning is required.
Hoses will be inspected for leaks at both points of connection above ceiling and inside the assemlby at the back of the outlets/inlets.
Inspection of the hoses at pivot points and locations that would cause the hose to possibly rub or wear against the inside of the assembly will be done by removing end caps or other coverings for visual examination.
NFPA 99 2024 requires that all hoses used for flexible connections inside manufactured assemblies be labeled with the CGA color designation, the name or chemical symbol of the gas per table 5.1.11, the non standard pressure if applicable, and the recommended replacement date based on the date of manufacture. Any new hoses or replacement hoses must meet these criteria.
Credential and #:Tanner Moore ASSE 6030 - 12454599
Oxygen safe leak detectant and/or ultrasonic leak detector, Borescope camera as needed, Proprietary tools required to disassemble booms.(803)621-6104
Testing is performed as outlined and required by NFPA 99 5.1.14.2.3.1(A) - Nonstationary booms and articulating assemblies, other than headwalls utilizing flexible connectors, shall be tested for leaks, per manufacturer's recommendations, every 18 months or at a duration as determined by a risk assessment performed by the facilities governing body in conjuction with the RFA.
Ralph H. Johnson VA Medical Center
Charleston, SC
6/3/2026
David Gatlin
Facility Information Equipment
Lead Technician
Kevin
Testing performed by EMS
Copyright Evergreen Medical Services, Inc. © 2025
Page 2 BOOMS & RETRACTABLE HOSES
Marion, NC
2/22/2025
Position
C eiling
C onnections
O utlet C onnection
H ose C ondition
3B GI Suite
(Endoscopy) 321 (GI Proc.
1) O₂ BOOM Amico ✓ ✓ ✓ PASS 6/3/2026
3B GI Suite
(Endoscopy) 321 (GI Proc.
1) Med Air
BOOM Amico ✓ ✓ ✓ PASS 6/3/2026
3B GI Suite
(Endoscopy) 321 (GI Proc.
1) Vac BOOM Amico ✓ ✓ ✓ PASS 6/3/2026
3B GI Suite
(Endoscopy) 321 (GI Proc.
1) O₂ BOOM Amico ✓ ✓ ✓ PASS 6/3/2026
3B GI Suite
(Endoscopy) 321 (GI Proc.
1) Med Air
BOOM Amico ✓ ✓ ✓ PASS 6/3/2026
3B GI Suite
(Endoscopy) 321 (GI Proc.
1) Vac BOOM Amico ✓ ✓ ✓ PASS 6/3/2026
3B GI Suite
(Endoscopy) 322 (GI Proc.
2) O₂ BOOM Amico ✓ ✓ ✓ PASS 6/3/2026
3B GI Suite
(Endoscopy) 322 (GI Proc.
2) Med Air
BOOM Amico ✓ ✓ ✓ PASS 6/3/2026
3B GI Suite
(Endoscopy) 322 (GI Proc.
2) Vac BOOM Amico ✓ ✓ ✓ PASS 6/3/2026
Leaking Outlet/Inlet Connection - Repaired at time of testing
3B GI Suite
(Endoscopy) 322 (GI Proc.
2) O₂ BOOM Amico ✓ ✓ ✓ PASS 6/3/2026
3B GI Suite
(Endoscopy) 322 (GI Proc.
2) Med Air
BOOM Amico ✓ ✓ ✓ PASS 6/3/2026
Test/Inspection D ate
Joint/DISS Leak Detection & Safe Working Condition
R ecom m endation(s) or
C om m ents
R oom
# (O utlets Listed Top to
Bottom
Left to Right & Front of Room to Back)
System
Boom or Retractable C olum n
A rea or Zone
A ssem bly M anufacturer
PA
SS/FA
IL
Lead Technician
Kevin
Page 3 BOOMS & RETRACTABLE HOSES
Marion, NC
2/22/2025
Position
C eiling
C onnections
O utlet C onnection
H ose C ondition
Test/Inspection D ate
Joint/DISS Leak Detection & Safe Working Condition
R ecom m endation(s) or
C om m ents
R oom
# (O utlets Listed Top to
Bottom
Left to Right & Front of Room to Back)
System
Boom or Retractable C olum n
A rea or Zone
A ssem bly M anufacturer
PA
SS/FA
IL
3B GI Suite
(Endoscopy) 322 (GI Proc.
2) Vac BOOM Amico ✓ ✓ ✓ PASS 6/3/2026
3B GI Suite
(Endoscopy) 325 (GI Proc.
3) O₂ BOOM Amico ✓ ✓ ✓ PASS 6/3/2026
3B GI Suite
(Endoscopy) 325 (GI Proc.
3) Med Air
BOOM Amico ✓ ✓ ✓ PASS 6/3/2026
3B GI Suite
(Endoscopy) 325 (GI Proc.
3) Vac BOOM Amico ✓ ✓ ✓ PASS 6/3/2026
3B GI Suite
(Endoscopy) 325 (GI Proc.
3) O₂ BOOM Amico ✓ ✓ ✓ PASS 6/3/2026
3B GI Suite
(Endoscopy) 325 (GI Proc.
3) Med Air
BOOM Amico ✓ ✓ ✓ PASS 6/3/2026
3B GI Suite
(Endoscopy) 325 (GI Proc.
3) Vac BOOM Amico ✓ ✓ ✓ PASS 6/3/2026
3B GI Suite
(Endoscopy) 326 (GI Proc.
4) O₂ BOOM Amico ✓ ✓ ✓ PASS 6/3/2026
3B GI Suite
(Endoscopy) 326 (GI Proc.
4) Med Air
BOOM Amico ✓ ✓ ✓ PASS 6/3/2026
3B GI Suite
(Endoscopy) 326 (GI Proc.
4) Vac BOOM Amico ✓ ✓ ✓ PASS 6/3/2026
3B GI Suite
(Endoscopy) 326 (GI Proc.
4) O₂ BOOM Amico ✓ ✓ ✓ PASS 6/3/2026
3B GI Suite
(Endoscopy) 326 (GI Proc.
4) Med Air
BOOM Amico ✓ ✓ ✓ PASS 6/3/2026
Lead Technician
Kevin
Page 4 BOOMS & RETRACTABLE HOSES
Marion, NC
2/22/2025
Position
C eiling
C onnections
O utlet C onnection
H ose C ondition
Test/Inspection D ate
Joint/DISS Leak Detection & Safe Working Condition
R ecom m endation(s) or
C om m ents
R oom
# (O utlets Listed Top to
Bottom
Left to Right & Front of Room to Back)
System
Boom or Retractable C olum n
A rea or Zone
A ssem bly M anufacturer
PA
SS/FA
IL
3B GI Suite
(Endoscopy) 326 (GI Proc.
4) Vac BOOM Amico ✓ ✓ ✓ PASS 6/3/2026
25 AA223 Cath 2 O₂ BOOM Amico ✓ ✓ ✓ PASS 6/3/2026 26 AA223 Cath 2 O₂ BOOM Amico ✓ ✓ ✓ PASS 6/3/2026
27 AA223 Cath 2
WAG
D BOOM Amico ✓ ✓ ✓ PASS 6/3/2026
28 AA223 Cath 2 Med Air
BOOM Amico ✓ ✓ ✓ PASS 6/3/2026
29 AA223 Cath 2 Med Air
BOOM Amico ✓ ✓ ✓ PASS 6/3/2026
30 AA223 Cath 2 Vac BOOM Amico ✓ ✓ ✓ PASS 6/3/2026 31 AA223 Cath 2 Vac BOOM Amico ✓ ✓ ✓ PASS 6/3/2026 32 Surgery A239 (OR 1) N₂ BOOM Beacon ✓ ✓ ✓ PASS 6/3/2026 33 Surgery A239 (OR 1) Vac BOOM Beacon ✓ ✓ ✓ PASS 6/3/2026 34 Surgery A239 (OR 1) Vac BOOM Beacon ✓ ✓ ✓ PASS 6/3/2026 35 Surgery A238 (OR 2) N₂ BOOM Beacon ✓ ✓ ✓ PASS 6/3/2026 36 Surgery A238 (OR 2) Vac BOOM Beacon ✓ ✓ ✓ PASS 6/3/2026 37 Surgery A238 (OR 2) Vac BOOM Beacon ✓ ✓ ✓ PASS 6/3/2026 38 Surgery A234 (OR 3) O₂ BOOM Beacon ✓ ✓ ✓ PASS 6/3/2026 39 Surgery A234 (OR 3) O₂ BOOM Beacon ✓ ✓ ✓ PASS 6/3/2026
40 Surgery A234 (OR 3) Med Air
BOOM Beacon ✓ ✓ ✓ PASS 6/3/2026
Lead Technician
Kevin
Page 5 BOOMS & RETRACTABLE HOSES
Marion, NC
2/22/2025
Position
C eiling
C onnections
O utlet C onnection
H ose C ondition
Test/Inspection D ate
Joint/DISS Leak Detection & Safe Working Condition
R ecom m endation(s) or
C om m ents
R oom
# (O utlets Listed Top to
Bottom
Left to Right & Front of Room to Back)
System
Boom or Retractable C olum n
A rea or Zone
A ssem bly M anufacturer
PA
SS/FA
IL
41 Surgery A234 (OR 3)
WAG
D BOOM Beacon ✓ ✓ ✓ PASS 6/3/2026
Leaking Outlet/Inlet Connection - Repaired at time of testing
42 Surgery A234 (OR 3) Vac BOOM Beacon ✓ ✓ ✓ PASS 6/3/2026 Leaking Outlet/Inlet Connection -
Repaired at time of testing
43 Surgery A234 (OR 3) Vac BOOM Beacon ✓ ✓ ✓ PASS 6/3/2026 Leaking Outlet/Inlet Connection -
Repaired at time of testing
44 Surgery A234 (OR 3) N₂ BOOM Beacon ✓ ✓ ✓ PASS 6/3/2026 45 Surgery A234 (OR 3) Vac BOOM Beacon ✓ ✓ ✓ PASS 6/3/2026 46 Surgery A234 (OR 3) Vac BOOM Beacon ✓ ✓ ✓ PASS 6/3/2026 47 Surgery A234 (OR 3) O₂ BOOM Beacon ✓ ✓ ✓ PASS 6/3/2026 48 Surgery A234 (OR 3) Vac BOOM Beacon ✓ ✓ ✓ PASS 6/3/2026 49 Surgery A234 (OR 3) Vac BOOM Beacon ✓ ✓ ✓ PASS 6/3/2026 50 Surgery A234 (OR 3) N₂O BOOM Beacon ✓ ✓ ✓ PASS 6/3/2026
51 Surgery A234 (OR 3) Med Air
BOOM Beacon ✓ ✓ ✓ PASS 6/3/2026
52 Surgery A234 (OR 3)
WAG
D BOOM Beacon ✓ ✓ ✓ PASS 6/3/2026
53 Surgery A234 (OR 3) O₂ BOOM Beacon ✓ ✓ ✓ PASS 6/3/2026 54 Surgery A235 (OR 4) N₂ BOOM Beacon ✓ ✓ ✓ PASS 6/3/2026
Lead Technician
Kevin
Page 6 BOOMS & RETRACTABLE HOSES
Marion, NC
2/22/2025
Position
C eiling
C onnections
O utlet C onnection
H ose C ondition
Test/Inspection D ate
Joint/DISS Leak Detection & Safe Working Condition
R ecom m endation(s) or
C om m ents
R oom
# (O utlets Listed Top to
Bottom
Left to Right & Front of Room to Back)
System
Boom or Retractable C olum n
A rea or Zone
A ssem bly M anufacturer
PA
SS/FA
IL
55 Surgery A235 (OR 4) Vac BOOM Beacon ✓ ✓ ✓ PASS 6/3/2026 Leaking Outlet/Inlet Connection -
Repaired at time of testing
56 Surgery A235 (OR 4) Vac BOOM Beacon ✓ ✓ ✓ PASS 6/3/2026
57 Surgery A236A (OR 5) N₂ BOOM Beacon ✓ ✓ ✓ PASS 6/3/2026
58 Surgery A236A (OR 5) Vac BOOM Beacon ✓ ✓ ✓ PASS 6/3/2026 Leaking Outlet/Inlet Connection -
Repaired at time of testing
59 Surgery A236A (OR 5) Vac BOOM Beacon ✓ ✓ ✓ PASS 6/3/2026
60 Surgery A236A (OR 5) O₂ BOOM Beacon ✓ ✓ ✓ PASS 6/3/2026
61 Surgery A236A (OR 5) Vac BOOM Beacon ✓ ✓ ✓ PASS 6/3/2026
62 Surgery A236A (OR 5) O₂ BOOM Beacon ✓ ✓ ✓ PASS 6/3/2026
63 Surgery A236A (OR 5) Med Air
BOOM Beacon ✓ ✓ ✓ PASS 6/3/2026
64 Surgery A236A (OR 5) N₂O BOOM Beacon ✓ ✓ ✓ PASS 6/3/2026
65 Surgery A236A (OR 5)
WAG
D BOOM Beacon ✓ ✓ ✓ PASS 6/3/2026
Lead Technician
Kevin
Page 7 BOOMS & RETRACTABLE HOSES
Marion, NC
2/22/2025
Position
C eiling
C onnections
O utlet C onnection
H ose C ondition
Test/Inspection D ate
Joint/DISS Leak Detection & Safe Working Condition
R ecom m endation(s) or
C om m ents
R oom
# (O utlets Listed Top to
Bottom
Left to Right & Front of Room to Back)
System
Boom or Retractable C olum n
A rea or Zone
A ssem bly M anufacturer
PA
SS/FA
IL
66 Surgery A236A (OR 5) Vac BOOM Beacon ✓ ✓ ✓ PASS 6/3/2026
67 Surgery C205 (OR 6) N₂ BOOM Beacon ✓ ✓ ✓ PASS 6/3/2026 68 Surgery C205 (OR 6) Vac BOOM Beacon ✓ ✓ ✓ PASS 6/3/2026 69 Surgery C205 (OR 6) Vac BOOM Beacon ✓ ✓ ✓ PASS 6/3/2026
Lead Technician
Kevin
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