R_SYS_2026_VA Charleston_6.pdf

Project ID(s): 2026 Medical Gas Inspection

Project Date(s): 6/2-4/2026

8047 Castleton Road

Indianapolis, IN 46250

109 Bee St

12454599

123456789

11225

Tanner Moore ASSE Credential #:

ASSE Credential #:

ASSE Credential #:

ASSE Credential #:

Charleston, SC

Project Contact:

David Gatlin

Engineering

(803)621-6104

Project Site:

123546

Ralph H. Johnson VA Medical Center

Technician 5: ASSE Credential #:

Report Authored By:

Technician 2:

Technician 3:

Technician 4:

Technical Safety Services

1-(800)-727-8321 www.Techsafety.com

MEDICAL GAS SYSTEMS MAINTENANCE INSPECTION

Project ID(s): 2026 Medical Gas Inspection

Project Date(s): 6/2-4/2026

Tested to NFPA 99:

Report Section: COVERSHEET

Page: 1 of 90

Filename: R_SYS_2026_VA Charleston

Report Version: 3.7,5K

TESTING & INSPECTION PROCEDURES

TSS 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 TSS maintenance inspection

SOP as such signals are required to be tested by the supplier/equipment owner annually and TSS views this testing as sufficient in satisfying the NFPA 99 inspection requirement. TSS can test these signals per request, however the facility will have to direct the method used to perform this testing.

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

Report Section: SCOPE & PROCEDURES

Page: 2 of 90

MEDICAL GAS SYSTEMS MAINTENANCE INSPECTION

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 TSS'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 TSS's maintenance inspection SOP.

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.

Report Section: SCOPE & PROCEDURES

Page: 3 of 90

MEDICAL GAS SYSTEMS MAINTENANCE INSPECTION

1)

2)

3)

TSS 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.

Report Section: SCOPE & PROCEDURES

Page: 4 of 90

TABLE OF CONTENTS

■ Summary of Findings

■ Master Alarms

■ Area Alarms

■ Valves

■ Outlets & Inlets

■ Contaminants

■ Source Equipment

■ Annex

Technical Safety 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 (47)

Area Alarm Signals (88)

Valves (115) Outlets & Inlets (1216)

Contaminant Test Sites

(16)

Source Systems (7)

Deficient 0 0 6 9 0 0

Compliant 47 88 109 1207 16 7

47 88 109 1207 16 7

6 9

MEDICAL GAS SYSTEMS HEALTH BY COMPONENT

99.0%

OVERALL MEDICAL

GAS SYSTEMS HEALTH

Report Section: SYSTEMS OVERVIEW

Page: 5 of 90

MASTER ALARMS

No deficiencies at time of test

No corrective action reported

AREA ALARMS

No deficiencies at time of test

CORRECTIVE ACTION DETAIL - AREA ALARMS ALARM PANEL LOCATION(S) QTY

Area monitored labeling missing/incorrect: Added new holding bays (1 &

2) opp. D205C to label.

Radiology Front Desk 3

VALVES

DEFICIENCY DETAIL - VALVES VALVE LOCATION(S) QTY

Remove patient terminal, install locking device or locate/install Zone Valve to control rooms A301-A303, A305, A306.

0 1

Service valves shall be placed in the branch piping prior to any zone valve box assembly on that branch. Wall mounted medical equipment blocks removal of Zone(Service) Valve box hard cover

ED Main Nurses Station 3

System depressurized. Remove patient terminal, install locking device or locate/install Zone Valve to control rooms A301-A303, A305, A306.

0 2

CORRECTIVE ACTION DETAIL - VALVES VALVE LOCATION(S) QTY

Labeling inaccurate - rooms/area served: Added new holding bays (1 & 2) opp. D205C to label.

O/S D205 3

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 TSS has provided a recommendation, please note the "Annex" section of this report.

Report Section: SUMMARY OF FINDINGS

Page: 6 of 90

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 TSS has provided a recommendation, please note the "Annex" section of this report.

OUTLET & INLETS

DEFICIENCY DETAIL - OUTLETS & INLETS OUTLET/INLET LOCATION(S) / ASSET # QTY

Remove patient terminal, install locking device and label "Not in Use" or locate/install Zone Valve to control patient terminal.

3A 301, 3A 302, 3A 303, 3A 305, 3A 306 9

CORRECTIVE ACTION DETAIL - OUTLETS & INLETS OUTLET/INLET LOCATION(S) / ASSET # QTY

Damaged adapter connection - Removed damaged secondary equipment at time of testing

2nd Fl ICU A214 (ICU 2) 1

Damaged faceplate - Repaired at time of testing 2nd Fl ICU A214 (ICU 2) 1

Leaking inner check - Repaired at time of testing 4A 421, 4B South 415, 4B North 437, 3B South 358, 3B GI

Suite (Endoscopy) 322 (GI Proc. 2), Surgery A239 (OR 1), Surgery A238 (OR 2), Surgery A234 (OR 3), Surgery A235

(OR 4), Surgery A236A (OR 5), Surgery C205 (OR 6), ED 5, ED 12

GAS CONTAMINANTS

No deficiencies at time of test

No corrective action reported

SOURCE EQUIPMENT

No deficiencies at time of testing

No corrective action reported

Report Section: SUMMARY OF FINDINGS

Page: 7 of 90

MASTER ALARM SIGNALS

BY SYSTEM GAS:

12 16 6 6 0 7 0 0 0

47TOTAL 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 6 8 3 3 4

Beacon Mega Digital Module 6 8 3 3 3

47TOTAL MASTER

ALARM SIGNALS

MASTER ALARMS BREAKDOWN (*EACH MASTER ALARM SIGNAL COUNTED AS SEPARATE ALARM BY SYSTEM GAS BELOW)

Report Section: MASTER ALARM INVENTORY

Page: 8 of 90

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 Facilities O2 Beacon Mega Liquid Level Low O2 Bulk

Enclosure

60 PSI PASS

2 Facilities O2 Beacon Mega Reserve in Use O2 Bulk

Enclosure

100 PSI PASS

3 Facilities O2 Beacon Mega Reserve Liquid

Level Low

O2 Bulk

Enclosure

60 PSI PASS

4 Facilities O2 Beacon Mega Reserve

Pressure Low

O2 Bulk

Enclosure

50 PSI PASS

5 Facilities O2 Beacon Mega High Line

Pressure Hospital 60 PSI PASS

6 Facilities O2 Beacon Mega Low Line

Pressure Hospital 40 PSI PASS

7 Facilities N2O Beacon Mega Reserve in Use Manifold Room 100 PSI PASS

8 Facilities N2O Beacon Mega High Line

Pressure Manifold Room 60 PSI PASS

9 Facilities N2O Beacon Mega Low Line

Pressure Manifold Room 40 PSI PASS

10 Facilities MA Beacon Mega (1-2) High Dew

Point

Mechanical

Room

32 PSI PASS

11 Facilities MA Beacon Mega (1-2) High CO Mechanical

Room

10 PPM PASS

12 Facilities MA Beacon Mega

(1-2) Lag

Compressor in

Use

Mechanical

Room

65 PSI PASS

13 Facilities MA Beacon Mega High Line

Pressure Hospital 60 PSI PASS

14 Facilities MA Beacon Mega Low Line

Pressure Hospital 40 PSI PASS

15 Facilities VAC Beacon Mega (1-2) Lag Pump in Use

Mechanical

Room 18 inHg PASS

16 Facilities MA Beacon Mega (3-4) High Dew

Point

Mechanical

Room

32 PSI PASS

MASTER ALARMS: LOCATION & SPECIFICATION FUNCTION & CONDITION

Report Section: MASTER ALARMS

Page: 9 of 90

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

17 Facilities MA Beacon Mega

(116)

Maintenance

Required

Mechanical

Room

PASS

18 Facilities MA Beacon Mega

(116) High Dew

Point

Mechanical

Room

32 PSI PASS

19 Facilities N2 Beacon Mega Low Line

Pressure

2nd Fl Manifold

Rm

140 PSI PASS

20 Facilities N2 Beacon Mega High Line

Pressure

2nd Fl Manifold

Rm

200 PSI PASS

21 Facilities N2 Beacon Mega Reserve in Use 2nd Fl Manifold

Rm

250 PSI PASS

22 Facilities VAC Beacon Mega (New) Lag

Pump in Use

Mechanical

Room 18 inHg PASS

23 Facilities VAC Beacon Mega Low Line

Pressure Hospital 12 inHg PASS

24 Boiler Rm Shop O2 Amico A2M Liquid Level Low O2 Bulk

Enclosure

60 PSI PASS

25 Boiler Rm Shop O2 Amico A2M Reserve in Use O2 Bulk

Enclosure

100 PSI PASS

26 Boiler Rm Shop O2 Amico A2M Reserve Liquid

Level Low

O2 Bulk

Enclosure

60 PSI PASS

27 Boiler Rm Shop O2 Amico A2M Reserve

Pressure Low

O2 Bulk

Enclosure

50 PSI PASS

28 Boiler Rm Shop O2 Amico A2M High Line

Pressure Hospital 60 PSI PASS

29 Boiler Rm Shop O2 Amico A2M Low Line

Pressure Hospital 40 PSI PASS

30 Boiler Rm Shop N2O Amico A2M Reserve in Use Manifold Room 100 PSI PASS

31 Boiler Rm Shop N2O Amico A2M High Line

Pressure Manifold Room 60 PSI PASS

32 Boiler Rm Shop N2O Amico A2M Low Line

Pressure Manifold Room 40 PSI PASS

Report Section: MASTER ALARMS

Page: 10 of 90

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

33 Boiler Rm Shop MA Amico A2M (1-2) High Dew

Point

Mechanical

Room

32 PSI PASS

34 Boiler Rm Shop MA Amico A2M (1-2) High CO Mechanical

Room

10 PPM PASS

35 Boiler Rm Shop MA Amico A2M

(1-2) Lag

Compressor in

Use

Mechanical

Room

65 PSI PASS

36 Boiler Rm Shop MA Amico A2M High Line

Pressure Hospital 60 PSI PASS

37 Boiler Rm Shop MA Amico A2M Low Line

Pressure Hospital 40 PSI PASS

38 Boiler Rm Shop VAC Amico A2M (1-2) Lag Pump in Use

Mechanical

Room 18 inHg PASS

39 Boiler Rm Shop VAC Amico A2M Low Line

Pressure Hospital 12 inHg PASS

40 Boiler Rm Shop MA Amico A2M (3-4) High Dew

Point

Mechanical

Room

32 PSI PASS

41 Boiler Rm Shop MA Amico A2M

(116)

Maintenance

Required

Mechanical

Room

PASS

42 Boiler Rm Shop MA Amico A2M

(116) High Dew

Point

Mechanical

Room

32 PSI PASS

43 Boiler Rm Shop N2 Amico A2M Low Line

Pressure

2nd Fl Manifold

Rm

140 PSI PASS

44 Boiler Rm Shop N2 Amico A2M High Line

Pressure

2nd Fl Manifold

Rm

200 PSI PASS

45 Boiler Rm Shop N2 Amico A2M Reserve in Use 2nd Fl Manifold

Rm

250 PSI PASS

46 Boiler Rm Shop VAC Amico A2M (New) Lag

Pump in Use

Mechanical

Room 18 inHg PASS

47 Boiler Rm Shop VAC Amico A2M Low Line

Pressure Hospital 12 inHg PASS

Report Section: MASTER ALARMS

Page: 11 of 90

TOTAL AREA ALARM SIGNALS

BY SYSTEM GAS:

31 27 1 1 0 28 0 0 0

88TOTAL 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

Allied Impact Ivory Cover - Digital LEDs 5 4 5

Amico A2A Gray Cover with Digital Pressure 6 6 1 1 5

Amico A3A LCD Display 10 10 10

Beacon Infinity Touch Screen LCD 1 1 1

Beacon Mega Digital Module 3 1

Beacon Mega 2 Tan Cover - Digital LEDs 1 1 1

Beacon P0321 White with Murphy gauges-"Area Line Press. Alm" 5 5 5

AREA ALARMS BREAKDOWN (EACH AREA ALARM SIGNAL COUNTED AS SEPARATE ALARM BY SYSTEM GAS BELOW)

TOTAL AREA

ALARM SIGNALS

Report Section: AREA ALARMS INVENTORY

Page: 12 of 90

# 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

MSA Desk Opp 4A

Nurses Station

(Left)

A419-423, A426, A429, A430 O2 Allied Impact 52 60 40 PASS

MSA Desk Opp 4A

Nurses Station

(Left)

A419-423, A426, A429, A430 MA Allied Impact 48 60 40 PASS

MSA Desk Opp 4A

Nurses Station

(Left)

A419-423, A426, A429, A430 VAC Allied Impact 21 12 PASS

MSA Desk Opp 4A

Nurses Station

(Right)

A401-404, AS407,

A409, A410, A413-

O2 Allied Impact 52 60 40 PASS

MSA Desk Opp 4A

Nurses Station

(Right)

A401-404, AS407,

A409, A410, A413-

MA Allied Impact 48 60 40 PASS

MSA Desk Opp 4A

Nurses Station

(Right)

A401-404, AS407,

A409, A410, A413-

VAC Allied Impact 21 12 PASS

7 Opp A470 A468-A470 VAC Amico A3A 22 12 PASS

8 Opp A470 A468-A470 O2 Amico A3A 53 60 40 PASS

9 Opp A470 A468-A470 MA Amico A3A 50 60 40 PASS

4B South Nurses

Station

B404-B409, B412, B415-B417, B420-

B422, B424-B427

O2 Allied Impact 53 60 40 PASS

AREA ALARMS: LOCATION & SPECIFICATION FUNCTION AND CONDITION

Report Section: AREA ALARMS

Page: 13 of 90

# Physical Location Area/Rooms

Monitored System MFR Model

P re s s a d

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

4B South Nurses

Station

B404-B409, B412, B415-B417, B420-

B422, B424-B427

MA Allied Impact 49 60 40 PASS

4B South Nurses

Station

B404-B409, B412, B415-B417, B420-

B422, B424-B427

VAC Allied Impact 20 12 PASS

4B North Nurses

Station

B428-B431, B433-

B435, B437-B439, B441, B444, B445, B447-B450

O2 Amico A2A 53 60 40 PASS

4B North Nurses

Station

B428-B431, B433-

B435, B437-B439, B441, B444, B445, B447-B450

MA Amico A2A 50 60 40 PASS

4B North Nurses

Station

B428-B431, B433-

B435, B437-B439, B441, B444, B445, B447-B450

VAC Amico A2A 21 12 PASS

16 I/S 4B Chemo B451 Chemo B451 O2 Allied Impact 52 60 40 PASS

17 I/S 4B Chemo B451 Chemo B451 VAC Allied Impact 21 12 PASS

Behavioral Nurses

Station Not in Use O2 Beacon Mega PASS Powered off. Labeled "Not In Use"

Report Section: AREA ALARMS

Page: 14 of 90

# Physical Location Area/Rooms

Monitored System MFR Model

P re s s a d

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

Behavioral Nurses

Station Not in Use O2 Beacon Mega PASS Powered off. Labeled "Not In Use"

20 Opp B382 B381, B382, B391 O2 Beacon P0321 52 60 40 PASS

21 Opp B382 B381, B382, B391 VAC Beacon P0321 21 60 40 PASS

22 Opp B382 B381, B382, B391 MA Beacon P0321 51 12 PASS

3B South Nurses

Station (Left)

B310, B312, B315, B317, B318 MA Amico A3A 51 60 40 PASS

3B South Nurses

Station (Left)

B310, B312, B315, B317, B318 O2 Amico A3A 53 60 40 PASS

3B South Nurses

Station (Left)

B310, B312, B315, B317, B318 VAC Amico A3A 22 12 PASS

3B South Nurses

Station (Center)

B304-B307, B355, B358 MA Amico A3A 51 60 40 PASS

3B South Nurses

Station (Center)

B304-B307, B355, B358 VAC Amico A3A 21 12 PASS

Report Section: AREA ALARMS

Page: 15 of 90

# Physical Location Area/Rooms

Monitored System MFR Model

P re s s a d

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

3B South Nurses

Station (Center)

B304-B307, B355, B358 O2 Amico A3A 53 60 40 PASS

3B South Nurses

Station (Right)

B321, B322, B325, B326, B366B MA Amico A3A 51 60 40 PASS

3B South Nurses

Station (Right)

B321, B322, B325, B326, B366B O2 Amico A3A 53 60 40 PASS

3B South Nurses

Station (Right)

B321, B322, B325, B326, B366B VAC Amico A3A 21 12 PASS

3B North Nurses

Station

B329-B334, B336-

B338, B342, B347, B348

O2 Amico A2A 52 60 40 PASS

3B North Nurses

Station

B329-B334, B336-

B338, B342, B347, B348

MA Amico A2A 50 60 40 PASS

3B North Nurses

Station

B329-B334, B336-

B338, B342, B347, B348

VAC Amico A2A 21 12 PASS

35 Opp AA205 AA204A & AA206 O2 Amico A3A 54 60 40 PASS

36 Opp AA205 AA204A & AA206 MA Amico A3A 48 60 40 PASS

37 Opp AA205 AA204A & AA206 VAC Amico A3A 21 12 PASS

Report Section: AREA ALARMS

Page: 16 of 90

# Physical Location Area/Rooms

Monitored System MFR Model

P re s s a d

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

38 Opp AA206 AA205 O2 Beacon P0321 54 60 40 PASS

39 Opp AA206 AA205 MA Beacon P0321 50 60 40 PASS

40 Opp AA206 AA205 VAC Beacon P0321 22 12 PASS

41 Opp AA220 AA223 O2 Amico A2A 55 60 40 PASS

42 Opp AA220 AA223 MA Amico A2A 48 60 40 PASS

43 Opp AA220 AA223 VAC Amico A2A 22 12 PASS

44 I/S AA239 AA239 O2 Amico A2A 55 60 40 PASS

45 I/S AA239 AA239 MA Amico A2A 48 60 40 PASS

46 Opp A281

A213-A215, A221-

A223, A281, A282, A287

O2 Amico A3A 55 60 40 PASS

Report Section: AREA ALARMS

Page: 17 of 90

# Physical Location Area/Rooms

Monitored System MFR Model

P re s s a d

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

47 Opp A281

A213-A215, A221-

A223, A281, A282, A287

MA Amico A3A 48 60 40 PASS

48 Opp A281 A213-A215, A221-

A223, A281, A282 VAC Amico A3A 21 12 PASS

49 Opp A217 A216-A220 O2 Amico A3A 55 60 40 PASS

50 Opp A217 A216-A220 MA Amico A3A 48 60 40 PASS

51 Opp A217 A216-A220 VAC Amico A3A 21 12 PASS

52 Opp A229 A224-A231 O2 Amico A3A 54 60 40 PASS

53 Opp A229 A224-A231 MA Amico A3A 48 60 40 PASS

54 Opp A229 A224-A231 VAC Amico A3A 21 12 PASS

55 I/S C212 OR Suite O2 Amico A2A 55 60 40 PASS

56 I/S C212 OR Suite VAC Amico A2A 20 12 PASS

Report Section: AREA ALARMS

Page: 18 of 90

# Physical Location Area/Rooms

Monitored System MFR Model

P re s s a d

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

57 I/S C212 OR Suite N2 Amico A2A 169 200 140 PASS

58 I/S C212 OR Suite MA Amico A2A 48 60 40 PASS

59 I/S C212 OR Suite N2O Amico A2A 50 60 40 PASS

60 Opp A237 A264 (Beds 1-11), A232A (Beds 1 & 2) O2 Allied Impact 52 60 40 PASS

61 Opp A237 A264 (Beds 1-11), A232A (Beds 1 & 2) MA Allied Impact 50 60 40 PASS

62 Opp A237 A264 (Beds 1-11), A232A (Beds 1 & 2) VAC Allied Impact 21 12 PASS

63 I/S B212 B212, B212B O2 Amico A2A 54 60 40 PASS

64 I/S B212 B212, B212B MA Amico A2A 50 60 40 PASS

65 I/S B212 B212, B212B VAC Amico A2A 22 12 PASS

66 I/S B206 B204, B206(A,B,D&E) O2 Beacon Mega 53 60 40 PASS

Report Section: AREA ALARMS

Page: 19 of 90

# Physical Location Area/Rooms

Monitored System MFR Model

P re s s a d

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

67 I/S B206 B206D VAC Beacon Mega 21 12 PASS

68 I/S BB208

BB203, BB208,

BB209, BB210

O2 Beacon P0321 54 60 40 PASS

69 I/S BB208

BB203, BB208,

BB209, BB210

MA Beacon P0321 48 60 40 PASS

70 I/S BB208

BB203, BB208,

BB209, BB210

VAC Beacon P0321 22 12 PASS

Radiology Front

Desk

D205, D205C, Holding bays 1 & 2 opp. D205C, D211, D237, D238, D241, D242, D243, D245

(Bay 1 & 2), D247, D269(A, B, & J)

O2 Amico A3A 54 60 40 REPAIRED

Area monitored labeling missing/incorrect: Added new holding bays (1 & 2) opp. D205C to label.

Radiology Front

Desk

D205, Holding bays opp. D205C, D211, D237, D238, D241, D242, D243, D245

(Bay 1 & 2), D247, D269(A, B, & J)

MA Amico A3A 48 60 40 REPAIRED

Area monitored labeling missing/incorrect: Added new holding bays (1 & 2) opp. D205C to label.

Report Section: AREA ALARMS

Page: 20 of 90

# Physical Location Area/Rooms

Monitored System MFR Model

P re s s a d

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

Radiology Front

Desk

D205, D205C, Holding bays 1 & 2 opp. D205C, D211, D237, D238, D241, D242, D243, D245

(Bay 1 & 2), D247, D269(A, B, & J)

VAC Amico A3A 22 12 REPAIRED

Area monitored labeling missing/incorrect: Added new holding bays (1 & 2) opp. D205C to label.

74 O/S D225 D222 O2 Beacon P0321 54 60 40 PASS

75 O/S D225 D222 MA Beacon P0321 54 60 40 PASS

76 O/S D225 D222 VAC Beacon P0321 24 12 PASS

77 I/S A164A

A110-A112, A114-

A116, A119-A127, A167

O2 Amico A3A 52 60 40 PASS

78 I/S A164A A167 MA Amico A3A 50 60 40 PASS

79 I/S A164A

A110-A112, A114-

A116, A119-A127, A167

VAC Amico A3A 23 12 PASS

Report Section: AREA ALARMS

Page: 21 of 90

# Physical Location Area/Rooms

Monitored System MFR Model

P re s s a d

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

Main ED Nurses

Station

ED 4-18 (Alarm sensors located downstream of ED

4-10 Service

Valves)

O2 Beacon Mega 2 52 60 40 PASS

Main ED Nurses

Station

ED 4-18 (Alarm sensors located downstream of ED

4-10 Service

Valves)

MA Beacon Mega 2 46 60 40 PASS

Main ED Nurses

Station

ED 4-18 (Alarm sensors located downstream of ED

4-10 Service

Valves)

VAC Beacon Mega 2 21 12 PASS

Rear ED Nurses

Station

ED 4-18 (Alarm sensors located upstream of ED 4-

10 Service Valves)

O2 Beacon Infinity 52 60 40 PASS

Rear ED Nurses

Station

ED 4-18 (Alarm sensors located upstream of ED 4-

10 Service Valves)

MA Beacon Infinity 46 60 40 PASS

Rear ED Nurses

Station

ED 4-18 (Alarm sensors located upstream of ED 4-

10 Service Valves)

VAC Beacon Infinity 21 12 PASS

86 O/S F215 G200 O2 Beacon P0321 55 60 40 PASS

Report Section: AREA ALARMS

Page: 22 of 90

# Physical Location Area/Rooms

Monitored System MFR Model

P re s s a d

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

87 O/S F215 G200 MA Beacon P0321 52 60 40 PASS

88 O/S F215 G200 VAC Beacon P0321 22 12 PASS

Report Section: AREA ALARMS

Page: 23 of 90

TOTAL VALVES

BY SYSTEM GAS:

36 33 6 6 0 34 0 0 0

115TOTAL

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

Allied Zone - 1/4 Turn Accessible valve through which all station outlets/inlets are served 3 2 2

Amico Zone - 1/4 Turn Accessible valve through which all station outlets/inlets are served 20 19 5 5 19

Beacon Service - 1/4 Turn For servicing or modification of lateral branch piping 1 1 1

Beacon Zone - 1/4 Turn Accessible valve through which all station outlets/inlets are served 12 11 1 1 12

VALVES BREAKDOWN (EACH SYSTEM GAS COUNTED AS SEPARATE ZONE VALVE)

115TOTAL

VALVES

Report Section: VALVES INVENTORY

Page: 24 of 90

# 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

O/S A413

A401-A404, A407, A409, A410, A413-

A417

O2 Allied Zone - 1/4 Turn 54 PASS

O/S A413

A401-A404, A407, A409, A410, A413-

A417

MA Allied Zone - 1/4 Turn 50 PASS

O/S A413

A401-A404, A407, A409, A410, A413-

A417

VAC Allied Zone - 1/4 Turn 21 PASS

Opp A423

A419-A423, A426, A429, A430 O2 Allied Zone - 1/4 Turn 54 PASS

Opp A423

A419-A423, A426, A429, A430 MA Allied Zone - 1/4 Turn 50 PASS

Opp A423

A419-A423, A426, A429, A430 VAC Allied Zone - 1/4 Turn 21 PASS

7 O/S A469 A468-A470 O2 Amico Zone - 1/4 Turn 53 PASS

8 O/S A469 A468-A470 MA Amico Zone - 1/4 Turn 50 PASS

9 O/S A469 A468-A470 VAC Amico Zone - 1/4 Turn 22 PASS

4B South Nurses

Station

B404-409, B412, B415-B417, B420-

B422, B424-B427

O2 Beacon Zone - 1/4 Turn 50 PASS

4B South Nurses

Station

B404-409, B412, B415-B417, B420-

B422, B424-B427

MA Beacon Zone - 1/4 Turn 42 PASS

4B South Nurses

Station

B404-409, B412, B415-B417, B420-

B422, B424-B427

VAC Beacon Zone - 1/4 Turn 21 PASS

Opp 4B North Nurses

Station

B428-B431, B433-

B435, B437-B439, B441, B444, B445, B447-B450

VAC Amico Zone - 1/4 Turn 22 PASS

VALVES: LOCATION & SPECIFICATION FUNCTION AND CONDITION

Report Section: VALVES

Page: 25 of 90

# 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

Opp 4B North Nurses

Station

B428-B431, B433-

B435, B437-B439, B441, B444, B445, B447-B450

MA Amico Zone - 1/4 Turn 50 PASS

Opp 4B North Nurses

Station

B428-B431, B433-

B435, B437-B439, B441, B444, B445, B447-B450

O2 Amico Zone - 1/4 Turn 52 PASS

16 Opp B405 Chemo B451 O2 Amico Zone - 1/4 Turn 58 PASS

17 Opp B405 Chemo B451 VAC Amico Zone - 1/4 Turn 23 PASS

A301, A302, A303, A305, A306

O2 FAIL

System depressurized. Remove patient terminal, install locking device or locate/install Zone Valve to control rooms A301-A303, A305, A306.

A301, A302, A303, A305, A306

MA FAIL

System depressurized. Remove patient terminal, install locking device or locate/install Zone Valve to control rooms A301-A303, A305, A306.

A301, A302, A303, A305, A306

VAC FAIL

Remove patient terminal, install locking device or locate/install Zone Valve to control rooms A301-A303, A305, A306.

21 3rd Fl Behavioral

Health Entrance Not In Use O2 Beacon Zone - 1/4 Turn X PASS Labeled "Not in Use"

22 Opp B382 B381, B382, B391 MA Amico Zone - 1/4 Turn 52 PASS

23 Opp B382 B381, B382, B391 O2 Amico Zone - 1/4 Turn 52 PASS

24 Opp B382 B381, B382, B391 VAC Amico Zone - 1/4 Turn 22 PASS

O/S B307

B304-B307, B355, B358 MA Beacon Zone - 1/4 Turn 52 PASS

O/S B307

B304-B307, B355, B358 O2 Beacon Zone - 1/4 Turn 52 PASS

O/S B307

B304-B307, B355, B358 VAC Beacon Zone - 1/4 Turn 21 PASS

Report Section: VALVES

Page: 26 of 90

# 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

28 3B South Nurses

Station

B310, B312, B315,B317, B318 MA Amico Zone - 1/4 Turn 52 PASS

29 3B South Nurses

Station

B310, B312, B315,B317, B318 O2 Amico Zone - 1/4 Turn 54 PASS

30 3B South Nurses

Station

B310, B312, B315,B317, B318 VAC Amico Zone - 1/4 Turn 21 PASS

31 O/S 3B South Nurses

Station

B321, B322, B325, B326, B366B MA Amico Zone - 1/4 Turn 50 PASS

32 O/S 3B South Nurses

Station

B321, B322, B325, B326, B366B O2 Amico Zone - 1/4 Turn 52 PASS

33 O/S 3B South Nurses

Station

B321, B322, B325, B326, B366B VAC Amico Zone - 1/4 Turn 22 PASS

Opp 3B North Nurses

Station

B329-B334, B336-

B338, B342, B347, B348

O2 Beacon Zone - 1/4 Turn 50 PASS

Opp 3B North Nurses

Station

B329-B334, B336-

B338, B342, B347, B348

MA Beacon Zone - 1/4 Turn 50 PASS

Opp 3B North Nurses

Station

B329-B334, B336-

B338, B342, B347, B348

VAC Beacon Zone - 1/4 Turn 21 PASS

37 O/S C318 Not In Use O2 Allied Zone - 1/4 Turn X PASS Labeled "Not in Use"

38 Opp AA205 AA204A & AA206 O2 Amico Zone - 1/4 Turn 54 PASS

39 Opp AA205 AA204A & AA206 MA Amico Zone - 1/4 Turn 48 PASS

40 Opp AA205 AA204A & AA206 VAC Amico Zone - 1/4 Turn 22 PASS

41 Opp AA207 AA205 O2 Beacon Zone - 1/4 Turn 54 PASS

42 Opp AA207 AA205 MA Beacon Zone - 1/4 Turn 50 PASS

43 Opp AA207 AA205 VAC Beacon Zone - 1/4 Turn 24 PASS

44 Opp AA220 AA223 O2 Beacon Zone - 1/4 Turn 54 PASS

45 Opp AA220 AA223 MA Beacon Zone - 1/4 Turn 50 PASS

46 Opp AA220 AA223 VAC Beacon Zone - 1/4 Turn 24 PASS

Report Section: VALVES

Page: 27 of 90

# 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

47 O/S AA239 AA239 MA Amico Zone - 1/4 Turn 50 PASS

48 O/S AA239 AA239 O2 Amico Zone - 1/4 Turn 56 PASS

Opp A215

A213-A215, A221-

A223, A281, A282, A287

O2 Amico Zone - 1/4 Turn 56 PASS

Opp A215

A213-A215, A221-

A223, A281, A282, A287

MA Amico Zone - 1/4 Turn 52 PASS

Opp A215

A213-A215, A221-

A223, A281, A282 VAC Amico Zone - 1/4 Turn 21 PASS

52 Opp A216 A216-A220 O2 Amico Zone - 1/4 Turn 54 PASS

53 Opp A216 A216-A220 MA Amico Zone - 1/4 Turn 50 PASS

54 Opp A216 A216-A220 VAC Amico Zone - 1/4 Turn 22 PASS

55 Opp A224 A224-A231 O2 Amico Zone - 1/4 Turn 54 PASS

56 Opp A224 A224-A231 MA Amico Zone - 1/4 Turn 50 PASS

57 Opp A224 A224-A231 VAC Amico Zone - 1/4 Turn 22 PASS

58 I/S Sub Sterile A238B

(O/S OR 1)

A239 (OR 1) N2 Amico Zone - 1/4 Turn 180 PASS

59 I/S Sub Sterile A238B

(O/S OR 1)

A239 (OR 1) MA Amico Zone - 1/4 Turn 50 PASS

60 I/S Sub Sterile A238B

(O/S OR 1)

A239 (OR 1) N2O Amico Zone - 1/4 Turn 50 PASS

61 I/S Sub Sterile A238B

(O/S OR 1)

A239 (OR 1) O2 Amico Zone - 1/4 Turn 54 PASS

62 I/S Sub Sterile A238B

(O/S OR 1)

A239 (OR 1) VAC Amico Zone - 1/4 Turn 22 PASS

63 I/S Sub Sterile A238B

(O/S OR 2)

A238 (OR 2) N2 Amico Zone - 1/4 Turn 180 PASS

64 I/S Sub Sterile A238B

(O/S OR 2)

A238 (OR 2) MA Amico Zone - 1/4 Turn 52 PASS

65 I/S Sub Sterile A238B

(O/S OR 2)

A238 (OR 2) N2O Amico Zone - 1/4 Turn 50 PASS

Report Section: VALVES

Page: 28 of 90

# 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

66 I/S Sub Sterile A238B

(O/S OR 2)

A238 (OR 2) O2 Amico Zone - 1/4 Turn 54 PASS

67 I/S Sub Sterile A238B

(O/S OR 2)

A238 (OR 2) VAC Amico Zone - 1/4 Turn 23 PASS

68 I/S Sub Sterile A234B

(O/S OR 3)

A234 (OR 3) N2 Amico Zone - 1/4 Turn 180 PASS

69 I/S Sub Sterile A234B

(O/S OR 3)

A234 (OR 3) MA Amico Zone - 1/4 Turn 52 PASS

70 I/S Sub Sterile A234B

(O/S OR 3)

A234 (OR 3) N2O Amico Zone - 1/4 Turn 50 PASS

71 I/S Sub Sterile A234B

(O/S OR 3)

A234 (OR 3) O2 Amico Zone - 1/4 Turn 54 PASS

72 I/S Sub Sterile A234B

(O/S OR 3)

A234 (OR 3) VAC Amico Zone - 1/4 Turn 21 PASS

73 I/S Sub Sterile A234B

(O/S OR 4)

A235 (OR 4) N2 Amico Zone - 1/4 Turn 180 PASS

74 I/S Sub Sterile A234B

(O/S OR 4)

A235 (OR 4) MA Amico Zone - 1/4 Turn 52 PASS

75 I/S Sub Sterile A234B

(O/S OR 4)

A235 (OR 4) N2O Amico Zone - 1/4 Turn 50 PASS

76 I/S Sub Sterile A234B

(O/S OR 4)

A235 (OR 4) O2 Amico Zone - 1/4 Turn 54 PASS

77 I/S Sub Sterile A234B

(O/S OR 4)

A235 (OR 4) VAC Amico Zone - 1/4 Turn 23 PASS

78 Opp A236A A236A (OR 5) N2 Amico Zone - 1/4 Turn 180 PASS

79 Opp A236A A236A (OR 5) MA Amico Zone - 1/4 Turn 52 PASS

80 Opp A236A A236A (OR 5) N2O Amico Zone - 1/4 Turn 50 PASS

81 Opp A236A A236A (OR 5) O2 Amico Zone - 1/4 Turn 54 PASS

82 Opp A236A A236A (OR 5) VAC Amico Zone - 1/4 Turn 21 PASS

83 O/S C205 C205 (OR 6) O2 Beacon Zone - 1/4 Turn 54 PASS

84 O/S C205 C205 (OR 6) MA Beacon Zone - 1/4 Turn 50 PASS

85 O/S C205 C205 (OR 6) N2O Beacon Zone - 1/4 Turn 50 PASS

Report Section: VALVES

Page: 29 of 90

# 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

86 O/S C205 C205 (OR 6) N2 Beacon Zone - 1/4 Turn 180 PASS

87 O/S C205 C205 (OR 6) VAC Beacon Zone - 1/4 Turn 21 PASS

88 O/S A233 A232A, A264 O2 Beacon Zone - 1/4 Turn 54 PASS

89 O/S A233 A232A, A264 MA Beacon Zone - 1/4 Turn 50 PASS

90 O/S A233 A232A, A264 VAC Beacon Zone - 1/4 Turn 22 PASS

91 O/S B212 B212 B212B O2 Beacon Zone - 1/4 Turn 54 PASS

92 O/S B212 B212 B212B MA Beacon Zone - 1/4 Turn 50 PASS

93 O/S B212 B212 B212B VAC Beacon Zone - 1/4 Turn 22 PASS

O/S B206

B204, B206(A,B,D&E) O2 Beacon Zone - 1/4 Turn 54 PASS

95 O/S B206 206D VAC Beacon Zone - 1/4 Turn 23 PASS

O/S BB232

BB203, BB208,

BB209, BB210

O2 Beacon Zone - 1/4 Turn 54 PASS

O/S BB232

BB203, BB208,

BB209, BB210

MA Beacon Zone - 1/4 Turn 48 PASS

O/S BB232

BB203, BB208,

BB209, BB210

VAC Beacon Zone - 1/4 Turn 22 PASS

99 Opp BB211 Not In Use MA Beacon Zone - 1/4 Turn 0 PASS

100 Opp BB211 Not In Use VAC Beacon Zone - 1/4 Turn 0 PASS

O/S D205

D205, D205C, Holding bays 1 & 2 opp. D205C, D211, D237, D238, D241, D242, D243, D245

(Bay 1 & 2), D247, D269(A, B, & J)

O2 Beacon Zone - 1/4 Turn 50 REPAIRED Labeling inaccurate - rooms/area served: Added new holding bays (1 &

2) opp. D205C to label.

Report Section: VALVES

Page: 30 of 90

# 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

O/S D205

D205, Holding bays 1

& 2 opp. D205C, D211, D237, D238, D241, D242, D243, D245 (Bay 1 & 2), D247, D269(A, B, &

J)

MA Beacon Zone - 1/4 Turn 50 REPAIRED Labeling inaccurate - rooms/area served: Added new holding bays (1 &

2) opp. D205C to label.

O/S D205

D205, D205C, Holding bays 1 & 2 opp. D205C, D211, D237, D238, D241, D242, D243, D245

(Bay 1 & 2), D247, D269(A, B, & J)

VAC Beacon Zone - 1/4 Turn 23 REPAIRED Labeling inaccurate - rooms/area served: Added new holding bays (1 &

2) opp. D205C to label.

104 O/S D225 D222 O2 Amico Zone - 1/4 Turn 56 PASS

105 O/S D225 D222 MA Amico Zone - 1/4 Turn 54 PASS

106 O/S D225 D222 VAC Amico Zone - 1/4 Turn 24 PASS

O/S A119

A110-A112, A114-

A116, A119-A127, A167

O2 Amico Zone - 1/4 Turn 52 PASS

108 O/S A119 A167 MA Amico Zone - 1/4 Turn 50 PASS

O/S A119

A110-A112, A114-

A116, A119-A127, A167

VAC Amico Zone - 1/4 Turn 23 PASS

Report Section: VALVES

Page: 31 of 90

# 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

ED Main Nurses

Station

ED 4-10 (Labeled as

"Service Valves") O2 Beacon Service - 1/4 Turn X FAIL

Service valves shall be placed in the branch piping prior to any zone valve box assembly on that branch. Wall mounted medical equipment blocks removal of Zone(Service) Valve box hard cover

ED Main Nurses

Station

ED 4-10 (Labeled as

"Service Valves") MA Beacon Service - 1/4 Turn X FAIL

Service valves shall be placed in the branch piping prior to any zone valve box assembly on that branch. Wall mounted medical equipment blocks removal of Zone(Service) Valve box hard cover

ED Main Nurses

Station

ED 4-10 (Labeled as

"Service Valves") VAC Beacon Service - 1/4 Turn X FAIL

Service valves shall be placed in the branch piping prior to any zone valve box assembly on that branch. Wall mounted medical equipment blocks removal of Zone(Service) Valve box hard cover

O/S CC117

ED 4-18 (B172, B174,

B180-B185, CC102-

CC105, CC107-

CC109)

O2 Amico Zone - 1/4 Turn 54 PASS

O/S CC117

ED 4-18 (B172, B174,

B180-B185, CC102-

CC105, CC107-

CC109)

MA Amico Zone - 1/4 Turn 49 PASS

O/S CC117

ED 4-18 (B172, B174,

B180-B185, CC102-

CC105, CC107-

CC109)

VAC Amico Zone - 1/4 Turn 22 PASS

116 O/S F215 G200 O2 Amico Zone - 1/4 Turn 55 PASS

117 O/S F215 G200 MA Amico Zone - 1/4 Turn 52 PASS

118 O/S F215 G200 VAC Amico Zone - 1/4 Turn 22 PASS

Report Section: VALVES

Page: 32 of 90

TOTAL

OUTLETS/

INLETS:

TOTAL OUTLETS/INLETS

BY SYSTEM GAS:

322 6 6 0 499 15 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

Amico O-CHEM Original Style - Chemetron Quick Connect 176 147 258 6

Amico O-DISS Original Style - DISS 35 29 35 2

Beacon B-CHEM Series B - CHEM 18 18 18

Beacon B-DISS Series B - DISS 12 6 5 24 6

Beacon CP-Ohmeda N2 Control Panel (Older Stainless Finish) 6

Beacon DIA III Diamond III Plastic Poppet w/ "Y" (Console Style Galvanized Plate) 33 27 28

Beacon DISS III Diamond III/Gemini w/ DISS Connection 2 2 1 3 1

Beacon O-CHEM 1 2 2

Schrader QC 1/8 turn quick connect 9 9 9

Tritech GRAD-CHEM CHEM - White Trim Plate/Color Graduated Front Plate 82 82 122

OUTLETS, INLETS & MANUFACTURED ASSEMBLY INVENTORY BREAKDOWN:

Report Section: OUTLETS & INLETS INVENTORY

Page: 33 of 90

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 4A 401 O2 Amico O-CHEM Artwall PASS

2 4A 401 MA Amico O-CHEM Artwall PASS

3 4A 401 VAC Amico O-CHEM Artwall PASS

4 4A 402 O2 Amico O-CHEM Artwall PASS

5 4A 402 MA Amico O-CHEM Artwall PASS

6 4A 402 VAC Amico O-CHEM Artwall PASS

7 4A 403 O2 Amico O-CHEM Artwall PASS

8 4A 403 MA Amico O-CHEM Artwall PASS

9 4A 403 VAC Amico O-CHEM Artwall PASS

10 4A 404 O2 Amico O-CHEM Artwall PASS

11 4A 404 MA Amico O-CHEM Artwall PASS

12 4A 404 VAC Amico O-CHEM Artwall PASS

13 4A 407 O2 Amico O-CHEM Artwall PASS

14 4A 407 MA Amico O-CHEM Artwall PASS

15 4A 407 VAC Amico O-CHEM Artwall PASS

16 4A 409 O2 Amico O-CHEM Artwall PASS

17 4A 409 MA Amico O-CHEM Artwall PASS

18 4A 409 VAC Amico O-CHEM Artwall PASS

19 4A 410 O2 Amico O-CHEM Artwall PASS

20 4A 410 MA Amico O-CHEM Artwall PASS

21 4A 410 VAC Amico O-CHEM Artwall PASS

22 4A 413 O2 Amico O-CHEM Artwall PASS

23 4A 413 MA Amico O-CHEM Artwall PASS

24 4A 413 VAC Amico O-CHEM Artwall PASS

25 4A 414 O2 Amico O-CHEM Artwall PASS

26 4A 414 MA Amico O-CHEM Artwall PASS

27 4A 414 VAC Amico O-CHEM Artwall PASS

FUNCTION & CONDITION

Report Section: OUTLETS & INLETS

Page: 34 of 90

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

28 4A 415 O2 Amico O-CHEM Artwall PASS

29 4A 415 MA Amico O-CHEM Artwall PASS

30 4A 415 VAC Amico O-CHEM Artwall PASS

31 4A 416 O2 Amico O-CHEM Artwall PASS

32 4A 416 MA Amico O-CHEM Artwall PASS

33 4A 416 VAC Amico O-CHEM Artwall PASS

34 4A 417 O2 Amico O-CHEM Artwall PASS

35 4A 417 MA Amico O-CHEM Artwall PASS

36 4A 417 VAC Amico O-CHEM Artwall PASS

37 4A 419 O2 Amico O-CHEM Artwall PASS

38 4A 419 MA Amico O-CHEM Artwall PASS

39 4A 419 VAC Amico O-CHEM Artwall PASS

40 4A 420 O2 Amico O-CHEM Artwall PASS

41 4A 420 MA Amico O-CHEM Artwall PASS

42 4A 420 VAC Amico O-CHEM Artwall PASS

43 4A 421 O2 Amico O-CHEM Artwall PASS

44 4A 421 MA Amico O-CHEM Artwall PASS

45 4A 421 VAC Amico O-CHEM Artwall REPAIRED Leaking inner check - Repaired at time of testing

46 4A 422 O2 Amico O-CHEM Artwall PASS

47 4A 422 MA Amico O-CHEM Artwall PASS

48 4A 422 VAC Amico O-CHEM Artwall PASS

49 4A 423 O2 Amico O-CHEM Artwall PASS

50 4A 423 MA Amico O-CHEM Artwall PASS

51 4A 423 VAC Amico O-CHEM Artwall PASS

52 4A 426 O2 Amico O-CHEM Artwall PASS

53 4A 426 MA Amico O-CHEM Artwall PASS

54 4A 426 VAC Amico O-CHEM Artwall PASS

Report Section: OUTLETS & INLETS

Page: 35 of 90

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

55 4A 429 O2 Amico O-CHEM Artwall PASS

56 4A 429 MA Amico O-CHEM Artwall PASS

57 4A 429 VAC Amico O-CHEM Artwall PASS

58 4A 430 O2 Amico O-CHEM Artwall PASS

59 4A 430 MA Amico O-CHEM Artwall PASS

60 4A 430 VAC Amico O-CHEM Artwall PASS

61 4A 468 O2 Amico O-CHEM Artwall PASS

62 4A 468 MA Amico O-CHEM Artwall PASS

63 4A 468 VAC Amico O-CHEM Artwall PASS

64 4A 469 O2 Amico O-CHEM Artwall PASS

65 4A 469 MA Amico O-CHEM Artwall PASS

66 4A 469 VAC Amico O-CHEM Artwall PASS

67 4A 470 O2 Amico O-CHEM Artwall PASS

68 4A 470 MA Amico O-CHEM Artwall PASS

69 4A 470 VAC Amico O-CHEM Artwall PASS

70 4B South 404 VAC Amico O-CHEM Headwall (Wall) PASS

71 4B South 404 MA Amico O-CHEM Headwall (Wall) PASS

72 4B South 404 VAC Amico O-CHEM Headwall (Wall) PASS

73 4B South 404 O2 Amico O-CHEM Headwall (Wall) PASS

74 4B South 404 VAC Amico O-CHEM Headwall (Wall) PASS

75 4B South 404 MA Amico O-CHEM Headwall (Wall) PASS

76 4B South 404 VAC Amico O-CHEM Headwall (Wall) PASS

77 4B South 404 O2 Amico O-CHEM Headwall (Wall) PASS

78 4B South 405 VAC Amico O-CHEM Headwall (Wall) PASS

79 4B South 405 MA Amico O-CHEM Headwall (Wall) PASS

80 4B South 405 VAC Amico O-CHEM Headwall (Wall) PASS

81 4B South 405 O2 Amico O-CHEM Headwall (Wall) PASS

Report Section: OUTLETS & INLETS

Page: 36 of 90

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

82 4B South 406 VAC Amico O-CHEM Headwall (Wall) PASS

83 4B South 406 MA Amico O-CHEM Headwall (Wall) PASS

84 4B South 406 VAC Amico O-CHEM Headwall (Wall) PASS

85 4B South 406 O2 Amico O-CHEM Headwall (Wall) PASS

86 4B South 407 VAC Amico O-CHEM Headwall (Wall) PASS

87 4B South 407 MA Amico O-CHEM Headwall (Wall) PASS

88 4B South 407 VAC Amico O-CHEM Headwall (Wall) PASS

89 4B South 407 O2 Amico O-CHEM Headwall (Wall) PASS

90 4B South 408 VAC Amico O-CHEM Headwall (Wall) PASS

91 4B South 408 MA Amico O-CHEM Headwall (Wall) PASS

92 4B South 408 VAC Amico O-CHEM Headwall (Wall) PASS

93 4B South 408 O2 Amico O-CHEM Headwall (Wall) PASS

94 4B South 408 VAC Amico O-CHEM Headwall (Wall) PASS

95 4B South 408 MA Amico O-CHEM Headwall (Wall) PASS

96 4B South 408 VAC Amico O-CHEM Headwall (Wall) PASS

97 4B South 408 O2 Amico O-CHEM Headwall (Wall) PASS

98 4B South 409 VAC Amico O-CHEM Headwall (Wall) PASS

99 4B South 409 MA Amico O-CHEM Headwall (Wall) PASS

100 4B South 409 VAC Amico O-CHEM Headwall (Wall) PASS

101 4B South 409 O2 Amico O-CHEM Headwall (Wall) PASS

102 4B South 412 VAC Amico O-CHEM Headwall (Wall) PASS

103 4B South 412 MA Amico O-CHEM Headwall (Wall) PASS

104 4B South 412 VAC Amico O-CHEM Headwall (Wall) PASS

105 4B South 412 O2 Amico O-CHEM Headwall (Wall) PASS

106 4B South 415 VAC Amico O-CHEM Headwall (Wall) PASS

107 4B South 415 MA Amico O-CHEM Headwall (Wall) PASS

108 4B South 415 VAC Amico O-CHEM Headwall (Wall) PASS

Report Section: OUTLETS & INLETS

Page: 37 of 90

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

109 4B South 415 O2 Amico O-CHEM Headwall (Wall) REPAIRED Leaking inner check - Repaired at time of testing

110 4B South 416 VAC Amico O-CHEM Headwall (Wall) PASS

111 4B South 416 MA Amico O-CHEM Headwall (Wall) PASS

112 4B South 416 VAC Amico O-CHEM Headwall (Wall) PASS

113 4B South 416 O2 Amico O-CHEM Headwall (Wall) PASS

114 4B South 417 VAC Amico O-CHEM Headwall (Wall) PASS

115 4B South 417 MA Amico O-CHEM Headwall (Wall) PASS

116 4B South 417 VAC Amico O-CHEM Headwall (Wall) PASS

117 4B South 417 O2 Amico O-CHEM Headwall (Wall) PASS

118 4B South 420 VAC Amico O-CHEM Headwall (Wall) PASS

119 4B South 420 MA Amico O-CHEM Headwall (Wall) PASS

120 4B South 420 VAC Amico O-CHEM Headwall (Wall) PASS

121 4B South 420 O2 Amico O-CHEM Headwall (Wall) PASS

122 4B South 421 VAC Amico O-CHEM Headwall (Wall) PASS

123 4B South 421 MA Amico O-CHEM Headwall (Wall) PASS

124 4B South 421 VAC Amico O-CHEM Headwall (Wall) PASS

125 4B South 421 O2 Amico O-CHEM Headwall (Wall) PASS

126 4B South 422 VAC Amico O-CHEM Headwall (Wall) PASS

127 4B South 422 MA Amico O-CHEM Headwall (Wall) PASS

128 4B South 422 VAC Amico O-CHEM Headwall (Wall) PASS

129 4B South 422 O2 Amico O-CHEM Headwall (Wall) PASS

130 4B South 424 VAC Amico O-CHEM Headwall (Wall) PASS

131 4B South 424 MA Amico O-CHEM Headwall (Wall) PASS

132 4B South 424 VAC Amico O-CHEM Headwall (Wall) PASS

133 4B South 424 O2 Amico O-CHEM Headwall (Wall) PASS

134 4B South 425 VAC Amico O-CHEM Headwall (Wall) PASS

135 4B South 425 MA Amico O-CHEM Headwall (Wall) PASS

Report Section: OUTLETS & INLETS

Page: 38 of 90

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

136 4B South 425 VAC Amico O-CHEM Headwall (Wall) PASS

137 4B South 425 O2 Amico O-CHEM Headwall (Wall) PASS

138 4B South 426 VAC Amico O-CHEM Headwall (Wall) PASS

139 4B South 426 MA Amico O-CHEM Headwall (Wall) PASS

140 4B South 426 VAC Amico O-CHEM Headwall (Wall) PASS

141 4B South 426 O2 Amico O-CHEM Headwall (Wall) PASS

142 4B South 426 VAC Amico O-CHEM Headwall (Wall) PASS

143 4B South 426 MA Amico O-CHEM Headwall (Wall) PASS

144 4B South 426 VAC Amico O-CHEM Headwall (Wall) PASS

145 4B South 426 O2 Amico O-CHEM Headwall (Wall) PASS

146 4B South 427 VAC Amico O-CHEM Headwall (Wall) PASS

147 4B South 427 MA Amico O-CHEM Headwall…