STATEMENT OF WORK.docx

?.## STATEMENT OF WORK

Hudson Valley Health Care System - Castle Point & Montrose Campus

I. Contract Title:

Maintenance, Repair, Tuning, Calibration and Safety Device Testing of High-Pressure Boilers at the VA Hudson Valley HCS II. Background:

The Hudson Valley Health Care System has a requirement for the Inspection, Safety Device Testing, Tuning, Calibration, Maintenance and Repair of the High-Pressure and Low-Pressure Boilers at Montrose and Castle Point Boiler Campuses. Hudson Valley Health Care System has a central boiler plant to provide steam for heating, air conditioning, domestic hot water, kitchens, sterilization, and laundry services. The contract also includes repair and maintenance for both campus low pressure boilers.

III. Place of Performance:

Department of Veterans Affairs Hudson Valley Health Care System VAMC-FDR-Montrose Campus 2094 Albany Post Road Montrose, New York 10548, Building 20 Boiler Plant

Department of Veterans Affairs Hudson Valley Health Care System VAMC – Castle Point Campus 41 Castle Point Road Wappinger Falls, New York 12590, Building 35 Boiler Plant

IV. Type of Contract:

Firm Fixed Price Contract, 12-month Base Year with four (4) Option Years.

V. Estimated Period of Performance:

The base period of performance will be one (1) year from the date of award with provision of four (4) Option Years

VI. Scope:

1. GENERAL REQUIREMENTS:

a. The vendor shall provide all labor, management, tools, supplies, and equipment to provide routine and emergency repair service, boiler safety device testing, tuning, and calibration for Government owned boilers and associated equipment in accordance with this contract. The vendor shall have the ability to provide or procure specialty services such as R-stamp welders, Boiler technicians, controls technicians, controls engineers as needed.

b. Vendor shall remove from service one boiler at a time for the boiler tests, tuning and calibration procedures. Work must be conducted when the COR or his/her designate is available on site to monitor the work.

c. Boiler Plant Preventive Maintenance shall be in accordance with Veterans Affairs (VA) Directive 1810 dated January 4, 2023, VHA Boiler Plant Safety Device Testing Manual 8th edition (or current edition), NFPA 85A, Boiler and Burner manufacturers’ requirements, industry standards and statutory requirements.

d. The vendor while performing preventive maintenance, safety device testing, tuning and calibration shall inform the COR of any required repairs, equipment malfunction and/or abnormalities.

2. HIGH PRESSURE (HP) BOILER PLANT SAFETY DEVICE TESTING REQUIREMENTS:

a. The vendor shall perform the below safety device testing in accordance with VHA Directive 1810 & VHA Boiler Plant Safety Device Testing Manual 8th edition (or current edition). All safety device test results and data shall be recorded and submitted in the VHA Boiler Plant Safety Device Testing Manual current edition, see reporting requirements for additional information. The safety device tests shall be performed at the frequencies indicated in the below tables, where (6M) indicates tests that shall be performed every six months (for our campus, that is typically August and February), and (Y) indicates tests that shall be performed annually.

Operational Testing of Boiler Safety Devices

Operational Testing of Plant Safety Device Test

Safety Device tests

Frequency

3. HIGH PRESSURE BOILER TUNING AND CALIBRATION REQUIREMENTS:

a. The following required combustion tuning shall be completed by the vendor semi-annually in the months of February and August of each contract year:

i. Boiler fouling and combustion gas flow check (natural gas and #2 fuel oil).

ii. Vendor shall provide O2 bottle for testing oxygen sensor.

iii. Adjust burner combustion settings and calibrate oxygen trim (natural gas and #2 fuel oil).

iv. Check vibration of burner fans.

v. Calibrate instrumentation, monitoring, and control systems (natural gas and #2 fuel oil).

vi. Change all batteries in boiler controls where applicable.

vii. Test and record the operation and set points of all burner/boiler safety interlock devices. Refer to list herein. Verify that the set points and operating points are within approximately 20 percent of normal operating parameters. Adjust as necessary and record the new settings. The operation of a device must result in burner shutdown and/or proper alarm operation.

viii. Operate burner(s) on each fuel from low fire to high fire and back to low fire in at least 10 increments on natural gas and 7 increments on fuel oil and record combustion performance (flue gas oxygen, carbon monoxide, Nitrogen Oxides (NOx) where applicable), fuel train pressures, atomizing train pressures, burner pressures, stack temperatures, boiler steam output.

ix. Compare the combustion performance data with Hudson Valley requirements as stated herein and previous readings. If necessary, adjust the fuel flow and combustion air controllers, control valves and dampers to obtain the required performance. Record the new performance data.

x. Verify accuracy of instrumentation listed below. Verify that all devices are properly selected for the application in terms of type, size, set point range, performance, and code approval. Calibrate all instruments that are not within manufacturer specifications for accuracy.

xi. Vendor shall perform boiler tuning to meet or exceed the following minimum requirements, and shall provide all combustion analyzers (Calibrated) as well as performance data indicating these requirements have been met or exceeded:

b. Required burner performance (natural gas and fuel oil):

i. Turndown (ratio of maximum and minimum firing rates): 10/1, 8/1, 5/1, 4/1 (Refer to original burner specification).

ii. Achieve, but do not exceed, boiler maximum steam flow output rating. Measure fuel input at minimum and maximum firing rates.

iii. Maximum Carbon Monoxide: 200 PPM throughout the firing rate.

iv. No visible smoke; must comply with local emissions regulations.

v. Must follow all Boiler Efficiency Institute (BEI) guidelines (provided locally).

vi. Flue gas oxygen: 2.5 – 4.2% O2 (Up to 5.2% at loads below 40% of maximum steam output, no upper limit at minimum firing rate, oxygen can be 1% point higher on oil firing on single point positioning systems).

vii. Flames shall be stable with no pulsations, shall be retained near burner, no blowoff or flashbacks, no constant flame impingement on refractory or water walls.

c. List of instrumentation and controls to be inspected and calibrated:

All instruments shall be calibrated in accordance with applicable manufacturers standards.

i. Steam flow transmitters (all)

ii. Steam flow recorders/computer readout.

iii. Flue gas oxygen sampling, analyzing, and recorder/computer readout.

iv. Boiler and economizer stack temperature transmitters and recorder/computer readout.

v. Master steam pressure and combustion controllers.

vi. Boiler outlet draft controllers.

vii. Boiler water level controllers.

viii. Feedwater deaerator and condensate storage tank water level controllers including overflow.

ix. All pressure and temperature sensors, recorders and transmitters.

x. All signal processing and readout devices.

xi. Square Root Extractors

xii. Fuel Oil pressure transmitter and receiver gauge

xiii. See appendix A for combustion test data form, collected date shall be inputted into the test data form and submitted to the VA COR.

4. HIGH PRESSURE BOILER MAINTENANCE AND REPAIR REQUIREMENTS:

a. High Pressure Boiler Repair Requirements for Castle Point Campus:

i. In the base year of the contract the vendor shall provide and install three new O2 analyzers and probes for Boilers # 1 through 3. The existing units are Hays units and are no longer available. The vendor shall make all field adjustments to transition from the existing system fittings to the applicable fittings for the new oxygen analyzer system and appurtenances.

The vendor shall provide the following as part of the installation…

· Three (3) Oxygen Analyzers (Yokogawa or approved equal)

· Three (3) Oxygen Probes (Yokogawa or approved equal)

· Three (3) Manual Calibration Stations for Oxygen Analyzer (Yokogawa or approved equal)

· Three (3) Air Regulators (Fairchild or approved equal)

· Three (3) Cables (Yokogawa or approved equal)

· Three (3) Flange Adapters for Probes.

· Electrical and Mounting accessories

ii. In the base year of the contract the vendor shall provide the following safety relief valves….

· Three (3) 130 PSI Safety Relief Valve (Kunkle or approved equal). Vendor shall field verify relief valve sizes.

· Three (3) 135 PSI Safety Relief Valve (Kunkle or approved equal). Vendor shall field verify relief valve sizes Vendor shall submit shop drawings and other applicable submittals for the valves for VA approval prior to vendor purchasing the valves. Vendor shall be responsible for selecting valves that meet the requirements VA requirements, and approval from the VA shall not absolve the vendor from this responsibility.

b. Non-Emergency Boiler Service Requirements Vendor shall provide support for non-emergency repairs include phone support, troubleshooting within 10 days of receiving notice from the VA, and repair quotes within 14 days of troubleshooting the boiler issue. Repair quotes shall be approved by the CO and COR prior to the vendor proceeding with the repair work. The vendor shall make best effort to repair the problem with 30 days of receiving the notice to proceed from the VA (unless the part is a long lead item which delays the start of the repair).

c. Emergency Boiler Service Requirements:

Vendor shall provide repair service call support for emergency corrective maintenance to the VA Hudson Valley HCS Boiler plant 24 hours a day, 7 days per week. Emergency service shall include labor, parts, and travel. In an emergency such as an event that jeopardizes VA “N+1” boiler redundancy requirements, an emergency service call will be initiated by a VA Hudson Valley HCS boiler plant operator or facilities engineer to the vendor’s service center via telephone, email, and/or text messaging.

Vendor shall acknowledge the call for emergency service within 4 hours, shall provide support by qualified technicians on site within 8 hours, and shall endeavor to return equipment to normal operation within 24 hours. Normal operation means that defective parts have been replaced with parts that meet or exceed manufacturer's original specifications and VA requirements, and that the equipment meets or exceeds the manufacturer's original performance specifications.

For emergency calls/service the vendor will furnish all Factory repair parts and service not to exceed a TBD amount per year. The vendor shall provide by email a requested itemized quote to include hourly rate and travel within 24 hours for any scheduled services and or parts. The vendor shall provide by email an invoice for any emergency call outs within 48 hours of emergency service completion. The vendor shall be familiar with all terms, conditions, and requirements herein contained with warranty items and conditions.

The vendor shall be responsible for all damages to persons or property that occurs because of the vendor’s fault or negligence.

Repair quotes shall be approved by the CO and COR prior to the vendor proceeding with the repair work.

5. HIGH PRESSURE BOILER PLANT EQUIPMENT LIST (BOTH CAMPUS):

a. Castle Point

(1) 400 Horsepower Superior Boilers (fire tube, 3-pass, wet back) – National Board Number - NB1107

(1) 400 Horsepower Superior Boilers (fire tube, 3-pass, wet back) – National Board Number – NB15624

(1) 200 Horsepower Superior Boiler (fire tube, 3-pass wet back) – National Board Number – NB15451

(1) De-Aeration Tank – George Marker & Sons Serial Number 9467-08-05A National Board Number –NB1108

(1) Condensate Tank – NB1107

b. Montrose

(1) Victory 1000HP Voyager Water Tube Boilers Serial Number 10828-1 National Board Stamp 318

(1) Victory 1000HP Voyager Water Tube Boilers Serial Number 10828-2 National Board Stamp 317

(1) Victory 1000HP Voyager Water Tube Boilers Serial Number 10828-3 National Board Stamp 320

(1) Burnham 200HP Fire Tube Boiler NB 31050

(1) De-Aeration Tank Alstrom Heat Transfer LLC ADA120SS Serial Number 74931, National Board Stamp 2096

(1) Condensate Storage Surge Tank Alstron Heat Transfer LLC AST-2500V Serial Number 749.32, National Board Stamp 2097

6. LOW PRESSURE (LP) BOILER PREVENTIVE MAINTENANCE REQUIREMENTS:

a. The vendor shall maintain, and repair elements of the low-pressure boiler systems identified herein. The vendor shall inspect and service components in accordance with the manufacturer’s recommendations, prevailing industry standards and local, state, national, and international (where applicable) codes and this agreement. Vendor shall perform this service on a semi-annual basis.

b. The vendor shall furnish all material, labor, supervision, tools and equipment necessary to provide a full preventive maintenance program. All work shall be in strict compliance with regulatory agencies as follows:

(a) Open heat exchangers and brush and vacuum fireside of boilers

(b) Inspect refractory and insulation, note any deficiencies

(c) Inspect all boiler tapping for sighs of leakage

(d) Re gasket fire doors with new material and close

(e) Test fire unit

(f) Visually inspect entire burner

(g) Check combustion air interlocks

(h) Visually inspect piping filters and pumps for leaks

(i) Check oil pump drive

(j) Check combustion air intakes to building

(k) Replace electrode assembly

(l) Replace oil nozzle

(m) Check, clean and lubricate combustion air fan and air circulation fan

(n) Visually inspect stacks

(o) Check all electrical connections and tighten as required. Inspect all motor starters

(p) Check combustion air system including fresh air dampers for proper operation and filters and screens are free of obstructions

(q) Check pilot assembly and adjust as required

(r) Check and lubricate combustion air control damper

(s) Visually inspect piping and supports

(t) Test gas valves for tight close off (no leaks)

(u) Check modulating valves and linkages for proper stroke

(v) Check gas supply and manifold gas pressures

(w) Test inspect calibrate as needed all safety pressure switches, gas etc

(x) Verify air flow switch operation

(y) Check all gauges

(z) Check low water cut off and auxiliary low water cut off

(aa) Inspect & test safety relief valve

(bb) Check operating and limit and water level controls

(cc) Check all safety and operating control functions

(dd) Check flame detector

(ee) Check timing of all stages

(ff) Check for proper shutdown

(gg) Make combustion adjustments as required. Utilizing an electronic combustion analyzer, adjust burner for best possible achievable performance throughout operating range and document same.

Documentation will include: Excess air Carbon Dioxide

(hh) Carbon Monoxide Stack Temperature Boiler efficiency – stack loss method

(ii) Complete all regulator documentation for NYSDEC and USEPA of 40 CFR Part 63 Subpart JJ for the four boilers that burn oil.

(5) Bound written copies of results the work shall be provided to the COR within 7 business days of completion of work

c. Low Pressure Boiler Equipment List (BOTH CAMPUS):

MONTROSE CAMPUS

CASTLE POINT CAMPUS

7. REPORT REQUIREMENTS:

a. Vendor shall provide two complete written reports for the High Pressure Boilers at the Boiler Plants. The first report shall be the burner tuning report for each boiler and the second shall be a safety device testing report fully describing all safety device tests performed, all findings, and recommendations.

i. The burner tuning report shall be a separate file for each boiler (see appendix for the Boiler Combustion Test Data & Instrument Calibration Sheet to complete and submit) and shall contain all tuning data for natural gas and fuel oil combustion. The following data shall be the minimum information listed on each tuning report: Boiler manufacturer, serial, model, burner manufacturer, model, serial, input, fuel, steam flow, fuel%, air%, sleeve%, Variable Frequency Drive ( VFD)%, stack O2, analyzer O2, CO (ppm), CO2, NOx (ppm), stack temp, room temp, outside temp, combustion efficiency, windbox inches water column (in. WC), steam pressure, flame signal pilot, flame signal main, manifold gas pressure, and supply gas pressure. For fuel oil, also include fuel oil valve%, breeching draft in. WC, oil nozzle pressure, bypass oil pressure, and supply oil pressure.

ii. The safety device testing report shall have two sections. The first section will be in a table form that with four columns:

The first column labeled “FUNCTION” (did the device pass or fail).

The second column labeled “Device” shall list the device number and description in accordance with the VHA Boiler Plant Safety Devices Testing Manual 8th, (or Current Edition).

The third labeled “Deficiencies-Recommendations” The fourth column labeled “corrective actions” shall list any corrective actions taken during the inspection.

The next section shall be in paragraph/bulleted form and list each device individually in accordance with the VHA Boiler Plant Safety Devices Testing Manual, Current Edition. Additionally, the section must reference the correct Master Specification and Standard Detail for that device.

Example:

Condensate Storage Tank High Water Alarm Purpose: High water level may be an indication of condensate transfer pump failure that could lead to low water condition in the feedwater deaerator and in the boilers. There may be a failure of make-up water controls.

Recommended set point: 4 inches below overflow level and 2/3 of tank height.

Potential hazards due to failure of high-water alarm: Feedwater deaerator running dry and, consequently, boiler feed pumps running dry will cause overheating and damage to pumps and potential for plant shut down. Failure of make- up water controls (in open position) could lead to significant cost from waste of water and condensate from the tank overflow if this occurs over a long.

b. See section 6 – LP Boiler Preventive Maintenance for low pressure boiler reporting requirements.

c. Vendor shall furnish reports within 7 business days of each facility inspection for review and approval.

8. QUALIFICATION/ CERTIFICATIONS:

a. Technicians shall have completed at least a 1 year of trade school and have 5 years of successful experience in this field. The experience shall be largely with institutional and industrial boiler plants similar in design to the Hudson Valley plants.

b. Technicians shall demonstrate familiarity with and ready access to the current versions of the following references:

c. National Fire Protection Association (NFPA) 85: Boiler and Combustion Systems Hazards Code. VHA Boiler Plant Safety Device Testing Manual, 8th Edition (or current edition)

d. Technicians shall be equipped with portable electronic flue gas analyzers and other test instruments necessary for the required tests and calibrations, all calibrated within 1 month of the site visits. At facilities with programmable digital controls, the technicians must be capable of programming the controls and have the appropriate hardware and software for this.

e. R-stamp Welder on-staff or the ability to procure third party services of an R-stamp welder.

9. PRIVACY

The C&A requirements do not apply. A Security Accreditation Package is not required.

ATTACHMENT K – VA PRIVACY TRAINING FOR PERSONNEL WITHOUT ACCESS TO VA COMPUTER SYSTEMS OR DIRECT ACCESS TO OR THE USE OF

VA SENSITIVE INFORMATION

The Department of Veterans Affairs, VA must comply with all applicable privacy and confidentiality statutes and regulations. One of the requirements in VA is to have all personnel trained annually on privacy requirements. “Privacy” represents what must be protected by VA in the collection, use, and disclosure of personal information whether the medium is electronic, paper or verbal.

This document satisfies the “basic” privacy training requirement for a contractor, volunteer, or other personnel only if the individual does not use VA sensitive information or protected health information (PHI) in any form such as electronic or paper or have access to any VA computer system such as VA Time and Attendance System (VATAS), Computerized Patient Record System (CPRS), Joint Legacy Viewer (JLV), Veterans Health Information Exchange (VHIE), Compensation and Pension Record Interchange (CAPRI).

You will find this training outlines your role and responsibility for protecting VA sensitive information (medical, financial, or educational) that you may incidentally or accidentally see or overhear.

If you have direct access to VA sensitive information or access to a VA computer system where there is protected health information such as VaTAS, CPRS, JLV, VHIE or CAPRI you must take Privacy and HIPAA Focused Training (TMS 10203).

VA Privacy and Information Security Awareness and Rules of Behavior (TMS 10176) is always required to use or gain access to a VA computer system or VA sensitive information, whether or not protected health information is included. Both trainings are located within the VA Talent Management System (TMS): https://www.tms.va.gov

What is VA Sensitive Information/Data?

All Department information and/or data on any storage media or in any form or format, which requires protection due to the risk of harm that could result from inadvertent or deliberate disclosure, alteration, or destruction of the information. The term includes not only information that identifies an individual but also other information whose improper use or disclosure could adversely affect the ability of an agency to accomplish its mission, proprietary information, and records about individuals requiring protection under applicable confidentiality provisions.

What is Protected Health Information?

The HIPAA Privacy Rule defines protected health information as Individually Identifiable Health Information transmitted or maintained in any form or medium by a covered entity, such as VHA.

What is an “Incidental” Disclosure?

An incidental disclosure is one where an individual’s information may be disclosed incidentally even though appropriate safeguards are in place. Due to the nature of VA communications and practices, as well as the various environments in which Veterans receive healthcare or other services from VA, the potential exists for a Veteran’s protected health information or VA sensitive information to be disclosed incidentally.

For example:

• You overhear a healthcare provider’s conversation with another provider or patient even when the conversation is taking place appropriately.

• You may see limited Veteran information on sign-in sheets or white boards within a treating area of the facility.

• You may hear a Veteran’s name being called out for an appointment or when the Veteran is being transported/escorted to and from an appointment.

Safeguards You Must Follow To Secure VA Sensitive Information:

• Secure any VA sensitive information found in unsecured public areas (parking lot, trash can, or vacated area) until information can be given to your supervisor or Privacy Officer. You must report such incidents to your Privacy Officer timely.

• Don’t take VA sensitive information off facilities grounds without VA permission unless the VA information is general public information, i.e., brochures/pamphlets.

• Don’t take pictures using a personal camera without the permission from the Medical Center Director.

• Any protected health information overheard or seen in VA should not be discussed or shared with anyone who does not have a need to know the information in the performance of their official job duties, this includes spouses, employers or colleagues.

• Do not share VA access cards, keys, or codes to enter the facility.

• Immediately report lost or stolen Personal Identity Verification (PIV) or Veteran Health Identification Cards (VHIC), VA keys or keypad lock codes to your supervisor or VA police.

• Do not use a VA computer using another VA employee’s access and password.

• Do not ask another VA employee to access your own protected health information. You must request this information in writing from the Release of Information section at your facility.

What are the Six Privacy Laws and Statutes Governing VA?

1. Freedom of Information Act (FOIA) compels disclosure of reasonably described VA records or a reasonably segregated portion of the records to any person upon written request unless one or more of the nine exemptions apply.

2. Privacy Act of 1974 provides for the confidentiality of personal information about a living individual who is a United States citizen or an alien lawfully admitted to U.S. and whose information is retrieved by the individual’s name or other unique identifier, e.g. Social Security Number.

3. Health Insurance Portability and Accountability Act (HIPAA) provides for the improvement of the efficiency and effectiveness of health care systems by encouraging the development of health information systems through the establishment of standards and requirements for the electronic transmission, privacy, and security of certain health information.

4. 38 U.S.C. 5701 provides for the confidentiality of all VA patient and claimant information, with special protection for their names and home addresses.

5. 38 U.S.C. 7332 provides for the confidentiality of drug abuse, alcoholism and alcohol abuse, infection with the human immunodeficiency virus (HIV) and sickle cell anemia medical records and health information.

6. 38 U.S.C. 5705 provides for the confidentiality of designated medical-quality assurance documents.

What are the Privacy Rules Concerning Use and Disclosure?

You are not authorized to use or disclose protected health information. In general, VHA personnel may only use information for purposes of treatment, payment or healthcare operations when they have a need-to-know in the course of their official job duties. VHA may only disclose protected health information upon written request by the individual who is the subject of the information or as authorized by law.

How is Privacy Enforced?

There are both civil and criminal penalties, including monetary penalties that may be imposed if a privacy violation has taken place. Any willful negligent or intentional violation of an individual’s privacy by VA personnel, contract staff, volunteers, or others may result in such corrective action as deemed appropriate by VA including the potential loss of employment, contract, or volunteer status.

Know your VA/VHA Privacy Officer and Information Systems Security Officer. These are the individuals to whom you can report any potential violation of protected health information or VA sensitive information, or any other concerns regarding privacy of VA sensitive information.

YOU ARE RESPONSIBLE FOR PROTECTING THE CONFIDENTIAL INFORMATION OF OUR VETERANS

Employee (Print Name) Date

Employee Signature

Print Name of Contract Agency, if contractor

Print Name of VHA Department/Supervisor/Contracting Officer

PROVIDE A COPY OF THIS FORM TO YOUR SUPERVISOR/CONTRACTING OFFICER FOR DATA ENTRY INTO TALENT MANAGEMENT SYSTEM

VII. Appendix

Appendix

BOILER COMBUSTION TEST DATA

CUSTOMER:

DATE:

ADDRESS

Boiler Mfg.:

Type:

Capacity: Boiler #

Burner Mfg:

Type:

Fuel:

Controls stem: P

Remarks and General Conditions

II

Mamoeter

Draft Cntl

Gage

Fluke

Stack Temperature

Opacity%

Feedwater Valve%

REMARKS/FLAME CONDITION/TIP SIZE

Copy of Calibration

Facility Boiler _ Date Completed

ITEM

As Found Low Input/Output

As Found High Input/Output

As Calibrated Low Input/Output

As Calibrated Mid Input/Output

As Calibrated High Input/Output

OK

Initials

Date (When) Due Date (Every 3 years EXCEPT02 Analyzer)

Comment-Use Addi Sheet if needed

Boiler Steam Drum Press Transmitter

Offset=

Drwn Level Transmitter

Boiler Steam Flow Transmitter

FW Flow Transmitter

Draft Transmitter

Combustion Air Flow Transmitter

O:\ygen Analyzer

Opacity Monitor

Flue Gas Temp R1Dtrransmitter

Fuel Oil Meter

Gas Flow Meter

Oil Fuel Control Valve Positioner

NIA

Gas Fuel Control Valve

NIA

FW Control Valve

NIA

FD Damper Actuator Positioner

NIA

Outlet Damper Actuator

NIA

N01ES:

1. ALL SMART1RANSMTITERSNEED TO BE CALIBRATEDEVERY3 YEARS. ZERO CHECKS ORZEROISPAN CHECKS WILL BE PERFORMED ON CRTIICAL INPUTS MORE FREQUENTLY IF OUR SERVICE ENGINEER DEEMS IT NECESSARY.

2. OXYGEN ANALYZERS NEED TO BE CALIBRATED ANNUALLY.

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INSTRUMENT CALIBRATION SHEET

May be used to calibrate both analog Transmitters and Transducers

1/11/2012

System ID:

Tag: Description:

Plant Location

Manufacture:

Model No.:

Calib Location Classification

Instrument Range LRV / URV / Units

Calibration Range LRV / URV / Units

Accuracy

Full Scale/Rg

Opt Fail position

Output Signal

Electrical

Pneumatic

Calibration data: Suggest using 10 25, 50, 75, 90 % for 5 points % Calib Signali

Calib Sianal '

EU!

Instr Required

Instr as Found

Instr as Left, As Left error!' '

URV= Upper Range Value LRV= Lower Range Value EU= Engineering Units

Notes:

Device cannot be calibrated to Mfr tolerance Device is beyond repair and should be replaced Next calibration due date Device needs chemical seal installed Device needs valve manufold to be installed

Device needs a pulsation dampner to be installed Device needs to be liquid filled before calibration

Remember>>> You can't simulate or test "O" Zero

Calibrator Mfr Calibrator Model

Calib Technician CaIib Assistant Approved By

Date: Date: _ Date: ------