HERMANSON - Med Gas Certification Phase 3.pdf
Hermanson Company LLP tel 206-575-9700
1221 2nd Avenue North fax 206-575-9800
Kent, WA 98032
SUBMITTAL DATA
Swedish Edmonds - ACC
21601 76 Avenue West
th
Edmonds, WA 98026
Submittal 001-3
SPEC SECTION:-
EQUIPMENT TAGS: None
ITEM:Medical Gas Certification Reports
* Emergency Oxygen Supply Connection
* Imaging Dept. Rooms 021A, 022A & X-Ray 3
* Rooms 1 through 10
MANUFACTURER:MedGas Certified, LLC.
SUPPLIER:MedGas Certified, LLC.
Date Submitted:05/24/16
Comments:
Mechanical Construction,
Engineering and Service
www.hermanson.com
Emergency Oxygen Supply Connection
(fax)
Expansion
Swedish Edmonds Medical Center
Medical Gas Professionals
Medical Gas Verification Report
MedGas Certified, LLC
3573
Hermanson
medgascertified@hotmail.com
2016
, 2016
MedGas Certified, LLC
:
La Center, WA 98629
May 24,
Verification performed by
Edmonds, WA 98026
-
456
May 25
Ambulatory Care Center
21601 76th Ave W
-
PO Box 83
888
Medical Gas Installer
Date of this Report:
erification:
2151
V
Date of
-
430
-
360
or agencies. The testing criteria were used as a base
of 11
aterials;
edGas Certified on
nt, or health
ith
The tests
cies
and is thus many
sponsibilities. Where public safety is primary, the authority having jurisdiction may be a federal, state, local, or
erformed.
he
2
erification Specialist Glenn Tsuda tested the Medical Pipeline System indicated by this report in accordance w
Page
y the
ate testing laboratories. In determining the acceptability of installation, procedures, equipment, or materials the authority having jurisdiction may base acceptance on compliance with
NFPA or other appropriate standards. In t
performed on this system were found to be within test specifications unless otherwise noted on the Discrepancies or separate
said authority may require evidence of proper installation, procedure or use. The authority having
nce
inspection department, rating bureau, or other insurance company representative may be the authority having jurisdiction. In
The National Fire Protection Association does not approve, inspect, or certify any installations, procedures, equipment, or m
The testing of this system may include all or part of the tests offered by MedGas Certified, LLC. Only the tests indicated bcircumstances, the property owner or his or her designated
agent assumes the role of the authority having jurisdiction; at
other regional department or individual such as a fire chief; fire marshal; chief of a fire prevention bureau, labor departme
Level 1 medical gas verification.
department; building official; electrical inspector; or others having statutory authority. For insurance purposes, an insura
pipeline system component forms. The additional documentation contains the results, dates and locations of the tests p
jurisdiction may also refer to the listing of labeling practices of an organization that is concerned with product evaluation
government installations, the commanding officer or departmental official may be the authority having jurisdiction.
report forms were performed on the dates indicated. The results of the tests reported represent the findings of M
determine compliance with appropriate standards for the current production of listed items.
Medical Gas Pipeline Verification
line for determining the performance of the separate components that make up this
and other applicable codes
the dates and locations indicated by the report forms only.
the Medical Gas and Vacuum Systems of NFPA99
MedGas Certified, LLC
nor does it approve or evalu
absence of such standard,
Gas Professionals
V
vary, as do their re
The Medical Gas
in a position to
::
Per NFPA99CPer NFPA99C
Medical
who has the nsibility of
design requirements (bulk capacity, bulk
levels of nitrogen or gas mixtures not
The AHJ is normally the Fire Marshall in your area. In some instances the AHJ is the Department of Health or in the case of of 11
This report is reflective of the facilities condition and if necessary, contains recommendations to comply with the current
upplying gas for patient treatment. This verification does
and
vel of inspection determined and contracted for by this collaboration.
as
e
is the sole responsibility of the hospital,
3
or Page
this is a testing of the installed medical gas systems from the source to the
nsibility to approve equipment, materials, an installation or a procedure. The AHJ will make any and all decisions to requir
The AHJ, in all matters, has the final
ified, LLC has no power, nor does it undertake, to police or enforce compliance with the contents of this
, inspected by the local building department,
collaboration between the owner, engineers, local authority having jurisdiction and the medical gas equipment provider. MedG
patient care. This
ical gas and vacuum systems. Level of the facility is determined by
, qualifications
Determinations of all areas affected by shut downs, nitrogen purges and for final gas concentration testing is the sole respo
inspection/verification. This document, in its entirety, must be presented to the local Authority Having Jurisdiction (AHJ),
MedGas Certified, LLC has no knowledge or limited knowledge of the facilities existing medical gas systems.
he General Contractor, the Plumbing Contractor or the Hospital
address in ground/slab piping installation, materials used, installer installation
for treatment and
Facilities/Operations Department, are responsible for identifying and providing reports to your local AHJ.
Errors in pipeline mapping can result in serious injury or death due to inhalation of high
Bulk system design and bulk pad requirements are covered by NFPA50/55. These
use
corrections, modifications or repairs to the medical gas system recorded in this report.
inspect the medical treatment equipment which is installed and connected
tal, surgery center, facility. Notification of staff to prevent accidental patient
pad design) are collaboration between the hospital and the bulk provider
.
installer testing compliance w/ ASSE 6010 & NFPA99 requirements, etc
decision to approve the facility opening and starting patient services.
plumber installed hard copper piping ending at connections for s
determine Level and performs the Le
are not the responsibility of the medical gas verifier.
mortality in the event of an interruption of the piped med
military facilities, the Commanding Officer. You, t
-
5.1.12.3 System Verification
suitable for human consumption.
NOT
NOT
surgery center, facility.
Certified, LLC does
verification does
IAW NFPA99
MedGas Cert
document.
the hospi
NOTE:NOTE:NOTE:NOTE:
respo
NOT
of 11
allowing enforcing authorities (governmental and nongovernmental) to grant exceptions to requirements.
1.4.1 Nothing in this code is intended to prevent the use of systems, methods, or devices of equivalent or
uperior quality, strength, fire resistance, effectiveness, durability, and safety to those prescribed by this
equivalency. The system, method, or device shall be approved for the intended purpose by the authority
compliance with the provisions of this standard shall be permitted to be continued in use as long as the
minder to authorities that they
has determined that such use does not constitute a distinct hazard to life.
4
to demonstrate
Page
NFPA Committee Member comments: Although authorities having jurisdiction can adopt and enforce
that they consider appropriate (e.g., adopt and enforce requirements as written;
; adopt a document but change
mmittee Member comments: Paragraph 1.4.2 adds to the concept of equivalency in 1.4.1,
The organization, office or individual responsible for
dition of NFPA 101, with some
1.4.2 Alternative systems, methods, or devices approved as equivalent by the authority having
An existing system that is not in strict
submitted to the authority having jurisdiction
certain requirements), 1.4.1 is intended to apply to the entire code as a re
jurisdiction shall be recognized as being in compliance with this code.
issue waivers to specific facilities not meeting certain requirements
This wording on equivalency is similar to Section 1.4 of the 2012 e
approving equipment, materials, an installation or a procedure.
can grant exemptions NOTE: Per NFPA99 para 5.1.1.3
n (AHJ)
code. Technical documentation shall be
Authority Having Jurisdictio
tion
authority having jurisdic
voluntary standards
having jurisdiction.
Equivalency
NFPA Co
3.2.2
1.4
s
of 11
construction and new equipment, except as modified in individual chapters. Only the altered, renovated,
Construction and equipment requirements shall be applied only to new
5
Page
individual component shall be required to meet the
existing operational facility that might have or has medical gas piping
modernization adversely impacts existing performance requirements of a system or component,
installation and equipment requirements stated in this standard. If the alteration, renovation, or
ode.
1.4.3 The authority having jurisdiction shall be permitted to grant exceptions to this c
or modernized portion of an existing system or
grading shall be required.
NOTE: Per NFPA99 para 1.3.2
compliance inspection.
-
This is a pre
additional up
of 11
6
of NFPA99
Page
of the hospitals ACC
System has been verified and meets the requirements
. This project:
s
inal phase
Medical Gas Verification Report Summary
expansion adding a new Emergency Oxygen Supply Connection (EOSC)
f
Medical Gas Verification Specialist
II. Findings and Recommendations:
This summary prepared by
.
MedGas Certified, LLC
1 piped systems
erification:
.
Professionals
Glenn Tsuda
MedGas Certified, LLC
Installed EOSC
V
Scope of
Category
Medical Gas
1.
I.
of 11
7
Page
ng to cross connection testing but before the piping purge test. Can be performed with oil free dry Nitrogen NF, gas of rm condition if the pressure in the piping system increases or
decreases 20% from the normal operating pressure for positive
support and critical
Valves installed in each medical gas and vacuum system shall be tested to verify proper operation and
possible connection points for terminals, each possible position
components function correctly
care areas, such as post anesthesia recovery, ICU, CCU, emergency suites and operating rooms shall be tested to verify an
Warning systems that are part of an addition to an existing piping system shall be tested prior to connection of the new pipi
minute
Connection Test. After closing of walls and completion of the Installers Initial Tests, it shall be
Installation of any manufactured assemblies supplied through flexible hoses or tubing has been completed.
-
5.1.12.3.2 Verifier Standing Pressure Test. Each positive pressure gas piping system shall be subjected to a ten
-
The warning signals for all medical gas piping systems supplying anesthetizing locations and other vital life
each of the medical gas and vacuum piping systems.
All warning systems for each medical gas and vacuum system shall be tested to ensure that all
pressure gases, or when the vacuum system drops below a gauge pressure of 12 in.
determined that no cross connections of the piping systems exist.
5.1.12.3.1.7 Where manufactured assemblies include multiple
system designation or the operating vacuum source.
Master alarm system tests shall be performed for
operating line pressure.
prior to placing system into service.
shall be tested independently.
rooms or areas of control.
standing pressure test at
-
5.1.12.3.3 Verifier Cross
Test
the existing system.
5.1.12.3.4 Valve
Performed after
1.12.3.1.6
5.1.12.3.5.2 Master Alarms
5.1.12.3 System Verification
5.1.12.3.5.3 Area Alarms
ala
5.
Verification
Alarm Tests
N/AN/AN/AN/AN/AN/AN/A
N/A
Fail
System
5.1.12.3.5
Pass
5/245/245/24
of 11
8
Page
free, dry Nitrogen NF or the system gas.
effective for use with oxygen.
appropriate adapter, a high purge rate (8scfm) will be established. It shall be rapidly interrupted several times until the
free, dry
A test for dew point shall be conducted at the outlet most remote from the source and dew point shall not exceed 12 degrees C
n no case
tent n the immediate zone or area that is downstream form the point or area of intrusion shall be purged per Verifier
tested with the gas of system
system gas. The test shall be for total hydrocarbons (as methane) and halogenated hydrocarbons and
tested, the specific altered zone and
filter at a minimum flow rate of 100 Nl/minute (3.5 scfm).
In order to remove any traces of particulate matter deposited in the pipelines as a result of construction, a heavy, intermit
-
For each positive pressure medical gas system, the purity of the piping system shall be verified. Test gas shall be oil
This test shall be performed at the outlet most remote form the source. The difference between the two tests shall i
designation or vacuum at the normal operating pressure by means of soapy water or other means
purge produces no discoloration in a white cloth loosely held over the adapter during the purge.
-
Each joint in the final connection between the new work and the existing system shall be leak
-
The cleanliness of the piping in each medical gas shall be verified. Test gas shall be oil
-
pressure gases, immediately after the final connection is made and leak
2 ppm.
.
If not accessible a successful completion of standing pressure test is required
25% of the zones shall be tested at the outlet most remote form the source
1 ppm and Halogenated Hydrocarbons
most remote outlet in every zone shall be tested
Filter shall accrue no more than 1 mg of matter from any outlet tested
1000 L of gas shall be filtered through a clean, white 0.45 micron
purging of each medical gas pipeline shall be done.
compared with the source gas.
exceed, Total Hydrocarbons
(10 degrees F) @ 50 psig.
If any outlet fails, the
Nitrogen NF or the
Piping Purge Test.
iculate Test
Verifier Piping Purge Test
5.1.12.3.8 Verifier Piping Purity Test
components i
-
in Test
For positive
Using an
5.1.12.3.7 Verifier Piping Part
-
5.1.12.3 System Verification
Verifier Final Tie
N/A
N/AN/A
N/A
Fail
5.1.12.3.6
5.1.12.3.9
Pass
5/245/245/245/245/245/245/245/24
of 11
9
Page
Operational pressure tests shall be performed at each station outlet in the medical gas piping systems where the user makes
/min without reducing the vacuum pressure below 12 in. HgV at any adjacent
be analyzed
,
All oxygen and medical air outlets serving critical care areas shall permit a transient flow rate of 170
The presence and correctness of labeling required by this standard for all components, station outlets/inlets, shutoff valves
55 psi.
Medical air source shall be analyzed for concentration of contaminants by volume prior to the source vale being opened.
Nitrogen outlets shall deliver 140 Nl/min with a pressure drop of no more than 5 psi and static pressure of 160 to 185 psi
outlets shall deliver 100 NL/min with a pressure drop of no more than 5 psi and static pressure of 50
After purging each piping system with the gas of system designation, each pressure gas source and outlet shall
free, dry Nitrogen NF or gas of system designation.
Testing of source equipment performed and results are recorded on individual equipment sheets.
-
connections and disconnections. Performed with either oil
at the system sample port.
Medical surgical vacuum inlets shall draw 85 Nl
for concentration of gas by volume.
and alarm panels, shall be verified.
/min (6 SCFM) for 3 seconds.
5.1.12.3.12 Medical Air Purity Test (Air Compressor)
Sample shall be taken
Critical care flow test
5.1.12.3.10 Verifier Operational Pressure Test
5.1.12.3.11 Medical Gas Concentration Test
Verification
Medical gas
station inlet
5.1.12.3.14 Source Equipment
Nl
N/AN/AN/AN/AN/AN/AN/A
N/A
5.1.12.3.13 Labeling
Fail
Pass
5/245/24
of 11
5.1.3.5.13* Emergency Oxygen Supply Connection (EOSC). Emergency oxygen supply connections (EOSCs) EOSC and one downstream of
Where the bulk cryogenic liquid central supply system is outside of and remote from the
10
shall be installed to allow connection of a temporary auxiliary source of supply for emergency or maintenance Where there is not in the building a connected oxygen reserves sufficient
for an average Where multiple freestanding buildings are served from a single oxygen source such that
immediately downstream of the main shutoff valve.
damage to the interconnecting oxygen line could result in one or more buildings losing oxygen supply.
Page
Has a female DN (NPS) inlet for connection of the emergency oxygen source that is
Located on the exterior of the building being served in a location accessible by
the main line shutoff valve, with both upstream from the tee connection for the two pipelines.
Equipped with a manual shutoff valve to isolate the EOSC when not in use.
100 percent of the system demand at the emergency source gas pressure.
Equipped with two check valves, one downstream of the
Physically protected to prevent unauthorized tampering.
eparate EOSC.
emergency supply vehicles at all times in all weather conditions.
In this situation, each building shall be provided with a s
Connected to the main supply line
s exist:
building that the oxygen supply serves.
situations where any of the following condition
------
(1) .1 (2) .2 (1) .2 (2) .2 (3) .2 (4)
---
(1) (2) (3)
5.1.3.5.13.1
5.1.3.5.13
5.1.3.4.135.1.3.4.135.1.3.4.135.1.3.4.135.1.3.4.135.1.3.4.135.1.3.4.13
sized for
N/A
n/a
No
Yes 5/245/245/245/245/245/245/245/24
of 11
Equipped with a relief valve sized to protect the downstream piping system and related A.5.1.3.5.13 If
11
ion is moved downstream from the check valve
Page
Equipped with any valves necessary to allow connection of an emergency supply of
Minimum of 1 m (3 ft) of clearance around the EOSC for connection of temporary
Gauge
in the emergency oxygen line, it should be connected to the system with a demand check fitting.
P
pressure.
Leakage
P
equipment from exposure to pressures in excess of 50% higher than normal line
Function
P
and isolation of the piping to the normal source of supply.
Access
P
the relief valve on the emergency oxygen supply connect
Label
P
Location
South side of building
---e.
.2 (5) .2 (6) (7)
auxiliary sourc
Pass/Fail
5.1.3.5.13.2
Pass
5.1.3.4.135.1.3.4.13
oxygen
Oxygen Source Valve
Valve Test
n/a
O2
No
Service
Yes 5/245/245/24
ray 3
-
Imaging Department Rooms 021A, 022A & X
(fax)
Expansion
Swedish Edmonds Medical Center
Medical Gas Professionals
Medical Gas Verification Report
MedGas Certified, LLC
3573
Hermanson
medgascertified@hotmail.com
May 24, 2016
, 2016
MedGas Certified, LLC
:
La Center, WA 98629
Verification performed by
Edmonds, WA 98026
-
456
May 25
Ambulatory Care Center
21601 76th Ave W
-
PO Box 83
888
Medical Gas Installer
Date of this Report:
erification:
2151
V
Date of
-
430
-
360
nt, or health
ble codes or agencies. The testing criteria were used as a base
of 10
aterials;
fied on
ith
The tests
cies
and is thus many
sdiction may be a federal, state, local, or
ed.
he
2
erification Specialist Glenn Tsuda tested the Medical Pipeline System indicated by this report in accordance w
Page
offered by MedGas Certified, LLC. Only the tests indicated by the
n, procedures, equipment, or
materials the authority having jurisdiction may base acceptance on compliance with NFPA or other appropriate standards. In t
ations unless otherwise noted on the Discrepancies or separate
use. The authority having
pipeline system component forms. The additional documentation contains the results, dates and locations of the tests perform
report forms were performed on the dates indicated. The results of the tests reported represent the findings of MedGas Certi
tutory authority. For insurance purposes, an insurance
inspection department, rating bureau, or other insurance company representative may be the authority having jurisdiction. In
The National Fire Protection Association does not approve, inspect, or certify any installations, procedures, equipment, or m
mes the role of the authority having jurisdiction; at
other regional department or individual such as a fire chief; fire marshal; chief of a fire prevention bureau, labor departme
Level 1 medical gas verification.
jurisdiction may also refer to the listing of labeling practices of an organization that is concerned with product evaluation
government installations, the commanding officer or departmental official may be the authority having jurisdiction.
of listed items.
absence of such standard, said authority may require evidence of proper installation, procedure or
nor does it approve or evaluate testing laboratories. In determining the acceptability of installatio
in a position to determine compliance with appropriate standards for the current production
vary, as do their responsibilities. Where public safety is primary, the authority having juri
Medical Gas Pipeline Verification
line for determining the performance of the separate components that make up this
circumstances, the property owner or his or her designated agent assu
and other applica
department; building official; electrical inspector; or others having sta
performed on this system were found to be within test specific
The testing of this system may include all or part of the tests
nly.
the dates and locations indicated by the report forms o
the Medical Gas and Vacuum Systems of NFPA99
MedGas Certified, LLC
Medical Gas Professionals
V
The Medical Gas
::
Per NFPA99CPer NFPA99C
who has the
downs, nitrogen purges and for final gas concentration testing is the sole responsibility of
ments are covered by NFPA50/55. These design requirements (bulk capacity, bulk
not
The AHJ is normally the Fire Marshall in your area. In some instances the AHJ is the Department of Health or in the case of of 10
This report is reflective of the facilities condition and if necessary, contains recommendations to comply with the current
plumber installed hard copper piping ending at connections for supplying gas for patient treatment. This verification does
and
determine Level and performs the Level of inspection determined and contracted for by this collaboration.
the medical gas equipment provider. MedGas
The AHJ will make any and all decisions to require
is the sole responsibility of the hospital,
acilities location at the time of this
3
Errors in pipeline mapping can result in serious injury or death due to inhalation of high levels of nitrogen or gas mixtures
or Page
cal gas systems from the source to the
The AHJ, in all matters, has the final
iance with the contents of this
, inspected by the local building department,
patient care. This
y
, qualifications
mortality in the event of an interruption of the piped medical gas and vacuum systems. Level of the facility is determined b
inspection/verification. This document, in its entirety, must be presented to the local Authority Having Jurisdiction (AHJ),
MedGas Certified, LLC has no knowledge or limited knowledge of the facilities existing medical gas systems.
military facilities, the Commanding Officer. You, the General Contractor, the Plumbing Contractor or the Hospital
address in ground/slab piping installation, materials used, installer installation
d
Operations Department, are responsible for identifying and providing reports to your local AHJ.
for treatment an
MedGas Certified, LLC has no power, nor does it undertake, to police or enforce compl
use
corrections, modifications or repairs to the medical gas system recorded in this report.
inspect the medical treatment equipment which is installed and connected
this is a testing of the installed medi
the hospital, surgery center, facility. Notification of staff to prevent accidental patient
collaboration between the owner, engineers, local authority having jurisdiction and
Determination of the facilities medical gas Level (1, 2 or 3) is based on t
pad design) are collaboration between the hospital and the bulk provider
responsibility to approve equipment, materials, an installation or a procedure.
.
installer testing compliance w/ ASSE 6010 & NFPA99 requirements, etc
decision to approve the facility opening and starting patient services.
.
are not the responsibility of the medical gas verifier
-
5.1.12.3 System Verification
Determinations of all areas affected by shutBulk system design and bulk pad require
suitable for human consumption.
NOT
ity.NOT
Certified, LLC does
surgery center, facil
verification does
IAW NFPA99
document.
Facilities/
TE:NOTE:NOTE:NOTE:
NOT
NO
of 10
allowing enforcing authorities (governmental and nongovernmental) to grant exceptions to requirements.
methods, or devices of equivalent or
superior quality, strength, fire resistance, effectiveness, durability, and safety to those prescribed by this
lency. The system, method, or device shall be approved for the intended purpose by the authority
compliance with the provisions of this standard shall be permitted to be continued in use as long as the
that they
at such use does not constitute a distinct hazard to life.
4
to demonstrate
Page
NFPA Committee Member comments: Although authorities having jurisdiction can adopt and enforce
ropriate (e.g., adopt and enforce requirements as written;
; adopt a document but change
s: Paragraph 1.4.2 adds to the concept of equivalency in 1.4.1,
The organization, office or individual responsible for
th some
1.4.2 Alternative systems, methods, or devices approved as equivalent by the authority having
certain requirements), 1.4.1 is intended to apply to the entire code as a reminder to authorities
An existing system that is not in strict
This wording on equivalency is similar to Section 1.4 of the 2012 edition of NFPA 101, wi
submitted to the authority having jurisdiction
jurisdiction shall be recognized as being in compliance with this code.
1.4.1 Nothing in this code is intended to prevent the use of systems,
issue waivers to specific facilities not meeting certain requirements
approving equipment, materials, an installation or a procedure.
can grant exemptions NOTE: Per NFPA99 para 5.1.1.3
has determined th
Authority Having Jurisdiction (AHJ)
voluntary standards that they consider app
code. Technical documentation shall be
NFPA Committee Member comment
authority having jurisdiction
having jurisdiction.
Equivalency
equiva
3.2.2
1.4
of 10
construction and new equipment, except as modified in individual chapters. Only the altered, renovated,
Construction and equipment requirements shall be applied only to new
5
Page
hall be required to meet the
existing operational facility that might have or has medical gas piping
modernization adversely impacts existing performance requirements of a system or component,
installation and equipment requirements stated in this standard. If the alteration, renovation, or
1.4.3 The authority having jurisdiction shall be permitted to grant exceptions to this code.
or modernized portion of an existing system or individual component s
red.
additional upgrading shall be requi
para 1.3.2
compliance inspection.
NOTE: Per NFPA99
-
This is a pre
of 10
medical gas system
completing the final medical
of NFPA99
medgas piping from the existing Imaging MedGas Zone piping (installed during
6
Page
piping (installed during the
initial construction project). This pipeline was extended down the corridor and is intended for
been verified and meet the requirements
is
of the
. This verification
Extended the medair piping from the existing Imaging MedGas Zone
Verification Report Summary
existing future service valves.
.
the initial construction project) to feed 3 additional rooms
ew Ambulatory Care Center (ACC)
This project:
ve
ha
Medical Gas
s
System
1
-
.
All new piping was tied in at pre
this ACC expansion
and Recommendations:
is a
This
Medical Gas Verification Specialist
.
future expansion.
piped systems
erification:
mv
This summary prepared by
Medical Gas Professionals
for the n
MedGas Certified, LLC
Extended o2,
MedGas Certified, LLC
gas phase for
expansion
V
Scope of
II. Findings
Glenn Tsuda
1
Level
1)2)3)
I.
of 10
alarm condition if
free dry Nitrogen NF, gas of system
o verify proper operation and rooms or
or when
After closing of walls and completion of the Installers Initial Tests, it shall be determined that
e
rior to
7
shall b
support and critical care Page
the
minute standing
the pressure in the piping system increases or decreases 20% from the normal operating pressure for positive pressure gases,
ng systems that are part of an addition to an existing piping system shall be tested prior to connection of the new piping to
All warning systems for each medical gas and vacuum system shall be tested to ensure that all components function correctly p
5.1.12.3.1.7 Where manufactured assemblies include multiple possible connection points for terminals, each possible position
Installation of any manufactured assemblies supplied through flexible hoses or tubing has been completed.
areas, such as post anesthesia recovery, ICU, CCU, emergency suites and operating rooms shall be tested to verify an
-
5.1.12.3.2 Verifier Standing Pressure Test. Each positive pressure gas piping system shall be subjected to a ten
-
The warning signals for all medical gas piping systems supplying anesthetizing locations and other vital life
Master alarm system tests shall be performed for each of the medical gas and vacuum piping systems.
Performed after cross connection testing but before the piping purge test. Can be performed with oil
Valves installed in each medical gas and vacuum system shall be tested t
the vacuum system drops below a gauge pressure of 12 in.
no cross connections of the piping systems exist.
designation or the operating vacuum source.
Connection Test.
pressure test at operating line pressure.
placing system into service.
-
5.1.12.3.3 Verifier Cross
5.1.12.3.4 Valve Test
tested independently.
areas of control.
existing system.
.12.3.1.6
5.1.12.3.5.2 Master Alarms
5.1.12.3 System Verification
5.1.12.3.5.3 Area Alarms
Warni
Alarm Tests
1
5.
System Verification
N/A N/A N/A N/A N/A N/A N/A
N/A
Fail
5.1.12.3.5
Pass
5/245/245/24
of 10
8
Page
free, dry Nitrogen NF or the system gas.
designation or vacuum at the normal operating pressure by means of soapy water or other means effective for use with oxygen.
propriate adapter, a high purge rate (8scfm) will be established. It shall be rapidly interrupted several times until the
free, dry
e A test for dew point shall be conducted at the outlet most remote from the source and dew point shall not exceed 12 degrees C
tent eam form the point or area of intrusion shall be purged per Verifier
tested with the gas of system
This test shall be performed at the outlet most remote form the source. The difference between the two tests shall in no cas
ydrocarbons (as methane) and halogenated hydrocarbons and
tested, the specific altered zone and
Nl/minute (3.5 scfm).
In order to remove any traces of particulate matter deposited in the pipelines as a result of construction, a heavy, intermit
-
For each positive pressure medical gas system, the purity of the piping system shall be verified. Test gas shall be oil
1000 L of gas shall be filtered through a clean, white 0.45 micron filter at a minimum flow rate of 100
purge produces no discoloration in a white cloth loosely held over the adapter during the purge.
-
oint in the final connection between the new work and the existing system shall be leak
-
The cleanliness of the piping in each medical gas shall be verified. Test gas shall be oil
-
pressure gases, immediately after the final connection is made and leak
2 ppm.
sible a successful completion of standing pressure test is required.
25% of the zones shall be tested at the outlet most remote form the source
pm and Halogenated Hydrocarbons
ll be tested
Filter shall accrue no more than 1 mg of matter from any outlet tested
Nitrogen NF or the system gas. The test shall be for total h
components in the immediate zone or area that is downstr
If any outlet fails, the most remote outlet in every zone sha
purging of each medical gas pipeline shall be done.
1 p
compared with the source gas.
exceed, Total Hydrocarbons
(10 degrees F) @ 50 psig.
Piping Purge Test.
ulate Test
Verifier Piping Purge Test
5.1.12.3.8 Verifier Piping Purity Test
-
in Test
Using an ap
If not accesFor positive
5.1.12.3.7 Verifier Piping Partic
Each j
-
5.1.12.3 System Verification
5.1.12.3.9 Verifier Final Tie
N/A N/A
N/A
N/A
Fail
5.1.12.3.6
Pass
5/245/245/245/245/245/245/245/24
of 10
9
Page
ch station outlet in the medical gas piping systems where the user makes
Medical surgical vacuum inlets shall draw 85 Nl/min without reducing the vacuum pressure below 12 in. HgV at any adjacent
After purging each piping system with the gas of system designation, each pressure gas source and outlet shall be analyzed
ling required by this standard for all components, station outlets/inlets, shutoff valves,
All oxygen and medical air outlets serving critical care areas shall permit a transient flow rate of 170
55 psi.
Medical air source shall be analyzed for concentration of contaminants by volume prior to the source vale being opened.
shall deliver 140 Nl/min with a pressure drop of no more than 5 psi and static pressure of 160 to 185 psi
op of no more than 5 psi and static pressure of 50
free, dry Nitrogen NF or gas of system designation.
equipment sheets.
Testing of source equipment performed and results are recorded on individual
Medical gas outlets shall deliver 100 NL/min with a pressure dr
-
connections and disconnections. Performed with either oil
Operational pressure tests shall be performed at ea
Sample shall be taken at the system sample port.
The presence and correctness of labe
for concentration of gas by volume.
and alarm panels, shall be verified.
Nl/min (6 SCFM) for 3 seconds.
ompressor)
Critical care flow test
5.1.12.3.10 Verifier Operational Pressure Test
1.12.3.11 Medical Gas Concentration Test
5.1.12.3.14 Source Equipment Verification
Nitrogen outlets
5.1.12.3.12 Medical Air Purity Test (Air C
station inlet
N/AN/AN/A
N/A
5.1.12.3.13 Labeling
Fail
Pass
5/245/245/245/245/24
5/24
5.
of 10
10
Page
41°F @ 50 psig
5°C @ 50 psig
Dew Point
Pass
Labeling
Outlet
PPPPPP
Gauge
Function
P
Lock
PPPPPP
Hydrocarbons
Halogenated
Pass
< 2ppm
Leakage
Leakage
Outlet
Inlet
P
PPPPPP
Function Total Hydrocarbons as
P
O2 161/MA 170
Critical Care
Methane
Pass
< 1ppm
Flow
n/an/an/a
PPP
Access
P
Label
Vacuum
ty Data
Max
Flow
0150150
n/an/an/a
1 mg @ 35 cuft
15
P
Particulates
Pass
Piping Puri
Operational Pressure Test
2
Above ceiling tiles in Xray
Particulates
LocationPPPPPP
Visual
Medical Gas Pipeline Purge & Purity Test
Pass
ray 3
Pass
Oil
(slpm)
Test
Flow 100100100
-
858585
ACC Imaging Rooms 021A, 022, X
Pass/Fail
Pass
Odor
PASS
PassPassPassPassPassPass
PassFail
or
Visible
Moisture
PASS
Pass
outlet/inlet
Room info
location
MA, Vac
Valve Test
-
Oxygen Pipeline
O2,
Gas Type
Service
ray 3
Gas or Service N2
Vac
VacVac
c
O2O2O2
A
Va
21022
-
0X
(fax)
Expansion
Swedish Edmonds Medical Center
Medical Gas Professionals
Medical Gas Verification Report
MedGas Certified, LLC
3573
Hermanson
medgascertified@hotmail.com
y 24, 2016
May 24, 2016
MedGas Certified, LLC
:
La Center, WA 98629
Verification performed by
Edmonds, WA 98026
-
456
Rooms 1 thru 10
Ambulatory Care Center
21601 76th Ave W
Ma
-
PO Box 83
888
Medical Gas Installer
Date of this Report:
erification:
2151
V
Date of
-
430
-
360
sting criteria were used as a base nt, or health
of 12
fied on l Fire Protection Association does not approve, inspect, or certify any installations, procedures, equipment, or materials;
ith
The tests
cies
d is thus many
te, local, or
ed.
e
2
erification Specialist Glenn Tsuda tested the Medical Pipeline System indicated by this report in accordance w
Page
LLC. Only the tests indicated by the
aterials the authority having jurisdiction may base acceptance on compliance with NFPA or other appropriate standards. In th
t, or
on the Discrepancies or separate
pipeline system component forms. The additional documentation contains the results, dates and locations of the tests perform
report forms were performed on the dates indicated. The results of the tests reported represent the findings of MedGas Certi
ce purposes, an insurance
inspection department, rating bureau, or other insurance company representative may be the authority having jurisdiction. In
absence of such standard, said authority may require evidence of proper installation, procedure or use. The authority having
isdiction may also refer to the listing of labeling practices of an organization that is concerned with product evaluation an
having jurisdiction; at
nor does it approve or evaluate testing laboratories. In determining the acceptability of installation, procedures, equipmen
other regional department or individual such as a fire chief; fire marshal; chief of a fire prevention bureau, labor departme
Level 1 medical gas verification.
vary, as do their responsibilities. Where public safety is primary, the authority having jurisdiction may be a federal, sta
government installations, the commanding officer or departmental official may be the authority having jurisdiction.
in a position to determine compliance with appropriate standards for the current production of listed items.
circumstances, the property owner or his or her designated agent assumes the role of the authority
and other applicable codes or agencies. The te
department; building official; electrical inspector; or others having statutory authority. For insuran
performed on this system were found to be within test specifications unless otherwise noted
The testing of this system may include all or part of the tests offered by MedGas Certified,
dical Gas Pipeline Verification
line for determining the performance of the separate components that make up this
the dates and locations indicated by the report forms only.
Me the Medical Gas and Vacuum Systems of NFPA99
MedGas Certified, LLC
Medical Gas Professionals
V
The Medical Gas
::
Per NFPA99CPer NFPA99C
The Nationa
jur
m
who has the
r final gas concentration testing is the sole responsibility of
. These design requirements (bulk capacity, bulk
mapping can result in serious injury or death due to inhalation of high levels of nitrogen or gas mixtures not
ire Marshall in your area. In some instances the AHJ is the Department of Health or in the case of of 12
This report is reflective of the facilities condition and if necessary, contains recommendations to comply with the current
plumber installed hard copper piping ending at connections for supplying gas for patient treatment. This verification does
and
determine Level and performs the Level of inspection determined and contracted for by this collaboration.
ider. MedGas
l decisions to require
is the sole responsibility of the hospital,
of this
3
or Page
e to the
The AHJ, in all matters, has the final
s
, inspected by the local building department,
patient care. This
f morbidity or
MedGas Certified, LLC has no power, nor does it undertake, to police or enforce compliance with the contents of thi
y
, qualifications
mortality in the event of an interruption of the piped medical gas and vacuum systems. Level of the facility is determined b
inspection/verification. This document, in its entirety, must be presented to the local Authority Having Jurisdiction (AHJ),
this is a testing of the installed medical gas systems from the sourc
MedGas Certified, LLC has no knowledge or limited knowledge of the facilities existing medical gas systems.
collaboration between the owner, engineers, local authority having jurisdiction and the medical gas equipment prov
military facilities, the Commanding Officer. You, the General Contractor, the Plumbing Contractor or the Hospital
responsibility to approve equipment, materials, an installation or a procedure. The AHJ will make any and al
address in ground/slab piping installation, materials used, installer installation
for treatment and
ponsible for identifying and providing reports to your local AHJ.
use
corrections, modifications or repairs to the medical gas system recorded in this report.
inspect the medical treatment equipment which is installed and connected
the hospital, surgery center, facility. Notification of staff to prevent accidental patient
Bulk system design and bulk pad requirements are covered by NFPA50/55
pad design) are collaboration between the hospital and the bulk provider
.
installer testing compliance w/ ASSE 6010 & NFPA99 requirements, etc
decision to approve the facility opening and starting patient services.
Determinations of all areas affected by shut downs, nitrogen purges and fo
are not the responsibility of the medical gas verifier.
-
5.1.12.3 System Verification
Facilities/Operations Department, are res
The AHJ is normally the F
suitable for human consumption.
Errors in pipeline
NOT
NOT
surgery center, facility.
Certified, LLC does
tion does
IAW NFPA99
document.
verifica
NOTE:NOTE:NOTE:NOTE:
NOT
of 12
allowing enforcing authorities (governmental and nongovernmental) to grant exceptions to requirements.
lent or
superior quality, strength, fire resistance, effectiveness, durability, and safety to those prescribed by this
device shall be approved for the intended purpose by the authority
compliance with the provisions of this standard shall be permitted to be continued in use as long as the
certain requirements), 1.4.1 is intended to apply to the entire code as a reminder to authorities that they
e a distinct hazard to life.
4
to demonstrate
Page
NFPA Committee Member comments: Although authorities having jurisdiction can adopt and enforce
rce requirements as written;
; adopt a document but change
concept of equivalency in 1.4.1,
1.4.1 Nothing in this code is intended to prevent the use of systems, methods, or devices of equiva
The organization, office or individual responsible for
This wording on equivalency is similar to Section 1.4 of the 2012 edition of NFPA 101, with some
1.4.2 Alternative systems, methods, or devices approved as equivalent by the authority having
An existing system that is not in strict
submitted to the authority having jurisdiction
has determined that such use does not constitut
voluntary standards that they consider appropriate (e.g., adopt and enfo
jurisdiction shall be recognized as being in compliance with this code.
issue waivers to specific facilities not meeting certain requirements
NFPA Committee Member comments: Paragraph 1.4.2 adds to the
approving equipment, materials, an installation or a procedure.
NOTE: Per NFPA99 para 5.1.1.3
risdiction (AHJ)
code. Technical documentation shall be
equivalency. The system, method, or
authority having jurisdiction
Authority Having Ju
additional information
can grant exemptions
having jurisdiction.
Equivalency
3.2.2
1.4
of 12
construction and new equipment, except as modified in individual chapters. Only the altered, renovated,
equipment requirements shall be applied only to new
5
Page
or modernized portion of an existing system or individual component shall be required to meet the
perational facility that might have or has medical gas piping
modernization adversely impacts existing performance requirements of a system or component,
nstallation and equipment requirements stated in this standard. If the alteration, renovation, or
1.4.3 The authority having jurisdiction shall be permitted to grant exceptions to this code.
Construction and
additional upgrading shall be required.
NOTE: Per NFPA99 para 1.3.2
compliance inspection.
existing o
-
This is a pre
i
of 12
medical gas system
medical
of NFPA99
6
Page
ompleting the final
been verified and meet the requirements
.
ms
r a new zone valve, area alarm panel and 10 patient roo
c
is
of the
. This verification
Medical Gas Verification Report Summary
ew Ambulatory Care Center (ACC)
This project:
ve
ha
s
System
1
.
gas phase for this ACC expansion
and Recommendations:
is a
fo
piping
This
Medical Gas Verification Specialist
.
piped systems
erification:
Added o2, ma, mv
This summary prepared by
Medical Gas Professionals
for the n
MedGas Certified, LLC
MedGas Certified, LLC
expansion
V
Scope of
II. Findings
Glenn Tsuda
1
Level
1)
I.
of 12
ndition if
as of system
Valves installed in each medical gas and vacuum system shall be tested to verify proper operation and rooms or
, it shall be determined that
ses or decreases 20% from the normal operating pressure for positive pressure gases, or when
shall be
rior to
7
support and critical care Page
em shall be tested prior to connection of the new piping to the
minute standing
areas, such as post anesthesia recovery, ICU, CCU, emergency suites and operating rooms shall be tested to verify an alarm co
All warning systems for each medical gas and vacuum system shall be tested to ensure that all components function correctly p
5.1.12.3.1.7 Where manufactured assemblies include multiple possible connection points for terminals, each possible position
Performed after cross connection testing but before the piping purge test. Can be performed with oil free dry Nitrogen NF, g
ible hoses or tubing has been completed.
-
est. Each positive pressure gas piping system shall be subjected to a ten
Connection Test. After closing of walls and completion of the Installers Initial Tests
-
upplying anesthetizing locations and other vital life
Master alarm system tests shall be performed for each of the medical gas and vacuum piping systems.
Installation of any manufactured assemblies supplied through flex
Warning systems that are part of an addition to an existing piping syst
the vacuum system drops below a gauge pressure of 12 in.
The warning signals for all medical gas piping systems s
no cross connections of the piping systems exist.
g vacuum source.
pressure test at operating line pressure.
the pressure in the piping system increa
5.1.12.3.2 Verifier Standing Pressure T
placing system into service.
designation or the operatin
-
5.1.12.3.3 Verifier Cross
5.1.12.3.4 Valve Test
tested independently.
areas of control.
existing system.
1.12.3.1.6
5.1.12.3.5.2 Master Alarms
5.1.12.3 System Verification
5.1.12.3.5.3 Area Alarms
sts
5.
Alarm Te
System Verification
N/A N/A N/A
N/A
Fail
5.1.12.3.5
Pass
5/245/245/245/245/245/245/24
of 12
8
Page
free, dry Nitrogen NF or the system gas.
lished. It shall be rapidly interrupted several times until the
designation or vacuum at the normal operating pressure by means of soapy water or other means effective for use with oxygen.
test for dew point shall be conducted at the outlet most remote from the source and dew point shall not exceed 12 degrees C
free, dry
e
r area of intrusion shall be purged per Verifier
der to remove any traces of particulate matter deposited in the pipelines as a result of construction, a heavy, intermittent
tested with the gas of system
This test shall be performed at the outlet most remote form the source. The difference between the two tests shall in no cas
and
tested, the specific altered zone and
1000 L of gas shall be filtered through a clean, white 0.45 micron filter at a minimum flow rate of 100 Nl/minute (3.5 scfm).
Nitrogen NF or the system gas. The test shall be for total hydrocarbons (as methane) and halogenated hydrocarbons
-
For each positive pressure medical gas system, the purity of the piping system shall be verified. Test gas shall be oil
purge produces no discoloration in a white cloth loosely held over the adapter during the purge.
-
ection between the new work and the existing system shall be leak
-
medical gas shall be verified. Test gas shall be oil
-
pressure gases, immediately after the final connection is made and leak
2 ppm.
components in the immediate zone or area that is downstream form the point o
pletion of standing pressure test is required.
e tested at the outlet most remote form the source
1 ppm and Halogenated Hydrocarbons
If any outlet fails, the most remote outlet in every zone shall be tested
Filter shall accrue no more than 1 mg of matter from any outlet tested
Using an appropriate adapter, a high purge rate (8scfm) will be estab
purging of each medical gas pipeline shall be done.
The cleanliness of the piping in each
If not accessible a successful com
compared with the source gas.
exceed, Total Hydrocarbons
(10 degrees F) @ 50 psig.
Each joint in the final conn
25% of the zones shall b
Piping Purge Test.
5.1.12.3.7 Verifier Piping Particulate Test
5.1.12.3.6 Verifier Piping Purge Test
5.1.12.3.8 Verifier Piping Purity Test
-
in Test
For positive
-
5.1.12.3 System Verification
In or
5.1.12.3.9 Verifier Final Tie
A
N/A N/A
N/A
N/A
Fail
Pass
5/245/245/245/245/245/245/245/24
of 12
9
Page
n the medical gas piping systems where the user makes
Medical surgical vacuum inlets shall draw 85 Nl/min without reducing the vacuum pressure below 12 in. HgV at any adjacent
After purging each piping system with the gas of system designation, each pressure gas source and outlet shall be analyzed
d by this standard for all components, station outlets/inlets, shutoff valves,
All oxygen and medical air outlets serving critical care areas shall permit a transient flow rate of 170
55 psi.
Medical air source shall be analyzed for concentration of contaminants by volume prior to the source vale being opened.
0 Nl/min with a pressure drop of no more than 5 psi and static pressure of 160 to 185 psi
5 psi and static pressure of 50
free, dry Nitrogen NF or gas of system designation.
sheets.
Testing of source equipment performed and results are recorded on individual equipment
Medical gas outlets shall deliver 100 NL/min with a pressure drop of no more than
Operational pressure tests shall be performed at each station outlet i
-
connections and disconnections. Performed with either oil
Sample shall be taken at the system sample port.
The presence and correctness of labeling require
for concentration of gas by volume.
and alarm panels, shall be verified.
Nl/min (6 SCFM) for 3 seconds.
Nitrogen outlets shall deliver 14
5.1.12.3.12 Medical Air Purity Test (Air Compressor)
Critical care flow test
5.1.12.3.10 Verifier Operational Pressure Test
cal Gas Concentration Test
5.1.12.3.14 Source Equipment Verification
station inlet
N/AN/AN/A
N/A
5.1.12.3.13 Labeling
5.1.12.3.11 Medi
Fail
Pass
5/245/245/245/245/24
5/24
of 12
10
Page
Labeling
Outlet
PPPPPPPPPPPPPPPPPPPP
Gauge
Function
P
Lock
PPPPPPPPPPPPPPPPPPPP
Leakage
Leakage
Outlet
Inlet
P
PPPPPPPPPPPPPPPPPPPP
Function
P
O2 161/MA 170
Critical Care
Flow
n/an/an/an/an/an/an/an/a
PPPPPPPPPPPP
Access
P
Label
Vacuum
Max
Flow
00000000
n/an/an/an/an/an/an/an/an/an/an/an/a
1515151515151515
P
Operational Pressure Test
PASS
CC Nurses Station
Vac
n/a
CC Nurses Station
LocationPPPPPPPPPPPPPPPPPPPP
PASSPASS
MA
A
A
Location:
(slpm)
Test
Flow 100100100100100100100100100100100100
8585858585858585
PASSPASS
O2
Pass/Fail
PASS
PassPassPassPassPassPassPassPassPassPassPassPassPassPassPassPassPassPassPassPass
PassFail
or
CC Rooms 1 thru 10
Medical Gas Monitored
outlet/inlet
oom info
location
WallWallWallWallWallWallWallWall
Line Pressure High
MA, Vac
Line Pressure Low
Area Alarm Test
Valve Test
R
O2,
oom 1234
oom oom oom
Gas or Service
Vac
VacVacVacVacVacVacVacVac
O2O2O2O2O2O2O2O2
Zone
MAMAMAMA
RRRR
A
of 12
11
Page
Labeling
Outlet
PPPPPPPPPPPPPPPPPPPPPPPPP
Function
Lock
PPPPPPPPPPPPPPPPPPPPPPPPP
Leakage
Outlet
Inlet
PPPPPPPPPPPPPPPPPPPPPPPPP
O2 161/MA 170
Critical Care
Flow
n/an/an/an/an/an/an/an/an/an/a
PPPPPPPPPPPPPPP
Vacuum
Max
Flow
0000000000
n/an/an/an/an/an/an/an/an/an/an/an/an/an/an/a
15151515151515151515
Operational Pressure Test
PPPPPPPPPPPPPPPPPPPPPPPPP
(slpm)
Test
Flow 100100100100100100100100100100100100100100100
85858585858585858585
t)
PassPassPassPassPassPassPassPassPassPassPassPassPassPassPassPassPassPassPassPassPassPassPassPassPass
PassFail
or
(con
CC Rooms 1 thru 10
outlet/inlet
oom info
location
WallWallWallWallWallWallWallWallWallWall
R
56789
oom oom oom oom oom
Gas or Service
Vac
VacVacVacVacVacVacVacVacVacVac
O2O2O2O2O2O2O2O2O2O2
MAMAMAMAMA
RRRRR
A
of 12
12
Page
41°F @ 50 psig41°F @ 50 psig
5°C @ 50 psig5°C @ 50 psig
Dew PointDew Point
PassPass
Labeling
Outlet
PPPPP
Function
Lock
PPPPP
Hydrocarbons <
Hydrocarbons
Halogenated Halogenated
PassPass
< 2ppm
2ppm
Leakage
Outlet
Inlet
PPPPP
Total Hydrocarbons as Total Hydrocarbons as
O2 161/MA 170
Critical Care
Methane Methane
PassPass
< 1ppm< 1ppm
Flow
n/an/a
PPP
Vacuum
Piping Purity DataPiping Purity Data
Max
Flow
00
n/an/an/a
1 mg @ 35 cuft1 mg @ 35 cuft
1515
ParticulatesParticulates
PassPass
Operational Pressure Test
ParticulatesParticulates
PPPPP
sual
Visual
Medical Gas Pipeline Purge & Purity Test
PassPass
Vi
PassPass
OilOil
(slpm)
Test
Flow 100100100
8585
t)
PassPass
OdorOdor
PassPassPassPassPass
PassFail
or
(con
PASS
CC Rooms 1 thru 10
Visible Visible
MoistureMoisture
PASS
PassPass
outlet/inlet
oom info
-
Medical Air Pipeline
location
WallWall
-
Oxygen Pipeline
R
Gas TypeGas Type
10
oom
Gas or Service N2N2
Vac
VacVac
O2O2
MA
R
A