Swedish Edmonds Campus-OR #6-3412-12.21.21Medical Gas Services
918 S Horton St, Suite 917
Seattle, WA 98134
medgasservices.io
(425) 894 5918
Medical Gas Line Verification Report
Date: December 215t,2021
Job Number: 3412
Contractor: MacDonald -Miller Facility Solutions
Date(s) / Time(s) of Testing: December 215t, 2021- 0100 hrs.
Facility: Swedish Edmonds Campus
2160176th Ave W
Edmonds, WA. 98026
Scope of Work: Installation of new medical oxygen, vacuum, nitrous oxide and WAGD
inlets/outlets downline of existing zone valves
Our firm certifies that the verifier named in the report is properly trained and certified to
perform the activities required. All testing and measurement equipment are properly
calibrated and maintained. As a representative of Medical Gas Services, LLC, the verifier
named in this report has conducted testing and verification of medical gas piping systems
and related equipment to certify the following on the above date.
General Findings:
A. Medical gases and vacuum are in compliance with NFPA 99 (2012ed): Category 1
B. No crossed lines were found in medical gas or vacuum systems in the tested
areas on the day of testing.
C. Medical gases meet minimum concentration.
D. Medical gases meet minimum flow and are at normal pressure.
E. Medical vacuum meets minimum flow and is at normal vacuum pressure.
F. Medical gas system components in the area tested are in compliance with
NFPA 99 (2012ed).
G. Medical Gas Line Purity Test: PASS
H. Initial Line Pressure Test: PASS (150# for 24 hrs.)
I. Permit #: BLD-2021-1583 / City of Edmonds
J. Attachments: Worksheet
Note: Existing Equipment and Systems
NFPA 99(2012ed)115114 - An existing system that is not in strict compliance
with the provisions of this standard shall be permitted to be continued in use
as long as the authority havingiurisdiction has determined that such use does
not constitute a distinct hazard to life.
3412-12.21.21-VR Pg.1 of 3
Medical Gas Services
918 S Horton St, Suite 917
Seattle, WA 98134
medgasservices.io
(425) 894 5918
II. Medical Gases:
A. Oxygen:
1. Static Line Pressure: 54.5 psi
2. Dynamic Outlet Free Flow: >3.5 scfm
3. Dynamic Outlet Free Flow: >6.0 scfm (for 3 seconds in 'Critical Care Area')
4. Oxygen Concentration: 98.6%
5. Delta Flow: PASS
B. Nitrous Oxide:
1. Static Line Pressure: 55.1 psi
2. Dynamic Outlet Free Flow: >3.5 scfm
3. Nitrous Oxide Concentration: >99.0%
4. Delta Flow: PASS
III. Vacuum:
A. Medical - Surgical Vacuum
1. Static Line Vacuum: 21.14" HqV
2. Dynamic Inlet Free Flow: >3.0 scfm
3. Delta Flow: PASS
B. WAGD (Waste Anesthesia Gas Disposal) (Not A Separate System)
1. Static Line Vacuum: 21.14" HqV
2. Dynamic Inlet Free Flow: >3.0 scfm
3. Delta Flow: PASS
IV. Particulate Test: PASS
V. Odor: None
VI. Outlets / Inlets:
A. Brand: Patton's Medical
B. Quick Connect Style: Chemetron
VII. Zone Valves:
A. Brand: Chemetron
B. Down line gauges: Some
C. Labeled for Area Controlled: Yes
VIII. Alarms:
A. Area Alarms:
1. Brand: Could not locate
2. Labeled for Area Monitored: Could not locate
3412-12.21.21-VR Pg. 2 of 3
Medical Gas Services
918 S Horton St, Suite 917
Seattle, WA 98134
medgasservices.io
(425) 894 5918
IX. Brazier: Garrett T. Swearingen
A. Brazier Number: SWEARGT872D2
B. Contractor: MacDonald -Miller Facility Solutions
X. Comments:
A. Oxygen zone valve does not have a downline pressure gauge
B. Nitrous oxide zone valve does not have a downline pressure gauge
C. Could not locate area alarm for operating rooms
XI. Recommendations:
A. Install zone valve with downline pressure gauge
B. Install zone valve with downline pressure gauge
C. Confirm and locate operating room area alarm
Reviewed By: Matthew Waacchhsmuth - ASSE 6030 Verifier
3412-12.21.21-VR Pg. 3 of 3
Medical Gas Services
918 S Horton St, Suite 917
Seattle. WA 98134
medsasservices.io
(425) 894 5918
Surgical Outlet Ei Zone Valve Evaluation Worksheet
Facility: Swedish Edmonds Campus Job #: 3412 Date: 12.21.21
Area Tested: Operating Room 6 Verifier: MW
?one Valve - r-1 New 171 Existing
Labeled As: OR 6
1ZV Brand: Chemetron
Gas
3 Part Valve
DL Gauge
a.
pal
Act
PSI
Comments:
OX
® Yes ❑ No
❑ Yes ® No
--
54.5
MA
❑ Yes ❑ No
❑ Yes ❑ No
N20
® Yes ❑ No
❑ Yes ® No
--
55.1
VAC
® Yes ❑ No
® Yes ❑ No
24
21.14
WAGD
❑ Yes ❑ No
❑ Yes ❑ No
--
21.14
Same System
N2
❑ Yes ❑ No
❑ Yes ❑ No
I_�f7�:1_�ICTi''n■�►•C7T�■�►C.�i�7�Z�.'l�f�:�■�►C��►1�4:i�i ■ •
Labeled As: Could Not Locate
Brand:
Gas
PSI
Set HI
Set LO
Sensor
Comments:
OX
Could not find area alarm
MA
N20
VAC
WAG D
N2
Uutlets & Inlets - M New I I Existino
Outlet / Inlets Brand: Patton's Medical
Location: Wall
I Quick Connect: Chemetron
Area Room Door
Gas
Flow
SCFM
Delta
Flow
Conc.
%
Part.
Comments:
OR # 6
OX
>8
<5
98.6
.000
OX
>8
<5
98.6
.000
VAC
5
>12
--
--
VAC
5
>12
--
--
VAC
5
>12
--
--
VAC
5
>12
--
--
VAC
5
>12
--
--
WAGD
5
>12
--
--
N20
>8
<5
>99
.000
3412-12.21.21 PS.1 of 1