Swedish – Birthing Center- Med Gas Special Inspection Report 3.31.2022 (2)Medical Gas Services
918 S Horton St, Suite 917
Seattle, WA 98134
medgasservices.io
(425) 894 5918
Medical Gas Line Verification Report
Date: March 29th, 2022
Job Number: 3626
Contractor: UMC, Inc.
Date(s) / Time(s) of Testing: March 29th, 2022 - 0900 hrs.
Facility: Swedish - Edmonds Campus
2160176th Ave W
Edmonds, WA 98026
Scope of Work: Addition of new outlets/inlets to existing distribution systems
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. Permit #: BLD2022-0106 / City of Edmonds
I. Attachments: Worksheets
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.
3626-3.29.22-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: 53.5 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: 97.5 %
5. Delta Flow: PASS
B. Medical Air:
1. Static Line Pressure: 51.6 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: 20.3 %
5. Delta Flow: PASS
6. Carbon Monoxide: Non -Detectable
7. Carbon Dioxide: 442 ppm
8. THC's: Non -Detectable
9. Dew Point: 13.5° F
III. Vacuum:
A. Medical -Surgical Vacuum
1. Static Line Vacuum: 20.51" 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: BeaconMedaes
B. Quick Connect Style: Chemetron
VII. Zone Valves:
A. Brand: Chemetron
B. Down line gauges: Yes
C. Labeled for Area Controlled: Yes
VIII. Alarms:
A. Area Alarms:
1. Brand: Chemetron
2. Labeled for Area Monitored: Yes
3626-3.29.22-VR Pq 2 of 3
Medical Gas Services
918 S Horton St, Suite 917
Seattle. WA 98134
medsasservices.io
(425) 894 5918
IX. Brazier: Chase Headrick
A. Brazier Number: HEADRC"913LH
B. Contractor: UMC, Inc.
X. Comments:
A. None
XI. Recommendations:
A. None
Tested By: Alexander Christensen - Medical Gas Technician
Reviewed By: Matthew Waa�chhsmuth - ASSE 6030 Verifier
3626-3.29.22-VR PS 3 of 3
Medical Gas Services
918 S Horton St, Suite 917
Seattle. WA 98134
medsasservices.io
(425) 894 5918
Medical Gas Outlet / Inlets Evaluation Worksheet
Facility: Swedish - Edmonds Campus
Job #: 3626
IDate: 3.29.22
Area Tested: Th Floor - Birthing Center
I Verifier: AC
Zone halve - r-1 None r-1 Not Reauired r-1 New 171 Existino
Labeled As: 704, 705, 706 6 707
ZV Brand: Chemetron
Gas
3 Part Valve
DL Gauge
Ga. PSI
Act PSI
Comments:
OX
® Yes ❑ No
® Yes ❑ No
52
53.5
MA
® Yes ❑ No
® Yes ❑ No
48
51.6
VAC
® Yes ❑ No
® Yes ❑ No
20
20.51
Area Alarm - F1 None F1 Not Reauired F1 New N Existino
Labeled As: Patient Rooms 704-707
Brand: Chemetron
Gas
PSI
Set HI
Set LO
Sensor
Comments:
OX
52.4
60
40
DL
MA
51.3
60
40
DL
VAC
20.5
--
12
DL
UUtletS & Inlets - M New rA Existino
Outlet / Inlets Brand: BeaconMedaes
Location: Wall
Quick Connect: Chemetron
Area Room Door
Gas
Flow
SCFM
Delta
Flow
Conc.
%
Part.Comments:
704
VAC
4.5
>12
--
--
All New
OX
>8
<5
97.5
.000
OX
I >8
<5
97.5
1 .000
VAC
4.5
>12
--
--
MA
>8
<5
20.3
.000
DP: 13.5°F CO:Oppm CO2:442ppm
705
VAC
4.5
>12
--
--
All New
OX
>8
<5
97.5
.000
OX
>8
<5
97.5
.000
VAC
4.5
>12
--
--
MA
>8
<5
20.3
.000
706
VAC
4.5
>12
--
--
Existing
OX
>8
<5
97.5
.000
Existing
OX
>8
<5
97.5
.000
New
VAC
4.5
>12
--
--
New
MA
>8
<5
20.3
.000
New
3626-3.29.22 Page 1 & 2
Medical Gas Services
918 S Horton St, Suite 917
Seattle, WA 98134
medgasserViceSJO
(425) 894 5918
Supplemental Outlet / Inlets Evaluation Worksheet
Facility: Swedish - Edmonds Campus
Job #: 3626
Date: 3.29.22
Area Tested: Birthing Center
Verifier: AC
Outlets & Inlets - ® New ® Existing
Outlet / Inlets Brand: BeaconMedaes
Location: Wall
Quick Connect: Chemetron
Area Room Door
Gas
Flow
SCFM
Delta
Flow
Conc.
Part.
Comments:
707
OX
>8
<5
97.5
.000
All existing
VAC
4.5
>12
--
--
MA
>8
<5
20.3
.000
OX
>8
<5
97.5
.000
VAC
4.5
>12
--
--
3626-3.29.22 Page 2 of 2