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Agency for Healthcare Research Quality www.ahrq.gov
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Facility Checklist

Gas and Ventilation/Basement

Inspect to determine whether to use existing or portable system.

Date: ____________  Location: _______________________  Team member: __________________________

General

 

Observations:  

 

Oxygen and Medical Gases

Y N Is there an existing centralized set-up?
Y N Was bulk oxygen tank removed?
Y N If yes, were lines capped?

When was centralized system last used? _________________________________________________

 

Y N Based on current system review, is it recommended to use portable gases?

 

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AHRQ Advancing Excellence in Health Care