Check Sheets for Annual Verification of Critical Systems · Check sheets for Annual Verification of...

Check sheets for Annual Verification of Critical Ventilation Systems on Healthcare Sites

Check Sheets forAnnual Verification of Critical SystemsRequired as a part of clause 4.1, 4.2 and 4.5 of HTM 03-01 Part B: 2007 for quarterly and six monthlyinspection.

Client Contract Name

Hospital Address Address

Description of Works short description

Area Served name

Engineer’s name

Report prepared by name

Checked By name

Date of Validation date

Date of Report Issue date

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Table of Contents

Section – Title

Introduction / Executive Summary

1. Scope of Works

2. General description of theatre suite and ventilation plant

3. Conditions at Time of Inspection

4. Information from client

5. Air Handling Unit supply and extract schematic diagrams.

6. AHU survey report

7. Plan of the ventilation system

8. Plan of the area served by the critical ventilation system

9. Theatre suite survey report

10. Air flow rates

11. Air change rates

12. Room differential pressures

13. Traverse reports

14. UCV Canopy Service Report

15. UCV - Velocity Profile

16. UCV - Filter Integrity Test Results

17. UCV - Entrainment Test Results

18. Light level readings

19. Noise level readings

20. Fire / smoke damper test

21. Test Equipment Used

22. Conclusion

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Appendix A

Appendix B

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Introduction and Executive Summary

Introduction

Executive Summary

Overall conclusion based on worst results Pass/Fail

Should the system be taken out of service as defined in HTM 03-01 Part B 4.29 Yes / No

Following failure, report to senior manager of the user department for them to decide if thereis a medical need as required by HTM 03-01 Part B 4.29 (actioned by AP) Done / Not done

date / /201Signed Competent Person …………….…………….date / /201

Signed Authorised Person…………….……………. date / /201

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1 – Scope of Works

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2 – General Description of Area/unit

1. Basic details of the system and where it serves including how they operate.This to include:

Location of plantroom Area servedName of plant

2. Air Handling Equipmenta. Supply Air Handling Unit:

i. Louvre intake damperii. Frost coil

iii. Pre filteriv. Fan sectionv. Cooling coil

vi. Heating coilvii. Main filter

viii. Operating damperb. Extract Air Handling Unit:

i. Fan sectionii. Motorised damper

3. Theatre Suitea. Operating theatre roomb. Anaesthetic roomc. SPS Prep roomd. Scrub areae. Dirty Utilityf. Clean corridor

4. Automatic Controls System Descriptiona. Hospital building management system

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3 – Conditions at Time of Inspection

Ventilation System Status: Operational

UCV Status: Operational

Note exceptional conditions: None

Theatre Temperature – HTM Range (18°C to 25°C) Measured 22.0°C

Operating Theatre Panel: Indicated 23.0°C

Theatre Humidity – HTM Range (35% to 60% RH) Measured 36.0% RH

Operating Theatre Panel: Indicated 34.0% RH

Anaesthetic Temperature: Measured 21.0°C

Anaesthetic Humidity: Measured 39.0% RH

Prep Temperature: Measured 22.0°C

Prep Humidity: Measured 38.0% RH

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4 – Information from Client

1. Floor plans etc2. Duct drawings etc3. Previous verification reports4. Previous validation reports

If information not available this should be clearly recorded in the conclusion

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5 – Air Handling Unit Supply and Extract Schematic Diagrams

Showing all details of components as described earlier, including traps and drains.

Two schematics

Supply

Extract

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6 - AHU Survey Report Date of installation:

Ventilation systems - minimum requirements (annual inspections)HTM ref. Survey question Yes No Comments

1 General requirements1 5.1 Have the inspection activities been assessed to ensure that

they do not create a hazard for those who undertake the work or for those who could be affected by it?

2 5.5 Was a permit-to-work completed to ensure that taking the ventilation system out of service did not compromise theactivities of the user department?

3 4.2a Is the system is still required?

4 3.1a Is there safe access when carrying out routine service andmaintenance activities?

5 3.1b Is there a Legionella (L8) risk assessment for the system?

6 3.1b Are there any risks associated with Legionella and otherpotential hazardous Organisms?If it is possible for water to be present between 20ᶿc and 45ᶿc and there is a possible hazard then this should be recorded.

7 4.2c Has the fire containment not been breached?

8 4.2d Is the general condition of the ventilation systemadequate?

9 4.2e Is the system overall operating in a satisfactory manner?

10 3.1c Is the system fit for purpose?

2 Location and access1 3.7 Is the area around an AHU within a building is it

tanked/bunded to prevent water penetration to adjacent areas, and adequately drained?

2 3.8 Are fire precautions in accordance with Fire code?E.g. Are the fire dampers and pressure fire pressurestabilisers installed correctly, are the dampers including pressure stabilisers fire rated where they pass through fire barriers.

3 3.9 Is combustion equipment located in a fire compartmentthat houses air-handling equipment?

4 3.10 Are plant rooms that house AHUs used for general storage?

5 3.10 Are combustible materials kept in the plantroom?

3 Basic requirements1 3.11 Does the plant contain any material or substance that could

support the growth of microorganisms?2 3.12 Does the plant contain any material or substance that could

cause or support combustion?3 3.13 Is access to items that require routine service, such as

filters, fog coils and chiller batteries, via hinged doors?4 3.14 Are items requiring infrequent access such as attenuators

accessed via clipped or bolted-on lift-off panels?5 3.15 Are all doors and panels close-fitting and without leaks?

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6 3.16 Is access available via fixed ladders and platforms or pulpit-style movable steps?

7 3.17 Do electrical and mechanical services restrict or impedeaccess to those parts of the AHU that require inspection?

8 3.18 Are viewing ports fitted in order to inspect filters and drainage trays?

9 3.19 Is internal illumination provided by fittings to at least IP55 rating?

10 3.19 Are fittings positioned so that they provide bothillumination for inspection and task lighting?

4 AHU intakes and discharges1 Pt A

3.57Are air intakes and discharge points located at high level, to minimise the risks of noise nuisance to surroundingbuildings, contamination and vandalism?

2 Pt A3.58

Are intakes and discharges located so that wind speed anddirection have a minimal effect on the plant throughput?

3 Pt A3.59

Are helicopter landing pads in the vicinity of ventilationintakes and discharges does this result in large short-term pressure changes?

4 Pt A3.59

Can exhaust fumes from a helicopter be drawn into intakes?

5 Pt A3.60

Are intake points situated away from cooling towers, boilerflues, and vents from oil storage tanks, fume cupboards and other discharges of contaminated air, vapours and gases,and places where vehicle exhaust gases may be drawn in?

6 Pt A3.61

Are intakes sited at or near ground level, the area aroundthem paved or concreted to prevent soil or vegetation being drawn in?

7 Pt A3.61

Are the intakes caged or located within a compound to prevent rubbish being left in the vicinity?

8 Pt A3.61

Is the protected area large enough to prevent vehicle exhausts entering the intake?

9 Pt A3.62

Is the discharge from a general extract system located sothat vitiated air cannot be drawn back into the supply-air intake or any other fresh-air inlet? Is, the extract discharge located on a different face of the building from the supplyintake(s)?

10 Pt A3.62

Is, there a minimum separation of 4 m between (any inlet or discharge), with the discharge mounted at a higher levelthan the intake?

11 Pt A3.63

Are discharges from LEV systems vertical and not less than3 m above roof level?

12 Pt A3.63

Is the LEV discharge fitted with a cowl that could cause thedischarge to be deflected downwards?

13 Pt A3.64

Are intake and discharge points fitted with corrosion- resistant weatherproof louvres or cowls to protect thesystem from driving rain (BS EN 13030, Class B)?

14 Pt A3.65

Are louvres operating with a maximum face velocity of< 2 m/s in order to prevent excessive noise generation and pressure loss and water ingress?

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15 Pt A3.66

Inside of the louvres is there a mesh of not less than 6 mmand not more than 12 mm to prevent infestation by vermin and prevent leaves being drawn in?

16 Pt A3.67

Is the duct behind a louvre self-draining? If this is not practicable, or tanked and provided with a drainagesystem?

17 Pt A3.68

Is cleaning access provided either from the outside viahinged louvres or by access doors in the plenum behind the louvre?

5 Ventilation system cleaning1 5.18 Has the intake section of a ventilation system been

vacuumed-out as necessary to remove visible particles?2 5.19 Has the AHUs been vacuumed-out and/or washed down

internally as necessary to remove obvious dust and dirt?3 5.22 Extract air systems handle unfiltered air. Have they been

cleaned as frequently as necessary in order to maintain their operating efficiency?(Note Room extract terminals, particularly those sited at low level in critical care areas, will need regular cleaning.)

4 5.23 Is there any evidence of chemical cleaning of the AHU or ductwork systems?

5 5.24 Have hatches been checked to ensure that they have beencorrectly replaced and do not leak?

6 AHU drainage system1 3.24 Are all items of plant that could produce moisture provided

with a drainage system?Also in appendix 1

2 3.24 Does, the system will comprise a drip-tray, glass trap, airbreak and associated drainage pipework?

3 3.25 Some existing units may not have been mounted farenough above the floor to permit the correct installation of a drainage system.If the AHU cannot be raised to an adequate height, has analternative arrangement (such as a pump-out system) must be provided?

4 3.26 Is the drip-tray should be constructed of a corrosion-resistant material (stainless steel is preferred) and be so arranged that it will completely drain.

Also in appendix 1

5 3.26 Also to prevent “pooling”, it is essential that the drainconnection should not have an up-stand and that a slope of approximately 1 in 20 in all directions should beincorporated to the drain outlet position.

6 3.26 And is the tray completely accessible or, for smaller units, easily removable for inspection and cleaning?

7 3.27 Is each drip-tray provided with its own drain trap? Thedrain trap should also be of the clear (borosilicate) glass type.Note. This permits the colour of the water seal to be observed, thus giving an early indication of corrosion, biological activity or contamination within the duct (seeTable 3).

Also in appendix 1

8 3.28 Is the trap water clean and clear, if not what action shouldbe taken?

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9 3.28 Has the trap a means for filling and incorporates couplingsto facilitate removal for cleaning.

Also in appendix 1

10 3.28 Also, It should be located in an easily visible position whereit will not be subject to casual knocks?And the pipework connecting it to the drainage tray shouldhave a continuous fall of not less than 1 in 20?

11 3.29 Are traps fitted to plant located outside or in unheatedplantrooms been trace-heated?The trace heating should also be checked for operation and must not raise the temperature of water in the trap above 5°C.

12 3.30 Does water from each trap discharge via a clear air gap of atleast 15 mm above the unrestricted spill-over level of either an open tundish connected to a drainage stack via a secondtrap, or a floor gully (or channel).

Also in appendix 1

13 3.30 Also is a support provided to ensure that the air gap cannotbe reduced?Note, More than one drain trap may discharge into the tundish, providing each has its own air break.

14 3.31 Is Drainage pipework thermoplastic, copper or stainless steel?Also, Glass should not be used. The pipework should also be a minimum diameter of 22 mm and have a fall of at least 1 in 60 in the direction of flow and It should be well supported, and located so as not to inhibit access to theAHU.

7 Dampers1 3.32 Is this AHU serving a critical area or those areas that are

shut down out of hours should be fitted with motorised low-leak shut-off dampers located immediately behind theintake and discharge of each supply and extract system?

Also in appendix 1

8 Fan drives1 3.33 Are fan-drive trains, whether supply or extract, for

weatherproof units designed to be located outside, the fan drive enclosed?

2 3.33 Are be these easily visible without the need to remove access covers?

Also in appendix 1

3 3.33 Are fan-drive trains easily visible through a viewing portwith internal illumination and accessed via a lockable, hinged door?

4 3.34 Are the motor windings of induction-drive “plug” motorarrangements and in-line axial fans having a pod motor within the air stream protected from over-temperature by athermistor and lockout relay?

5 3.35 If the computer control system or its software develop afault – can the fan can be switched to a direct start with fixed speed and manual operation?(applicable to, critical care systems serving operating suites,high dependency care units of any type, isolation facilities, laboratories and pharmaceutical production suites.)

9 Heater-batteries1 3.36 Is access for cleaning provided to both sides of all fog coils

and heater-batteries?

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2 3.37 Where auxiliary wet heater-batteries are located in falseceilings, are they fitted with a catch tray and leak alarm?

3 3.37 Is the auxiliary wet heater-batteries catch tray installedunder both the battery and the control valve assembly to protect the ceiling from leaks?

4 3.37 Is a moisture sensor and alarm fitted to the auxiliary wetheater-batteries drip tray?

10 Cooling coils1 3.38 Are all cooling coils – whether with the AHU or with a

branch duct – fitted with their own independent drainagesystem as specified in HTM?

2 3.38 For all cooling coils is there a baffle or similar deviceprovided in the drip-tray to prevent air bypassing the coil?

3 3.38 Is the drip tray large enough to capture the moisture fromthe eliminator, bends and headers?

4 3.39 Does the cooling-coil control valve close upon selection of low speed, system shut-down, low air flow and fan failure?

5 3.40 Are auxiliary wet-cooling coils located in false ceilings, fitted with a catch tray and leak alarm?Are the auxiliary wet-cooling coils catch trays installed under both the battery and the control valve assembly to protect the ceiling from leaks?Are the auxiliary wet-cooling coils provided with a moisture sensor and alarm should be fitted in the tray?

11 Humidifiers1 3.41 Where humidifiers are not in use has all associated

pipework should also been isolated2 3.41 At its junction with the running main?

3 Pt A4.93

Are humidifiers operating safely and are not a source ofcontamination?

12 General requirements

Only answer the following humidifier questions if the device IS WORKING (12 to 12 e)

1 Pt A4.94

Does the humidifier create complete mixing of the steam with the air?

2 Pt A4.94

Have The humidifier manufacturers’ instructions been closely followed regarding minimum distances, which should be allowed before bends or other components including filter mounted downstream?(If it becomes saturated by the humidifier, organisms can grow through the filter and be released into the duct. These may then be carried on the air stream into an occupiedspace.)

3 Pt A4.95

Are hinged access doors with viewing ports and internalillumination should be provided to the Humidifier?Is a label warning that the device emits live steam andshould be isolated prior to opening affixed to the access doors to the humidifier?

4 Pt A4.96

Are all parts of the humidifier and its associated ductworkin contact with moisture manufactured from corrosion- resistant materials; stainless steel is preferred?

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5 Pt A4.97

Are the electrodes of self-generating electrode-boilerhumidifiers stainless steel?

6 Pt A4.99

Is the water supply for the humidifier derived from apotable source?Chemical treatments must not be added to the water supply to humidifier units.

7 Pt A4.101

Is there provision for draining down supply pipework and break tanks serving self-generating humidifiers during theseasons when they are not required in service?

8 Pt A4.101

Is there isolation of the water supply at its junction with the“running” main to prevent the creation of a dead leg?

9 Pt A4.101

Are all parts of the humidifier water supply system capableof being cleaned and/or disinfected?

12a Humidifier - Acceptable types1 Pt A

4.102Are Water-curtain, spray or mist humidifiers of any type fitted? (They should not be used.)

2 Pt A4.104

Is the introduction of steam, by an appliance specifically designed to discharge dry steam into the air-conditioning system without objectionable noise or carry-over ofmoisture?

12b Humidifier – Selection1 Pt A

4.107Is the humidifier operating at a pressure of approximately 1bar?

2 Pt A4.107

Is the Humidifier supply pipework provided with a dirt pocket, pressure-reducing valve and steam trap installed as close as practicable to the humidifier so that the steamcondition at entry is as dry as possible?

3 Pt A4.107

Is a temperature switch on the condensate line (or equivalent design provision by the humidifier manufacturer) incorporated to prevent “spitting” on start-up?

4 Pt A4.108

Mains steam humidifiers is there any back-pressure in thecondensate discharge line, which will result in flooding into the duct?

5 Pt A4.109

Some steam generators incorporate a heated tank thatrequires regular cleaning and descaling. Does this allow the steam-supply manifold to be physically isolated from the air duct in order to prevent contamination of the air stream bycleaning agents while this is taking place?

12c Humidifier - Location1 Pt A

4.110Is the humidifier lance located to prevent the steamimpinging onto the side(s) of the duct, condensing and generating excess moisture?

12d Humidifier - Control1 Pt A

4.111Accurate humidity control can only be provided on single- zone systems or multi-zone systems with zonal humidifiers. Do the, humidity sensors control the humidifier for low- level humidity control and override the temperature controls to open the cooling-coil valve for high-level humidity control?

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2 Pt A4.112

In multi-zone humidification systems is a minimumhumidity sensor located in the supply duct(s) following the last heater-battery?

3 Pt A4.113

Do overriding controls separate from the normal plant humidistat and prevent excessive condensation in theconditioned space when starting up?

4 Pt A4.113

Is a time delay incorporated into the humidifier controlsystem such that the humidifier does not start until 30 minutes after the ventilation/plant start-up?

5 Pt A4.113

Is a high-limit humidistat installed to limit the output of the humidifier so that the saturation in the duct does notexceed 70%?

6 Pt A4.113

Does this humidistat control the added Moisture?(It is not necessary to install a dehumidifier to reduce the humidity of the incoming air if it already exceeds 70%.)

7 Pt A4.113

Does the humidifier control system ensure that the humidifier is switched off when the fan is not running?

8 Pt A4.114

Does the control isolate the humidifier upon selection ofset-back operation and in addition, on system shutdown, low air flow or fan failure, does the humidifier be isolate?

9 Pt A4.115

For where a water-supplied local steam generator is unusedfor a period exceeding 48 hours, does it automatically self- drain (that is, all water content must drain out – including that contained in the supply pipework – all the way back tothe running main) and remain empty?

10 3.43 Are hinged access doors with viewing ports and internalillumination provided?

11 3.47 Are Steam generators of a type that requires regularcleaning and descaling?And can the installation be physically isolated from the air duct in order to prevent contamination of the air supply bycleaning agents?

12e Humidity - Control methods and application1 6.41 For certain types of steam humidifier, it may be necessary

to install a thermostat in the condensate line from the humidifier’s steam supply, to ensure that the steam at the control valve is as dry as possible before it is injected intothe air supply, is this fitted and working?

2 6.43 Does the humidifier control system ensure that it isswitched off with the fan?

3 6.43 Does the control system ensure the humidifier is isolatedfor an adequate time before the fan is turned off so as to purge humid air from the system?

4 6.44 Do all control valves fail-safe (that is, close in the event of power failure), and the humidifier be interlocked with thelow air-flow switch?

13a Filtration - General1 3.49 Are mounting frames designed so that the air flow pushes

the filter into its housing to help minimise air bypass?

2 3.50 Are all filters of the dry type?

3 3.50 Are pre-filters positioned on the inlet side of the supply fan,downstream of the frost coil?

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4 3.50 Are secondary filters on the positive-pressure side of thefan?

5 3.51 Does the filter installation provide easy access to filtermedia for cleaning, removal or replacement?

Also in appendix 1

6 3.51 Are hinged access doors provided?

7 3.51 Is the upstream side of the filter visible for inspectionthrough a viewing port with internal illumination?

8 3.52 Are all filters provided with a means of checking the differential pressure across them?(Direct-reading dial-type gauges marked with clean anddirty sectors are preferred.)

13b Filtration - High-efficiency filters – HEPA and ULPA1 3.53 Are HEPA filters of the replaceable-panel type with leak-

proof seals?(Their installation should permit the validation of the filter and its housing.)

2 3.54 Are HEPA filters used in extract systems for the containment of hazardous substances or organisms? (They may be fitted with pre-filters to extend their servicelife.) And does, the installation incorporate provision for the subsequent safe removal and handling of contaminatedfilters by maintenance staff?

13c Filter changing1 5.8 Are workmen handling, Dirty extract-and-return air filters

that may pose an increased level of hazard protected?2 5.10 Have dirty filters been removed from the plantroom?

3 5.12 Are filters fitted the right way round?

4 5.13 Have bag filters been fitted with the pockets vertical. Haveany transit tapes been removed and individual pockets are separate and free to inflate?

13d Changing extract filters containing hazardous substances1 5.15 Were filters removed from an extract system for the

containment of hazardous substances or organisms? Was this be achieved by:a. sealing the hazardous substance into the filter before it isremoved;b. a system to fumigate the filter to kill any organisms;c. housing it in a ”safe change” unit that permits the filter tobe ejected into a bag and sealed without staff having to come into direct contact with it.Did the method of filter removal/replacement chosenshould reflect the nature of the hazard?

14 Energy recovery

1 3.56 3.56 For energy recovery, is cleaning access to both sides of the device?

2 3.57 3.57Are energy recovery devices fitted, on the extract sideprotected by a G3 filter?

3 3.57 Are energy recovery devices provided with a drainagesystem to remove Condensate?

4 3.58 3.58 Is the heat-recovery device controlled in sequencewith the main heater-battery?

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5 3.58 Does the heat recovery incorporate a control to preventthe transfer of unwanted heat when the air-on condition rises above the plant’s required set-point?

15 Attenuation1 3.59 Is cleaning access provided at both ends of any attenuator

unit.?

16 Identification and labelling1 3.60 Are all supply and extract ventilation systems clearly

labelled? (The label should identify both the AHU and the area that it serves. The lettering should be at least50 mm high and be mounted in an easily visible place near the fan of the unit.)

Also in appendix 1

2 3.60 Are all subsystems and the principal branch ducts similarlylabelled?(The label should identify both the AHU and the area that it serves. The lettering should be at least 50 mm high and bemounted in an easily visible place near the fan of the unit.)

3 3.61 Is the direction of air flow clearly marked on all main andbranch ducts?

4 3.62 Are all air-flow test-points clearly identified, and the size ofthe duct given?

17 DuctworkAre there test holes in the principal ducts?Are the test holes capped?Are the principal ducts lagged?

18 Pressure stabilisers1 3.63 Are Pressure stabilisers unobstructed and silent in

operation?

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7 – Plan of the ventilation system

1. A schematic plan of the ventilation system including:1.1. Location of traverse points1.2. Fire dampers or fire/smoke dampers1.3. Balance damper1.4. Air flow straighter

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8 - Plan of area served by the Critical Ventilation System

A plan showing room names and numbers – numbers are located on the doors.

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9 – Name of Critical area

Survey Question Y N Comments

2 Are windows hermetically sealed? (all areasserved by ventilation system)

3 Are the ceilings in the theatre and prep roomcomplete and sealed? (also applies to other high dependency medical locations)

4 Are there any significant faults in the fabric ofthe rooms in the suite? (all areas served by ventilation system)

5 Are room light fittings correctly sealed? (allareas served by ventilation system)

6 Do all doors close completely and hold againstthe room pressure? (all areas served by ventilation system)

7 Are the pressure stabilisers operatingcorrectly and silently? (all areas served by ventilation system)

8 Are all supply and extract air terminals and pressure stabilisers visibly clean? (all areas served by ventilation system)

9 Measure and record the operating roomtemperature (all areas served by ventilation system)

............ᶿC

10 Does this accord with that displayed on thesurgeon’s panel? (also applies to other high dependency medical locations)

11 Measure and record the operating roomrelative humidity (all areas served byventilation system)

............%RH

12 Does this accord with that displayed on the surgeon’s panel (also applies to other high dependency medical locations)

13 Measure and record the supply and extract airflow in the principle ducts (all areas served by ventilation system)

14 Measure and record the air flow at all supplyand extract terminals (all areas served by ventilation system)

15 Does the derived air-change rate achieve at least 75% of the design? (all areas served by ventilation system)

16 For UCV units, also measure and record the airvelocities within the canopy using the method set out in Chapter 8 of Health Technical Memorandum 03-01 (Part A) (UCV theatres

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only)

17 Do the air velocities achieve the standardappropriate for the type of canopy? (UCV theatres only)

18 Measure and record the room differentialpressures (all areas served by ventilation system)

19 Do the room differential pressures ensure a flow of air from the clean to the less clean areas? (all areas served by ventilation system provided with pressure/air flow cascade)

20 Measure and record the noise levels in theprincipal rooms of the suite (all areas servedby ventilation system)

21 Do the noise levels fall below the limits set out in Table 2 of health Technical Memorandum 03-01, Part B? (all areas served by ventilation system)

22 Check the operation of all ventilation controlfunctions represented on the surgeon’spanel. (also applies to other highdependency medical locations)

23 Do the indicators accurately represent theoperational state of ventilation system(s)? (also applies to other high dependency medical locations)

24 For UCV systems: is the UCV and AHUinterlocked to ensure that the AHU runs at full speed when the UCV is at operating speed or at set-back? (see Table 6 in Health Technical Memorandum 03-01, part A) (UCV theatres only)

25 With the UCV running at set-back, does thesystem maintain the standard of a conventional operating room? (UCV Theatres only)

26 For all theatres: with the system running atset-back, does it maintain a flow of air fromthe clean to the less clean areas? (allventilation systems with two speed/multispeed or set back ventilation)

10 – Air Flow rates

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Show correction factor for test instrument.Supply

Area Served GrilleRef:

Design Air FlowRate m³/sec

Measured Air Flow Rate m³/sec

% of Design Tolerance(-0% to +10%)

NoteThe supply air design volume of 0.92m³/sec is to control the temperature within the theatre suite room in overcoming the UCV heat gains.

Show correction factor for test instrumentExtract

Area Served GrilleRef:

Design Air FlowRate m³/sec

Measured Air Flow Rate m³/sec

% of Design Tolerance(-0% to +10%)

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11 – Air Change Rates

Area ServedRoom

Volume(m³)

Air FlowRate

(m³/sec)

Air FlowRate

(m³/hr)

Air ChangeRates

(HTM 2025)

Air ChangeRates

(HTM 03-01)

Air ChangeRates(ACH)

Test equipment:

Plan

Length:_________mWidth:__________mHeight:__________m

Volume:_______m³


Volume:_______m³


Volume:_______m³


Volume:_______m³


Volume:_______m³

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12 – Room Differential Pressures

Differential Pressure(ΔP) Locations

PRV or Transfer Grille(Tg)

Design DifferentialPressure (ΔP) (Pa)

Measured DifferentialPressure (ΔP) (Pa)

Test equipment:

Plan

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13 – Traverse Reports

Include details of the fan, motors x 2, drives and speed controller setting.

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14 – UCV Canopy Service Report

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14 – UCV – Velocity Profile

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16– UCV, Filter Integrity Test

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17 – UCV, Entrainment Test

1. Clarity of test:a. Particle challenge has been taken at the supply grille in the Anaesthetic room for this

theatre suite.b. Sampler at 1 meter above floor level.c. The centre measurement should be taken with the detector head mounted vertically

upwards, 1 meter above floor level.d. The number of intermediate test positions should be as equally spaced as possible around

the periphery, with no fewer than three and no more than five complete test squares between test positions.

Insert details

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18 – Light level Readings

Area Served Guideline CIBSE, LG2, Table 1(Lux)

Measured Light level (Lux)

Test equipment:Identify exact location of test reading for reference for future years. Plan

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19 – Noise level Readings

Area Served HTM 2025Guideline

(dB(A))

HTM 03-01Guideline

(dB(A))

Measured Noise Level(dB(A))

Test equipment:Identify exact location of test reading for reference for future years. Plan

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20 - Fire / Smoke Damper test

Include schedule and drawing to show location.

Photo before activated, when activated and final photo when reset. (for each damper)

Reference Number:1 Damper Reference2 Check damper installation for any deterioration of the fire

stopping material on both sides of the barrier. This inspection should include all external supports which may form part of the damper installation.

3 Check actuator wiring for damage (where applicable).4 Check end-switch wiring for damage (where applicable).5 Check damper cleanliness and clean where necessary.6 Check the condition of blades and seals, rectify and report

where necessary.7 Confirm the safety closure operation of the fire damper

according to the manufacturer’s instructions.8 Confirm operation of damper to OPEN and CLOSE by use

of the control system and physical observation of the damper, rectify and report where necessary.

9 Photograph taken in CLOSED condition10 Photograph taken in OPEN condition11 Confirm operation of OPEN and CLOSED end-switches,

rectify and report (where necessary).12 Confirm that the damper fulfils its function as part of the

control system (where necessary).13 Confirm that the damper is left in its normal working posi-

tion.

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21– Test Equipment Used

Clarity of calibration – The measuring instrument should be a hotwire anemometer with a digital read-out. The instrument resolution should be at least 0.01 m/s, have a tolerance of ±0.015 m/s or 3% of the reading and be calibrated down to 0.15 m/s or lower. An alternative instrument may be used, providing it is of no lesser specification.

Instrument Manufacturer Model Serial number CalibrationDate

CalibrationCertificateappended

YES NO

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22 – Conclusion & Recommendations

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Appendix A Scanned certs

Need to ensure the accuracy is correct and the correct range is covered.

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Appendix B

Provide appropriate qualifications / CV of personnel carrying out testing to demonstrate knowledge of standards etc.

Name Qualifications / CV Date

There is no objection to the free reproduction of this Guidance Note, providing its source and author Richard Knight CEng., MCIBSE, FIHEEM & Trevor Edwards CEng., MCIBSE, FIHEEM is acknowledged

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