Medical Gas Pipeline Systems (SHTM 02-01)

The SHTM 02 series covers piped medical gases, medical and surgical air, and medical vacuum installations. It applies to all medical gas pipeline systems installed in healthcare premises and anaesthetic gas scavenging disposal systems.

• Part A: design, installation, validation and verification.
• Part B: operational management.

The forms detailed in Appendix A of SHTM 02-01 Part A are provided in editable format and are available to download by following the links below:

• Form A1 - MGPS test summary sheet
• Form A2 - Carcass - 1st fix pressure, labelling/ marking, sleeving/ supports and cross-connection
• Form A3 - 2nd fix pressure test and vacuum leakage test
• Form A4 - Area valve service unit - Zoning, closure and non-interchangeable screw thread (NIST) tests
• Form A5 - Line valve assembly and line valve - Zoning, closure and non-interchangeable screw thread (NIST) test
• Form A6 - Pendant/miscellaneous non-interchangeable screw thread (NIST) connectors - Specificity and function tests
• Form A7 - Terminal unit schedule, cross-connection and gas specificity tests
• Form A8 - Terminal unit functional tests exemplar
• Form A9 - Plant performance, operation and siting - Liquid oxygen systems
• Form A10 - Plant performance, operation and siting - Medical gas manifold systems
• Form A11 - Plant performance, operation and siting - Medical/ surgical air plant
• Form A12 - Plant performance, operation and siting - Synthetic air systems
• Form A13 - Plant performance, operation and siting - Medical vacuum plant
• Form A14 - Area alarm panel test
• Form A15 - Central alarm panel test
• Form A16 - Particulate matter tests
• Form A17 - Anaesthetic gas scavenging system (AGSS) tests
• Form A18 - Design review and as-installed drawings test sheet (not available)
• Form A19 - Purging and filling
• Form A20 - Medical gas identification tests
• Form A21 - Medical gas quality tests
• Form A22 - Medical gas pipeline system - Completion certificate
• Form A23 - MGPS minor works design review and as-installed information record
• Form A24 - MGPS sectional completion certificate

This is an updated version of this Guidance document, please click here to see the archived version.

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