ALPS Domestic Legionella Risk Assessment

• Site conducted

  Select
• Client
  Address
• Location
  Address

• Conducted on

  Date

• Responsible Person

• Prepared by

Legionella Hazard Assessment

• Is there any tenant, resident or regular visitor particularly suscetible to legionella due to age, health or lifestyle?

  Yes

  None

• Did the person carrying out the assessment have access to competent help and advice when carrying out the assessment?

  Yes

  No

  N/A

• Take a photo of the cold water system

  Media

• Provide a short description

• Take a photo of the hot water system

  Media

• Provide a short description

Water Outlet Temperature

• Is the cold water temperature at water outlets below 20° Celsius?

  Yes

  No

  N/A
Temperature in Celsius:

• Is the hot water temperature at water outlets above 50° Celsius?

  Yes

  No

  N/A
Temperature in Celsius:

Cold Water System

• Cold water storage tank location (photo)

  Media

• Is a cold water storage tank present?

  Yes

  No

  N/A

• Is the cold water tank accessible?

  Yes

  No

  N/A

• Does it have a tight-fitting lid?

  Yes

  No

  N/A

• Is the water in the tank clean and free from rust, debris, scale, and organic matter?

  Yes

  No

  N/A

• Is the temperature of the water in the tank below 20 ° celsius?

  Yes

  No

  N/A
Temperature in Celsius:

• Is the cold water tank insulated?

  Yes

  No

  N/A

Hot Water System

• Is the temperature setting on the boiler and/or hot water tank such that hot water is heated to and stored at a temperature of 60 ° celsius?

  Yes

  No

  N/A

• Are the hot water distribution pipes insulated?

  Yes

  No

  N/A

• If more than one calorifier is used, are they connected in parallel?

  Yes

  No

  N/A

• Does the calorifier have the following fitted?

• A drain valve?

  Yes

  No

  N/A

• A temperature gauge on the inlet and outlet?

  Yes

  No

  N/A

• An access panel?

  Yes

  No

  N/A

Little Used Outlets

• Are there any water outlets are used less than once per week?

  Yes

  None

• Are there arrangements in place to flush them through on at least a weekly basis?

  Yes

  No

  N/A

Shower heads

• Are there any showers in the property?

  Yes

  None

• Take photo of shower location

  Media

Dead Legs and Redundant Pipework

• Sections of pipework which are redundant or owing to the system design and have little/no through the flow of water (knows as 'dead legs") can allow water to stagnate in the system.

• Are there any dead legs on the property?

  Yes

  No

  N/A

• Take photo location

  Media

Unoccupied Properties

• Is the property left unoccupied for periods of time?

  Yes

  No

  N/A

• Are there arrangements in place to flush them through on at least a weekly basis?

  Yes

  No

  N/A

Completion

• Assessor

  Sign

• Responsible Person

  Sign