Title Page

  • Site conducted

  • Client
  • Location
  • Conducted on

  • 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?

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

  • Take a photo of the cold water system

  • Provide a short description

  • Take a photo of the hot water system

  • Provide a short description

Water Outlet Temperature

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

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

  • Temperature in Celsius:

Cold Water System

  • Cold water storage tank location (photo)

  • Is a cold water storage tank present?

  • Is the cold water tank accessible?

  • Does it have a tight-fitting lid?

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

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

  • Temperature in Celsius:
  • Is the cold water tank insulated?

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?

  • Are the hot water distribution pipes insulated?

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

  • Does the calorifier have the following fitted?

  • A drain valve?

  • A temperature gauge on the inlet and outlet?

  • An access panel?

Little Used Outlets

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

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

Shower heads

  • Are there any showers in the property?

  • Take photo of shower location

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?

  • Take photo location

Unoccupied Properties

  • Is the property left unoccupied for periods of time?

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

Completion

  • Assessor

  • Responsible Person

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.