Information
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Document No.
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Conducted on
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Prepared By
- Habib Tarabay
- Janine Collins
- Sabra Azimullah
- George Webb
- Stacey Gavrilis
Reason For Inspection
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This Inspection
- Routine - First Annual Inspection
- Re-inspection 1
- Complaint - First Inspection
- Complaint - Re-inspection
Business Details
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Premises Name
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Trading Address
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Occupier
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Date / Time
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Contact
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Email
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Phone
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After Hours Phone
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Maintenance Contractor
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Date of Current Disinfection Process
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Date of Next Disinfection Process Due
Type of Water Cooling System
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- Water Cooling Tower
- Evaporative Condenser
- Evaporative Cooler
- Warm Water System
Location of System
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- Roof
- Ground
- Basement
- Side of Building
- Other
Inspection Safety
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Easy and Safe Acess
Manuals
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Copy Of Maintenance Manuals Provided Near Unit
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Copy of Operations Manual Provided Near Unit
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Current Certificate of Disinfection Provided
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Emergency Startup and Shutdown Procedure Provided
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Maintenance Work (Worksheet) Noted in Maintenance Manual
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Comments
Water Cooling System (Cleanliness / Condition)
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Inspected Monthly
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Cleaned Every 3 Months
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Cleaned After Seasonal Shutdown
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Sampled Every 3 Months - Certificates of Analysis Provided In Manual
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Automatic Waste Water Bleed Provided
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Water Basin Satisfactory
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Drift Eliminators Satisfactory
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Constructed of Corrosion Resistant Materials
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Waste Water Discharged to Sewer
Results
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- Satisfactory
- Unsatisfactory
Further Action Required
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Re-Inspection Required
- 24 Hours
- 7 Days
- 14 Days
- 28 Days
- 60 Days
- Other
- Warning Letter
- Improvement Notice
- Prohibition Order
I have Read and Understood The Content
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Contractors Name and Signature
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Environmental Health Officer Name and Signature
