Information
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Audit Title
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Premises name
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Location
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Application Number
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Conducted on
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Prepared by
- Angela Rose. P: 9911 6417 Email: angelarose.canadabay.nsw.gov.au
- Nerisha James. P: 9911 6416 Email: nerisha.james@canadabay.nsw.gov.au
- Megan Roberts P: 9911 6466 Email: megan.roberts@canadabay.nsw.gov.au
- Dhanuka Siriwardena P: 9911 6415 Email: dhanuka.siriwardena@canadabay.nsw.gov.au
- Renae Barnes. P: 9911 6588 Email: renae.barnes@canadabay.nsw.gov.au
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Inspection Result
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Reinspection
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Invoice
Premises Details
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Premises name
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Owners name
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ABN Number
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Occupiers name
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Contact Person
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Contacts Phone Number
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Contacts Position
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Contacts Email
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Emergency contact
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Emergency number
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Microbial System Service Company
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Service Company Contact Phone Number
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Service Company Email Address
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Cleaning Company
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Cleaning Company Contact Phone Number
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Cleaning Company Email Address
Cooling Tower Inspections
Cooling Tower 1
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Documentation
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Photo of cooling tower
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Cooling Tower Model
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Cooling Tower Serial Number
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Operation manual provided on site
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Maintenance manual and records provided on site
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Manuals comply with AS/NZS 3666.2:2011?
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Drawings, suppliers recommendations, cleaning and dismantling instructions, set up and shut down procedures, maintenance management program.
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Certificate of disinfection
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Certificate of disinfection expiry date
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Photo of Certificate of Disinfection
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System inspected monthly?
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Date of last monthly inspection
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Photo of most recent months inspection report
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Cleaning interval not exceeding 6 months?
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Date of last system cleaning
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Photo of most recent system cleaning
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Microbiological test results satisfactory (recommended 3 monthly):<br>(a) the level of Legionella in the system is not more than 10 colony-forming units per millilitre, and<br>(b) the heterotrophic plate count in the system is not more than 100,000 colony-forming units per millilitre.
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Date of last microbiological test
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Photo of most recent microbiological test results
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Tower Inspection
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Does access to the tower appear safe and easy?
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Condition of exterior of tower
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Condition of water in the basin
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Condition of drift eliminators
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Tower free of rust, biofilm, sludge and algae
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Disinfectant chemical drums located on bunded trays
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Do biocide drums contain adequate product
Cooling tower 2
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Documentation
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Photo of cooling tower
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Cooling Tower Model
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Cooling Tower Serial Number
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Operation manual provided on site
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Maintenance manual and records provided on site
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Manuals comply with AS/NZS 3666.2:2011?
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Drawings, suppliers recommendations, cleaning and dismantling instructions, set up and shut down procedures, maintenance management program.
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Certificate of disinfection
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Certificate of Disinfection expiry date
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Photo of Certificate of Disinfection
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System inspected monthly?
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Date of last monthly inspection
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Photo of most recent months inspection report
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Cleaning interval not exceeding 6 months?
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Date of last system cleaning
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Photo of most recent system cleaning
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Microbiological test results satisfactory (recommended 3 monthly):<br>(a) the level of Legionella in the system is not more than 10 colony-forming units per millilitre, and<br>(b) the heterotrophic plate count in the system is not more than 100,000 colony-forming units per millilitre.
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Date of last microbiological test
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Photo of most recent microbiological test results
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Tower Inspection
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Does access to the tower appear safe and easy?
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Condition of exterior of tower
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Condition of water in the basin
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Condition of drift eliminators
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Tower free of rust, biofilm, sludge and algae
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Disinfectant chemical drums located on bunded trays
Cooling tower 3
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Documentation
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Photo of cooling tower
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Cooling Tower Model
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Cooling Tower Serial Number
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Operation manual provided on site
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Maintenance manual and records provided on site
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Manuals comply with AS/NZS 3666.2:2011?
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Drawings, suppliers recommendations, cleaning and dismantling instructions, set up and shut down procedures, maintenance management program.
-
Certificate of disinfection
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Certificate of Disinfection expiry date
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Photo of Certificate of Disinfection
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System inspected monthly?
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Date of last monthly inspection
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Photo of most recent months inspection report
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Cleaning interval not exceeding 6 months?
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Date of last system cleaning
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Photo of most recent system cleaning
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Microbiological test results satisfactory (recommended 3 monthly):<br>(a) the level of Legionella in the system is not more than 10 colony-forming units per millilitre, and<br>(b) the heterotrophic plate count in the system is not more than 100,000 colony-forming units per millilitre.
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Date of last microbiological test
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Photo of most recent microbiological test results
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Tower Inspection
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Does access to the tower appear safe and easy?
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Condition of exterior of tower
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Condition of water in the basin
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Condition of drift eliminators
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Tower free of rust, biofilm, sludge and algae
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Disinfectant chemical drums located on bunded trays
Cooling tower 4
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Documentation
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Photo of cooling tower
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Cooling Tower Model
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Cooling Tower Serial Number
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Operation manual provided on site
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Maintenance manual and records provided on site
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Manuals comply with AS/NZS 3666.2:2011?
-
Drawings, suppliers recommendations, cleaning and dismantling instructions, set up and shut down procedures, maintenance management program.
-
Certificate of disinfection
-
Certificate of Disinfection expiry date
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Photo of Certificate of Disinfection
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System inspected monthly?
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Date of last monthly inspection
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Photo of most recent months inspection report
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Cleaning interval not exceeding 6 months?
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Date of last system cleaning
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Photo of most recent system cleaning
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Microbiological test results satisfactory (recommended 3 monthly):<br>(a) the level of Legionella in the system is not more than 10 colony-forming units per millilitre, and<br>(b) the heterotrophic plate count in the system is not more than 100,000 colony-forming units per millilitre.
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Date of last microbiological test
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Photo of most recent microbiological test results
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Tower Inspection
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Does access to the tower appear safe and easy?
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Condition of exterior of tower
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Condition of water in the basin
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Condition of drift eliminators
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Tower free of rust, biofilm, sludge and algae
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Disinfectant chemical drums located on bunded trays
Signature
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Site manager/owner name
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Environmental Health Officer
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Select date
Inspection Outcome
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Inspection Rating
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Further Action Required
