Title Page
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Site conducted
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Date
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PPMID
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Temperature requirements of hot and cold water: Flow temperature at calorifier – minimum of 60˚C eg; cylinder/ calorifier stored water Return temperature to calorifier – minimum 50˚C Hot water at outlets – minimum of 50˚C – within 1 minute of running outlet. If over 60˚C then action should be taken to reduce temp or advise remedial action to prevent scalding risk Mixed water (TMV) – between 38˚C - 46˚C from water outlet Inlet to TMV – minimum of 50˚C on pipe surface Stored cold water - 20˚C or less eg; cold water storage tank. Cold water at outlets - 20˚C or less within 2 minutes of running the outlet. All sentinel outlets can be identified within the on site log book or by contacting the Water Hygiene Team. I can confirm all required temperatures have been measured during this task following the above guidance with a calibrated, submersible and surface temperature probe. (Please take a photo of probe)
Calorifier Flow & Return Temperatures
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Calorifier 1 location
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Is the hot water recirculated?
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Sentinel (Cal 1) - Nearest Outlet
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Sentinel (Cal 1) - Furthest Outlet
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Calorifier 1 location
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Is the hot water recirculated?
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Calorifier 2 location
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Is the hot water recirculated?
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Sentinel (Cal 1) - Nearest Outlet
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Sentinel (Cal 1) - Furthest Outlet
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Sentinel (Cal 2) - Nearest Outlet
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Sentinel (Cal 2) - Furthest Outlet
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Calorifier 1 location
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Is the hot water recirculated?
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Calorifier 2 location
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Is the hot water recirculated?
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Calorifier 3 location
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Is the hot water recirculated?
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Sentinel (Cal 1) - Nearest Outlet
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Sentinel (Cal 1) - Furthest Outlet
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Sentinel (Cal 2) - Nearest Outlet
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Sentinel (Cal 2) - Furthest Outlet
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Sentinel (Cal 3) - Nearest Outlet
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Sentinel (Cal 3) - Furthest Outlet
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Calorifier 1 location
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Is the hot water recirculated?
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Calorifier 2 location
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Is the hot water recirculated?
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Calorifier 3 location
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Is the hot water recirculated?
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Calorifier 4 location
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Is the hot water recirculated?
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Sentinel (Cal 1) - Nearest
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Sentinel (Cal 1) - Furthest
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Sentinel (Cal 2) - Nearest
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Sentinel (Cal 2) - Furthest
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Sentinel (Cal 3) - Nearest
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Sentinel (Cal 3) - Furthest
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Sentinel (Cal 4) - Nearest
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Sentinel (Cal 4) - Furthest
Point Of Use Water Heaters
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Are all POU WH's operating correctly?
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What POU WH is non-operational and why? Detail location and fault type.
Rotational Outlet Coverage - Hot & Cold System (Rotate Outlets Monthly)
- Hot & Cold Water System (Minimum of 10% coverage rotated each month in addition to sentinel outlets)
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Outlet location
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Is the outlet regulated? (TMV)
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TMV fail-safe test
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Why was the TMV not tested? Is there any further action needed related to not being able to test TMV?
- No access
- Isolation valve non-operational
- No local isolation valve fitted
Additional Findings
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Please detail any additional findings (if applicable)
