KSR011 - Legionella

• Site conducted

  Select

• Site

• Conducted on

  Date

• Prepared by

• Location
  Address

Legionella

• 1. Are dip slides being completed weekly for cooling towers and truck wash

  Select Well Controlled Some improvement required Significant improvement required

  • Well Controlled
  • Some improvement required
  • Significant improvement required

• 2. Are dip slide readings recorded in the log book.

  Select Well Controlled Some improvement required Significant improvement required

  • Well Controlled
  • Some improvement required
  • Significant improvement required

• 3. Is there an escalation process for dip slide readings over 10-4

  Select Well Controlled Some improvement required Significant improvement required

  • Well Controlled
  • Some improvement required
  • Significant improvement required

• 4. Are monthly visits by the service provider recorded in the log book.

  Select Well Controlled Some improvement required Significant improvement required

  • Well Controlled
  • Some improvement required
  • Significant improvement required

• 5. Are Corrective actions requested by the service provider fully closed out.

  Select Well Controlled Some improvement required Significant improvement required

  • Well Controlled
  • Some improvement required
  • Significant improvement required

• 6. Are temperature checks of hot and cold water systems recorded in the log book.

  Select Well Controlled Some improvement required Significant improvement required

  • Well Controlled
  • Some improvement required
  • Significant improvement required

• 7. Are temperature readings within the correct range (cold below 20 degrees - hot above 50 degrees)

  Select Well Controlled Some improvement required Significant improvement required

  • Well Controlled
  • Some improvement required
  • Significant improvement required

• 8. Have any little used outlets been flushed through and details recorded.

  Select Well Controlled Some improvement required Significant improvement required

  • Well Controlled
  • Some improvement required
  • Significant improvement required

Overall Comments

• overall comments

Signature

• Signature

  Sign