Information
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Conducted on
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Inspection Type
- Routine
- Reinspection
- Compliant
- Outbreak Investigation
- Failed audit
- RMP review
- Reportable HCC result
- Reportable Legionella result
Premise Details
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Council ID for Cooling Water System (CWS)
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CWS Current Risk Level
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Total number of cooling towers in system
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Unique Identification Number/s (UIN)
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System Address
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Make/Model
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Location on site
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Location within building
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Details
Contact Details
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Occupier's Name
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Street Address
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Postal Address
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Mobile (24 hour contact)
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Email
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ABN/ACN
Building Manager
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Name
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Phone
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Email
Water Treatment Company
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Name
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Phone
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Email
Servicing Company
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Name
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Phone
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Email
Water Sampling Contractor - Micro
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Name
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Phone
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Email
Water Sampling Contractor - Chemical
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Name
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Phone
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Email
Other Contacts
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Contact
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Name
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Phone
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Email
Urgent Contact
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Same as Existing Contact?
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Name
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Phone
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Alternate phone
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Email
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Which contact?
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Note: Urgent contact person/organisation must be able to provide required documentation to regulatory authorities (e.g. Council or NSW Health) within 4 hours of that documentation being requested via phone and/or e-mail.
Documentation
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Current RMP is in place
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Remedial actions in RMP are being addressed
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System is audited annually
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Monthly report is being completed
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Operation and maintenance manuals on site
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Electronic records available within 4hrs of request
Display of UIN
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UIN displayed on each cooling tower in approved manner
Microbial Sampling
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Sampling is undertaken monthly and tested by a NATA accredited laboratory
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Sample is collected at least 72 hours after disinfection/decontamination/cleaning
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Sampling point on the return leg of chemical dosing
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Sample < 100,000cfu/ml HCC and <10cfu/ml Legionella within last 12 months
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If non-compliance:???
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If water sample is collected during the inspection for testing, please indicate the sample location
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Other Location
Risk Assessment
Stagnant Water
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CWS in continuous operation (i.e. not shut down for periods > 48 hours) or otherwise drained, cleaned and kept dry if operated intermittently or seasonally
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No dead legs observed
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Other
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Assessment
Nutrient availability and growth
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CWS visibly clean with no signs of sludge, slime, sediment, biofilm, algae, fungi, rust, dust, dirt or foreign material
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CWS cleaned at frequency in accordance with RMP
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Direct sunlight prevented from entering wetted areas
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Other
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Assessment
Poor water quality
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Chemicals are automatically dosed, or automatic continuous water treatment system is installed
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Adequate chemical volume remaining in chemical containers
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Chemical supply lines clear from blockage and not kinked
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Monthly servicing and water sampling completed. If servicing is outside of specified control range in RMP, appropriate corrective actions undertaken
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Other
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Assessment
Deficiencies in CWS
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Louvress in place, constructed of corrosion resistant material, fitted to prevent entry of contaminants, and in good working condition
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Fill in place, constructed of corrosion resistant material, designed for effective cleaning and in good working condition
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Drift eliminators in place, constructed of corrosion resistant material, and in good working condition
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Other
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Assessment
Location and access
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No public access to the cooling tower
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Safe and easy access provided for cleaning, inspection and maintenance of the system
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CWS located away from air intakes, exhaust outlets, and passers-by
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Decommissioned cooling tower/s not in operation
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Other
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Assessment
Inspection Outcome
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Inspection Result
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Further Actions
- No action required
- Verbal warning
- Warning letter
- Reinspection
- Improvement Notice
- Prohibition Order
- PIN
- Charge for microbial sample
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Comments/Direction
Officer Details
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Name
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Title
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Signature
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Phone
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Email
Person spoken to onsite
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Name
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Title
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Signature
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Phone
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Email
