Legionella Monthly Temperature Checks

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date
• Location
  Address

• Personnel

• The temperature of blended water outlets must be distributed in the range of 41 and 43 Degrees Celsius
  The temperature of cold water outlets must be distributed at or below 20 Degrees Celsius
  The temperature of hot water outlets must be distributed at or above 50 Degrees Celsius
  
  1. Run the outlet for 1 minute on hot and blended water outlets, cold water outlets run water for 2 minutes
  2. Test the temperature with a thermometer
  3. Record the temperature in the following audit by stating Safe/At Risk and add the reading into the text box

Outside

• Cold tap raiser rear loading yard

Test Area

• Sealed tank

Fulton Factory Area

• Kitchen sink Cold tap

• Kitchen Sink Hot tap

• Hot water dispenser

• Kitchen water dispenser

• Toilet tap L/H cold

• Toilet tap L/H Hot

• Toilet Tap R/H Cold

• Toilet Tap R/H Hot

Upstairs office Area

• Mop wash Room tap cold

• Gents L/H Cold Tap

• Gents L/H Hot Tap

• Gents R/H Cold Tap

• Gents R/H Hot Tap

• Ladies L/H Cold Tap

• Ladies L/H Hot Tap

• Ladies R/H Cold Tap

• Ladies R/H Hot Tap

• Kitchen Cold Tap

• Kitchen Hot Tap

• Reception water dispenser

Down stairs Disabled Toilet

• Mixer Tap

• Cold Tap

• Hot Tap

Barrettine Area

• Gents L/H Cold Tap

• Gents L/H Hot Tap

• Gents R/H Cold Tap

• Gents R/H Hot Tap

• Ladies Cold Tap

• Ladies Hot Tap

Pixel Hospital Area

• Gents L/H Cold tap

• Gents L/H Hot Tap

• Gents R/H Cold Tap

• Gents R/H Hot Tap

• Ladies L/H Cold Tap

• Ladies L/H Hot Tap

• Ladies R/H Cold Tap

• Ladies R/H Hot Tap

• Kitchen Cold Tap

• Kitchen Hot Tap

• Kitchen Hot Water dispenser

• Downstairs Mop room Tap

Signature

• Testing Operative

  Sign