Title Page

  • Residency/Site

  • Location
  • Conducted on

  • Prepared by

Legionella Risk Assessment

  • Is there any tenant, resident or regular visitor particularly suscetible to legionella due to age, health or lifestyle?

  • Did the person carrying out the assessment have access to competent help and advice when carrying out the assessment?

  • Take a photo of the cold water system

  • Provide a short description

  • Take a photo of the hot water system

  • Provide a short description

Water Outlet Temperature

  • Is the cold water temperature at water outlets below 20° Celsius?

  • Temperature in Celsius:
  • Is the hot water temperature at water outlets above 50° Celsius?

  • Temperature in Celsius:

Cold Water System

  • Cold water storage tank location (photo)

  • Is a cold water storage tank present?

  • Is the cold water tank accessible?

  • Does it have a tight-fitting lid?

  • Is the water in the tank clean and free from rust, debris, scale, and organic matter?

  • Is the temperature of the water in the tank below 20 ° celsius?

  • Temperature in Celsius:
  • Is the cold water tank insulated?

Hot Water System

  • Is the temperature setting on the boiler and/or hot water tank such that hot water is heated to and stored at a temperature of 60 ° celsius?

  • Are the hot water distribution pipes insulated?

  • If more than one calorifier is used, are they connected in parallel?

  • Does the calorifier have the following fitted?

  • A drain valve?

  • A temperature gauge on the inlet and outlet?

  • An access panel?

Little Used Outlets

  • Are there any water outlets are used less than once per week e.g. guest bathrooms?

  • Are there arrangements in place to flush them through on at least a weekly basis?

Shower heads

  • Are there any showers in the property?

  • Take photo of shower location

Dead Legs and Redundant Pipework

  • Sections of pipework which are redundant or owing to the system design and have little/no through the flow of water (knows as 'dead legs") can allow water to stagnate in the system.

  • Are there any dead legs on the property?

  • Take photo location

Unoccupied Properties

  • Is the property left unoccupied for periods of time?

  • Are there arrangements in place to flush them through on at least a weekly basis?

Completion

  • Full Name and Signature of Landlord

  • Full Name and Signature of Legionella Responsible Person

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