Title Page
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Assessment Conducted on Behalf of
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Property Location
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Conducted on
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Prepared by
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It is worth noting that while every effort will be made to inspect the entirety of the property, this is an intrusive but Non-destructive survey. We will endeavor to visually inspect all pipework and mechanical fixtures where practicable however, areas without reasonable access available will be outwith the scope of this report.
Legionella Risk Assessment
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Is the property currently occupied with a live tenant?
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Property Type/description (i.e. Detached, bungalow, flat?
- Detached House
- Semi-detached House
- Bungalow/cottage
- Maisonette
- Flat
- Other (place details in notes)
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Nr of Bathrooms in the property
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Any Additional Information
Water Outlet Temperature
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Is the cold water temperature at water outlets below 20° Celsius?
Temperature in Celsius:
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Is the hot water temperature at water outlets above 50° Celsius?
- Yes
- No
- Unable to confirm at time of inspection (give reason in notes)
Temperature in Celsius:
Cold Water System
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Is a cold water storage tank present?
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Is the cold water tank accessible?
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Does it have a tight-fitting lid?
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Is the water in the tank clean and free from rust, debris, scale, and organic matter?
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Is the temperature of the water in the tank below 20 ° celsius?
Temperature in Celsius:
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Is the cold water tank insulated?
Hot Water System
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Heating Type (Oil, Gas, LPG, Electric etc.)
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Location of Boiler
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Boiler Location (photo)
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Make and model of boiler (where available)
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Is a hot water cylinder present?
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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?
- Yes
- No
- Unable to confirm at time of inspection (give reason in notes)
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Are the hot water distribution pipes insulated?
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If more than one calorifier is used, are they connected in parallel?
- Yes
- No
- Item is integral to boiler type
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Does the calorifier have the following fitted?
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A drain valve?
- Yes
- No
- Item is integral to boiler type
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A temperature gauge on the inlet and outlet?
- Yes
- No
- Item is integral to boiler type
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An access panel?
- Yes
- No
- Item is integral to boiler type
Little Used Outlets
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Are there any water outlets are used less than once per week e.g. guest bathrooms?
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Are there arrangements in place to flush them through on at least a weekly basis?
- Yes
- No
- Unable to confirm at time of inspection (give reason in notes)
Shower heads
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Are there any showers in the property?
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Is the shower electric or thermostatic?
Dead Legs and Redundant Pipework
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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.
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Are there any visible dead legs on the property?
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Take photo location
Unoccupied Properties
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Is the property left unoccupied for periods of time?
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Are there arrangements in place to flush them through on at least a weekly basis?
- Yes
- No
- Unable to confirm at time of inspection (give reason in notes)
Completion
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Full Name and Signature of Legionella Responsible Person