Title Page
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Residency/Site
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Location
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Conducted on
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Prepared by
Legionella Risk Assessment
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Is there any tenant, resident or regular visitor particularly suscetible to legionella due to age, health or lifestyle?
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Did the person carrying out the assessment have access to competent help and advice when carrying out the assessment?
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Take a photo of the cold water system
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Provide a short description
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Take a photo of the hot water system
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Provide a short description
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?
Temperature in Celsius:
Cold Water System
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Cold water storage tank location (photo)
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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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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?
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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?
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Does the calorifier have the following fitted?
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A drain valve?
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A temperature gauge on the inlet and outlet?
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An access panel?
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?
Shower heads
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Are there any showers in the property?
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Take photo of shower location
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 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?
Completion
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Full Name and Signature of Landlord
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Full Name and Signature of Legionella Responsible Person