Legionella Risk Assessment

• Assessment Conducted on Behalf of

• Property Location
  Address

• Conducted on

  Date

• Prepared by

• 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

• Is the property currently occupied with a live tenant?

  Yes

  No

• Property Type/description (i.e. Detached, bungalow, flat?

  Select Detached House Semi-detached House Bungalow/cottage Maisonette Flat Other (place details in notes)

  • Detached House
  • Semi-detached House
  • Bungalow/cottage
  • Maisonette
  • Flat
  • Other (place details in notes)

• Nr of Bathrooms in the property

• Any Additional Information

Water Outlet Temperature

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

  Yes

  No

  N/A
Temperature in Celsius:

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

  Select Yes No Unable to confirm at time of inspection (give reason in notes)

  • Yes
  • No
  • Unable to confirm at time of inspection (give reason in notes)
Temperature in Celsius:

Cold Water System

• Is a cold water storage tank present?

  Yes

  No

• Is the cold water tank accessible?

  Yes

  No

  N/A

• Does it have a tight-fitting lid?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A
Temperature in Celsius:

• Is the cold water tank insulated?

  Yes

  No

  N/A

Hot Water System

• Heating Type (Oil, Gas, LPG, Electric etc.)

  Oil

  Gas

  LPG

  Electric

  Other (details in notes)

• Location of Boiler

• Boiler Location (photo)

  Media

• Make and model of boiler (where available)

• Is a hot water cylinder present?

  Yes

  No

• 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?

  Select Yes No Unable to confirm at time of inspection (give reason in notes)

  • Yes
  • No
  • Unable to confirm at time of inspection (give reason in notes)

• Are the hot water distribution pipes insulated?

  Yes

  No

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

  Select Yes No Item is integral to boiler type

  • Yes
  • No
  • Item is integral to boiler type

• Does the calorifier have the following fitted?

• A drain valve?

  Select Yes No Item is integral to boiler type

  • Yes
  • No
  • Item is integral to boiler type

• A temperature gauge on the inlet and outlet?

  Select Yes No Item is integral to boiler type

  • Yes
  • No
  • Item is integral to boiler type

• An access panel?

  Select Yes No Item is integral to boiler type

  • Yes
  • No
  • Item is integral to boiler type

Little Used Outlets

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

  Yes

  No

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

  Select Yes No Unable to confirm at time of inspection (give reason in notes)

  • Yes
  • No
  • Unable to confirm at time of inspection (give reason in notes)

Shower heads

• Are there any showers in the property?

  Yes

  No

• Is the shower electric or thermostatic?

  Electric

  Thermostatic

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 visible dead legs on the property?

  Yes

  No

• Take photo location

  Media

Unoccupied Properties

• Is the property left unoccupied for periods of time?

  Yes

  No

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

  Select Yes No Unable to confirm at time of inspection (give reason in notes)

  • Yes
  • No
  • Unable to confirm at time of inspection (give reason in notes)

Completion

• Full Name and Signature of Legionella Responsible Person

  Sign