Legionnaires Risk Assessment Template

• Property/Site

• Address
  Address

• Assessed by

• Conducted on

  Date

Cooling Tower System

Cooling Tower

• Take a photo of the cooling tower, including its make, model, year of manufacture, and type.

  Media

The Written Scheme

• Is there a written scheme for controlling the risk from exposure to legionella bacteria?

  Yes

  No

• Does the scheme contain an up-to-date plan and instructions for operating the sytem?

  Yes

  No

• Does the plan show all cooling towers, system control valves, and standby equipment, e.g. spare pumps?

  Yes

  No

• Does the plan show the location of the system bleed valves and drain valve?

  Yes

  No

• Does the plan show all associated storage tanks and pipework?

  Yes

  No

• Does the plan show the location of chemical dosing points and/or injection points?

  Yes

  No

• Does the plan show the origin of the water supply?

  Yes

  No

• Does the plan show any parts that may be temporarily out of use?

  Yes

  No

• Does the scheme contain details of the precautions to be taken to control the risk of exposure to legionella bacteria?

  Yes

  No

• Does the scheme contain details of the checks that are to be carried out (and their frequency) to ensure that the scheme is effective?

  Yes

  No

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

  Yes

  No

Design & Construction

• Are drift eliminators fitted correctly?

  Yes

  No

• Are drift eliminators effective in reducing drift?

  Yes

  No

• Are all visible surfaces free from slime or algae, scale, and corrosion?

  Yes

  No

• Does the water flow evenly across the fill pack?

  Yes

  No

• Have dead legs/blind ends and redundant pipework & plant been removed as far as possible?

  Yes

  No

• Are those parts of the tower that become wet, accessible and/or removable for cleaning?

  Yes

  No

Operation & Maintenance

• Is the cooling system in regular operation?

  Yes

  No

• Are there procedures in place to operate standby equipment on a rotational basis?

  Yes

  No

• Is there an operations manual for the cooling system?

  Yes

  No

• If the tower is used intermittently or is required at short notice, is it run at least once a week, so that water treatment chemicals are circulated to all parts of the system?

  Yes

  No

• If the tower is out of use for longer than a week, are there procedures in place to bring the tower back into operation safely?

  Yes

  No

Water Treatment Program

• Is there a water treatment program in place?

  Yes

  No

• Are chemicals/biocides used to control scale, corrosion, fouling, and microbiological activity?

  Yes

  No

• List methods used below.

• If non-oxidising biocides are used, are two used alternately?

  Yes

  No

• Are chemicals dosed automatically?

  Yes

  No

• Are the pumps calibrated regularly?

  Yes

  No

Monitoring

• Is there a daily check to make sure that the system is operating as described in the operations manual?

  Yes

  No

• Is there a daily visual check of the cleanliness of the water in the system?

  Yes

  No

• Is the physical condition of the system checked at least every week?

  Yes

  No

• Is the chemical composition of the cooling and make-up water monitored on a regular basis?

  Yes

  No

• Are the safe operating limits for each parameter which is being measured, known and recorded in the operating manual?

  Yes

  No

• Is the corrective action for out of limit situations known and included in the operations manual?

  Yes

  No

• Are results of all tests and checks recorded, together with details of any remedial action taken (if required)?

  Yes

  No

• Are dip slides taken on at least a weekly basis?

  Yes

  No

• Are slides incubated in an incubator (at 30°C for 48 hours)?

  Yes

  No

• Are results recorded, so trends over time can be seen?

  Yes

  No

• Are samples for legionella taken on at least a quarterly basis?

  Yes

  No

• Have the circumstances when more frequent sampling may be required been identified and recorded?

  Yes

  No

Cleaning & Disinfection

• Is there a written procedure for regular cleaning and disinfection of the system?

  Yes

  No

• Does this take place at least every six months?

  Yes

  No

• If the system is not shut down every six months, list reasons and alternative measures taken to ensure the cleanliness of the system below.

• Does the cleaning and disinfection procedure include the initial concentration of oxidizing biocide in use for the pre- and post-cleaning disinfection stages?

  Yes

  No

• Does the cleaning and disinfection procedure include contact time for each disinfection stage and methods for carrying out cleaning, including the removal of packing?

  Yes

  No

• If packs cannot be removed, are there alternative methods of making sure they remain clean in place?

  Yes

  No

• List methods below.

• Are measures taken to protect staff when carrying out cleaning of the tower?

  Yes

  No

• List precautions below.

Sign Off

• Additional Observations

• Landlord Name & Signature

  Sign

• Legionella-Responsible Person Name & Signature

  Sign