Monthly - Legionella Prevention Checks

• Site conducted

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• Location
  Address

• Assessor's Name

• Date and Time

  Date

• Temperature measurements may be taken on the surface of metallic pipework. and must meet the following.: Hot >55°C in one minute. Cold <20°C in two minutes.

• Refer to Legionella File for detailed test results.

General Checks

What was the temperature of the furthest hot tap? What was the temperature of the furthest cold tap?

• Have all infrequently used taps been flushed correctly?

  Pass

  Fail

  N/A
What was the temperature on the Hot Water Calorifier (Flow) What was the temperature on the Hot Water Calorifier (Return)

• Is any Remedial Action required

  Yes

  No

  N/A

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• Signature

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