Title Page

  • Audit Title

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

Site Duty Holder Paul Duffell Site Responsible Person Paul Mallon Deputy Responsible Person Jayne Roots

Shower Daily Flushing-See Duty Manager Opening Building Checks

Calorifer Temperature Inspections-Every Month (Flow greater than 60oC return greater than 50oC)

  • Monthly Water Heater Inspections Completed?

  • PHE 1 boiler house Flow Temp

  • PHE 1 boiler house Return Temp

  • PHE 2 boiler house Flow Temp

  • PHE 2 boiler house Return Temp

  • PHE 3 back of boiler house Flow Temp

  • PHE 3 back of boiler house Return Temp

Monthly Hot Tap Temp Inspections (Greater than 50oC) Sentinal Outlets (nearest outlet, furthest outlet and along branches to outlets)

  • Monthly Hot Water Inspections Completed?-Sentinal Outlets (greater than 50cO) (nearest outlet, furthest outlet and along branches to outlets)

  • Hot Tap 1 First Aid Room temp

  • Hot Tap 2 First aid room tap temp

  • Hot Tap 3 Staff Kitchen by playzone temp

  • Hot Tap 3 Gents Wet Side mixer Hot feed temp

  • Hot Tap 3 Creche Kitchen by Hot temp

  • Hot Tap 3 Creche Toilet Mixer Hot feed temp

Monthly Cold Tap Temp Inspections (Less than 20oC) Sentinal Outlet (nearest outlet, furthest outlet and along branches to outlets)

  • Monthly cold water Inspections Completed?

  • Cold Tap 1 Plant Room Kitchen Mains temp

  • Cold Tap 2 Plant Room Toilet temp

  • Cold Tap 3 Ladies Dry Change Mains temp

  • Cold Tap 4 Creche Toilet Mixer Cold side temp

  • Cold Tap 5 Male Dry Side temp

Monthly Hot Water Heater Temp Inspections (greater than 50oC)

  • Monthly Hot Water Heater Inspections Completed?

  • Water heater 1 Hot Temp Check (Male Staff Toilet)

  • Water heater 2 Hot Temp Check (Female Staff Toilet)

  • Water heater 3 Hot Temp Check (Staff Toilet Room)

Week 1 low Use Outlet Flush (3 Min)

  • Is Week 1 Tap Flushing Completed?

  • Outlet 1 Flushed- Staff Male Toilet Sink

  • Outlet 2 Flushed-Staff Female Toilet Sink

  • Outlet 3 Flushed-Female Soft PLay Toilet 2x Sinks

  • Outlet 4 Flushed-Lola Jones Female Toilet 3x Sinks

  • Outlet 5 Flushed-Lola Jones Male Toilet 3x Sinks

  • Outlet 6 Flushed Village Change Disabled Sink/Shower

  • Outlet 7 Flushed Lola Jones Kitchen Sinks

  • Outlet 8 Flushed Lola Jones Food Prep Sink

  • Outlet 9 Flushed Village Change Cleaners Sink

  • Outlet 10 Flushed-Dryside Male Disabled Sink/Shower

  • Outlet 11 Flushed-Dryside Female Disabled Sink/Shower

  • Outlet 12 Flushed-First Aid Room Sink

  • Outlet 13 Flushed Wetside Male/Female Sinks x6 (Summer due to high incomming temp Jun/Jul/Aug/Sep)

  • Week 1 Sign-Off

Week 2 low Use Outlet Flush (3Min)

  • Is Week 2 Flushing Completed?

  • Outlet 1 Flushed- Staff Male Toilet Sink

  • Outlet 2 Flushed-Staff Female Toilet Sink

  • Outlet 3 Flushed-Female Soft PLay Toilet 2x Sinks

  • Outlet 4 Flushed-Lola Jones Female Toilet 3x Sinks

  • Outlet 5 Flushed-Lola Jones Male Toilet 3x Sinks

  • Outlet 6 Flushed Village Change Disabled Sink/Shower

  • Outlet 7 Flushed Lola Jones Kitchen Sinks

  • Outlet 8 Flushed Lola Jones Food Prep Sink

  • Outlet 9 Flushed Village Change Cleaners Sink

  • Outlet 10 Flushed-Dryside Male Disabled Sink/Shower

  • Outlet 11 Flushed-Dryside Female Disabled Sink/Shower

  • Outlet 12 Flushed-First Aid Room Sink

  • Outlet 13 Flushed Wetside Male/Female Sinks x6 (Summer due to high incomming temp Jun/Jul/Aug/Sep)

  • Week 2 Sign-Off

Week 3 low Use Outlet Flush (3 Min)

  • Is Week 3 Flushing Completed?

  • Outlet 1 Flushed- Staff Male Toilet Sink

  • Outlet 2 Flushed-Staff Female Toilet Sink

  • Outlet 3 Flushed-Female Soft PLay Toilet 2x Sinks

  • Outlet 4 Flushed-Lola Jones Female Toilet 3x Sinks

  • Outlet 5 Flushed-Lola Jones Male Toilet 3x Sinks

  • Outlet 6 Flushed Village Change Disabled Sink/Shower

  • Outlet 7 Flushed Lola Jones Kitchen Sinks

  • Outlet 8 Flushed Lola Jones Food Prep Sink

  • Outlet 9 Flushed Village Change Cleaners Sink

  • Outlet 10 Flushed-Dryside Male Disabled Sink/Shower

  • Outlet 11 Flushed-Dryside Female Disabled Sink/Shower

  • Outlet 12 Flushed-First Aid Room Sink

  • Outlet 13 Flushed Wetside Male/Female Sinks x6 (Summer due to high incomming temp Jun/Jul/Aug/Sep)

  • Week 3 Sign-Off

Week 4 low Use Outlet Flush (3 Min)

  • Is Week 4 Flushing Completed?

  • Outlet 1 Flushed- Staff Male Toilet Sink

  • Outlet 2 Flushed-Staff Female Toilet Sink

  • Outlet 3 Flushed-Female Soft PLay Toilet 2x Sinks

  • Outlet 4 Flushed-Lola Jones Female Toilet 3x Sinks

  • Outlet 5 Flushed-Lola Jones Male Toilet 3x Sinks

  • Outlet 6 Flushed Village Change Disabled Sink/Shower

  • Outlet 7 Flushed Lola Jones Kitchen Sinks

  • Outlet 8 Flushed Lola Jones Food Prep Sink

  • Outlet 9 Flushed Village Change Cleaners Sink

  • Outlet 10 Flushed-Dryside Male Disabled Sink/Shower

  • Outlet 11 Flushed-Dryside Female Disabled Sink/Shower

  • Outlet 12 Flushed-Outlet 12 Flushed-First Aid Room Sink

  • Outlet 13 Flushed Wetside Male/Female Sinks x6 (Summer due to high incomming temp Jun/Jul/Aug/Sep)

  • Week 4 Sign-Off

Week 5 low Use Outlet Flush (3 Min)

  • Is Week 5 Flushing completed?

  • Outlet 1 Flushed- Staff Male Toilet Sink

  • Outlet 2 Flushed-Staff Female Toilet Sink

  • Outlet 3 Flushed-Female Soft PLay Toilet 2x Sinks

  • Outlet 4 Flushed-Lola Jones Female Toilet 3x Sinks

  • Outlet 5 Flushed-Lola Jones Male Toilet 3x Sinks

  • Outlet 6 Flushed Village Change Disabled Sink/Shower

  • Outlet 7 Flushed Lola Jones Kitchen Sinks

  • Outlet 8 Flushed Lola Jones Food Prep Sink

  • Outlet 9 Flushed Village Change Cleaners Sink

  • Outlet 10 Flushed-Dryside Male Disabled Sink/Shower

  • Outlet 11 Flushed-Dryside Female Disabled Sink/Shower

  • Outlet 12 Flushed-First Aid Room Sink

  • Outlet 13 Flushed Wetside Male/Female Sinks x6 (Summer due to high incomming temp Jun/Jul/Aug/Sep)

  • Week 5 Sign-Off

Quarterly Shower Mixer Inspections-Mar/Jun/Sep/Dec (hot inlet greater than 50oC cold inlet less than 20oC mixed water 41oC)

  • Quarterly Shower Mixer Inspections Completed?

  • Mixer 1 -Male Dryside side x6 Showers Does the water shut off when the cold is isolated ? (Located above Lockers near showers)

  • Mixer 1 hot inlet pipe temp

  • Mixer 1 cold inlet pipe temp

  • Mixer 1 mixed water temp

  • Mixer 2 -Male Dryside Disabled Shower Does the water shut off when the cold is isolated ? (Shower mixer unit)

  • Mixer 2 hot inlet pipe temp

  • Mixer 2 cold inlet pipe temp

  • Mixer 2 mixed water temp

  • Mixer 3 -Female Dry side x4 Showers Does the water shut off when the cold is isolated? (mixer above ceiling outside corridor to change)

  • Mixer 3 hot inlet pipe temp

  • Mixer 3 cold inlet pipe temp

  • Mixer 3 mixed water temp

  • Mixer 4 -Female Dry side Disabled Shower Does the water shut off when the cold is isolated? (Shower Mixer Unit)

  • Mixer 4 hot inlet pipe temp

  • Mixer 4 cold inlet pipe temp

  • Mixer 4 mixed water temp

  • Mixer 5-Village male x5 Showers change Does the water shut off when the cold is isolated? (Mixer above showers)

  • Mixer 5 hot inlet pipe temp

  • Mixer 5 cold inlet pipe temp

  • Mixer 5 mixed water temp

  • Mixer 6- Village Famale x5 Showers Does the water shut off when the cold is isolated ? (mixer above showers)

  • Mixer 6 hot inlet pipe temp

  • Mixer 6 cold inlet pipe temp

  • Mixer 6 mixed water temp

  • Mixer 7-Village Disabled Does the water shut off when the cold is isolated (Shower Mixer Unit)

  • Mixer 7 hot inlet pipe temp

  • Mixer 7 cold inlet pipe temp

  • Mixer 7 mixed water temp

  • Mixer 8-Village Change sauna/steam showers x 5 (does cubical showers behind x2)Does the water shut off when the cold is isolated (mixer located above showers)

  • Mixer 8 hot inlet pipe temp

  • Mixer 8 cold inlet pipe temp

  • Mixer 8 mixed water temp

  • Mixer 9-Village Change set 1 (2 sets of 2 open showers neares sauna) Does the water shut off when the cold is isolated ? (Mixer above 1st two showers)

  • Mixer 9 hot inlet pipe temp

  • Mixer 9 cold inlet pipe temp

  • Mixer 9 mixed water temp

  • Mixer 10-Village Change set 2 (2 sets of 2 open Showers nearest squash side) Does the water shut off when the cold is isolated ? (Mixer above first two)

  • Mixer 10 hot inlet pipe temp

  • Mixer 10 cold inlet pipe temp

  • Mixer 10 mixed water temp

Quarterly Shower Descale-Mar/Jun/Sep/Dec

  • Shower Head Descale Completed

  • Area 1 heads descaled? Male dry change x 6

  • Area 2 heads descaled? Male dry change disabled x2

  • Area 3 heads descaled? Female dry change x 4

  • Area 4 heads descaled? Female dry change disabled x 2

  • Area 5 heads descaled? Village wetside male x5

  • Area 6 heads descaled? Village wetside female x5

  • Area 7 heads descaled? Village wetside disabled x2

  • Area 8 heads descaled? village wetside sauna/steam x3

  • Area 9 heads descaled? Village wetside x10

  • Area 10 heads descaled? Boys school change x5

  • Area 11 heads descaled? Girls school change x5

Half Yearly Tap Mixer-Apr/Oct (Hot inlet greater than 50oC Cold inlet less than 20oC Mixed water 41oC

  • Tap mixer inspections completed?

  • Mixer 1-Male Dry side sinks x 2 Sinks Left Does the water shut off when the cold is isolated (mixer right of sink top panel)

  • Mixer 1 hot inlet pipe temp

  • Mixer 1 cold inlet pipe temp

  • Mixer 1 mixed water temp

  • Mixer 2-Male Dry side sinks x 2 Sinks Right Does the water shut off when the cold is isolated (Mixer right of sinks behind top panel)

  • Mixer 2 hot inlet pipe temp

  • Mixer 2 cold inlet pipe temp

  • Mixer 2 mixed water temp

  • Mixer 3-Male Dry side disabled sink Does the water shut off when the cold is isolated? (Mixer Behind panel under sink)

  • Mixer 3 hot inlet pipe temp

  • Mixer 3 cold inlet pipe temp

  • Mixer 3 mixed water temp

  • Mixer 4-Female Dry side 2x Sinks Left Does the water shut off when the cold is isolated? (Mixer Behind panel under sink)

  • Mixer 4 hot inlet pipe temp

  • Mixer 4 cold inlet pipe temp

  • Mixer 4 mixed water temp

  • Mixer 5-Female Dry side 2x Sinks right Does the water shut off when the cold is isolated? (Mixer Behind panel under sink)

  • Mixer 5 hot inlet pipe temp

  • Mixer 5 cold inlet pipe temp

  • Mixer 5 mixed water temp

  • Mixer 6-Female Dry side disabled sink Does the water shut off when the cold is isolated

  • Mixer 6 hot inlet pipe temp

  • Mixer 6 cold inlet pipe temp

  • Mixer 6 mixed water temp

  • Mixer 7 Creche x 2 sinks Does the water shut off when the cold is isolated (mixer located on wall)

  • Mixer 7 hot inlet pipe temp

  • Mixer 7 cold inlet pipe temp

  • Mixer 7 mixed water temp

  • Mixer 8-Lola Jones Male x2 sinks Does the water shut off when the cold is isolated (mixer located under sink behind panel)

  • Mixer 8 hot inlet pipe temp

  • Mixer 8 cold inlet pipe temp

  • Mixer 8 mixed water temp

  • Mixer 9-Lola jones Female x2 sinks Does the water shut off when the cold is isolated? (mixer located under sink behind panel)

  • Mixer 9 hot inlet pipe temp

  • Mixer 9 cold inlet pipe temp

  • Mixer 9 mixed water temp

  • Mixer 10-Playzone female baby change toilet Does the water shut off when the cold is isolated? (Mixer under sink behind panel)

  • Mixer 10 hot inlet pipe temp

  • Mixer 10 cold inlet pipe temp

  • Mixer 10 mixed water temp

  • Mixer 11 Does the water shut off when the cold is isolated

  • Mixer 11 hot inlet pipe temp

  • Mixer 11 cold inlet pipe temp

  • Mixer 11 mixed water temp

  • Mixer 12 Does the water shut off when the cold is isolated

  • Mixer 12 hot inlet pipe temp

  • Mixer 12 cold inlet pipe temp

  • Mixer 12 mixed water temp

Annual Tap Temp Inspections-Nov (taps not inspected under sentinel Inspections) (Hot greater than 50oC Cold less than 20oC)

  • Annual tap temp inspections completed?

  • Tap 1 Hot - Area Plant Room Kitchen

  • Tap 1 Cold - Area Plant Room Kitchen

  • Tap 2 Hot - Area Plant Room Toilets

  • Tap 2 Cold - Area Plant Room Toilets

  • Tap 3 Hot - Area Staff Room

  • Tap 3 Cold - Area Staff Room

  • Tap 4 Hot - Area Staff Room Men Toilets

  • Tap 4 Cold - Area Staff Room Men Toilets

  • Tap 5 Hot - Area Staff Room Lady Toilets

  • Tap 5 Cold - Area Staff Room Lady Toilets

  • Tap 6 Hot - Area Lady Toilets near Play zone Right Sink

  • Tap 6 Cold - Area Lady Toilets near Play zone Right Sink

  • Tap 7 Hot - Area Lady Toilets near Play zone Left Sink

  • Tap 7 Cold - Area Lady Toilets near Play zone Left Sink

  • Tap 8 Hot - Area Cafe Kitchen Left Sink

  • Tap 8 Cold - Area Staff Kitchen Left Sink

  • Tap 8A Hot - Area Staff Kitchen Right Sink

  • Tap 8A Cold- Area Staff Kitchen Right Sink

  • Tap 8B Cold - Gym Water Fountain

  • Tap 9 Hot - Area Men Dry Side Right Sink

  • Tap 10 Cold - Area Men Dry Side Right Sink

  • Tap 11 Hot - Area Men Dry Side Middle Sink

  • Tap 11 Cold - Area Men Dry Side Middle Sink

  • Tap 12 Hot - Area Men Dry Side Left Sink

  • Tap 12 Cold - Area Men Dry Side Left Sink

  • Tap 13 Hot - Area Lady Dry Side Right Sink

  • Tap 13 Cold - Area Lady Dry Side Right Sink

  • Tap 14 Hot - Area Lady Dry Side Middle Sink

  • Tap 14 Cold - Area Lady Dry Side Middle Sink

  • Tap 15 Hot - Area Lady Dry Side Left Sink

  • Tap 15 Cold - Area Lady Dry Side Left Sink

  • Tap 16 Hot - Area Lady Wet Side Left Sink

  • Tap 16 Cold - Area Lady Wet Side Left Sink

  • Tap 17 Hot - Area Lady Wet Side Middle Sink

  • Tap 17 Cold - Area Lady Wet Side Middle Sink

  • Tap 18 Hot - Area Lady Wet Side Right Sink

  • Tap 18 Cold - Area Lady Wet Side Right Sink

  • Tap 19 Hot - Area Men Wet Side Right Sink

  • Tap 19 Cold - Area Men Wet Side Right Sink

  • Tap 20 Hot - Area Men Wet Side Middle Sink

  • Tap 20 Cold - Area Men Wet Side Middle Sink

  • Tap 21 Hot - Area Men Wet Side Left Sink

  • Tap 21 Cold - Area Men Wet Side Left Sink

  • Tap 21A Cold - Area Men Wet Side Left Sink

  • Tap 22 Hot - Area Lola Jones Lady Toilets Left Sink

  • Tap 22 Cold - Area Lola Jones Lady Toilets Left Sink

  • Tap 23 Hot - Area Lola Jones Lady Toilets Right Sink

  • Tap 23 Cold - Area Lola Jones Lady Toilets Right Sink

  • Tap 24 Hot - Area Lola Jones Men Toilets Left Sink

  • Tap 24 Cold - Area Lola Jones Men Toilets Left Sink

  • Tap 25 Hot - Area Lola Jones Men Toilets Right Sink

  • Tap 25 Cold - Area Lola Jones Men Toilets Right Sink

  • Tap 26 Hot - Area Lola Jones Kitchen Sink

  • Tap 26 Cold - Area Lola Jones Kitchen Sink

  • Tap 27 Hot - Area Lola Kitchen Hand Wash Sink

  • Tap 27 Cold - Area Lola Kitchen Hand Wash Sink

  • Tap 28 Hot - Area Lola Jones Prep Room Right Sink

  • Tap 28 Cold - Area Lola Jones Prep Room Right Sink

  • Tap 29 Hot - Area Lola Prep Room Left Sink

  • Tap 29 Cold - Area Lola Prep Room Left Sink

  • Tap 30 Hot - Area Lola Prep Room Hand Wash Sink

  • Tap 30 Cold - Area Lola Prep Room Hand Wash Sink

  • Tap 31 Hot - Area Creche Kitchen

  • Tap 31 Cold - Area Creche Kitchen

  • Tap 32 Hot - Area Creche Toilets Right Sink

  • Tap 32 Cold - Area Creche Toilets Right Sink

  • Tap 33 Hot - Area Creche Toilets Left Sink

  • Tap 33 Cold - Area Creche Toilets Left Sink

  • Tap 34 Hot - Area Cleaning Cupboard

  • Tap 34 Cold - Area Cleaning Cupboard

  • Tap 35 Hot - Area Teaching Pool Boys Right Sink

  • Tap 35 Cold - Area Teaching Pool Boys Right Sink

  • Tap 36 Hot - Area Teaching Pool Boys Middle Sink

  • Tap 36 Cold - Area Teaching Pool Boys Middle Sink

  • Tap 37 Hot - Area Teaching Pool Boys Left Sink

  • Tap 37 Cold - Area Teaching Pool Boys Left Sink

  • Tap 38 Hot - Area Teaching Pool Girls Right Sink

  • Tap 38 Cold - Area Teaching Pool Girls Right Sink

  • Tap 39 Hot - Area Teaching Pool Girls Middle Sink

  • Tap 39 Cold - Area Teaching Pool Girls Middle Sink

  • Tap 40 Hot - Area Teaching Pool Girls Left Sink

  • Tap 40 Cold - Area Teaching Pool Girls Left Sink

  • Tap 41 Hot - Area Therapy Room 1 Sink

  • Tap 41 Cold - Area Therapy Room 1 Sink

  • Tap 42 Hot - Area Therapy Room 2 Sink

  • Tap 42 Cold - Area Therapy Room 2 Sink

Is The Annual Mixer Service/Filter Clean/Replacement In Date-Either Attach Here worksheet with photo evidence or take pic on mixer quaterly/half yearly temp checks

  • Is Annual Mixer Service In Date?

  • in date to 23.8.19

    tooting mixer.jpg

Annual Thermometer Calibration-April-Advance Will do

  • Is The Annual thermometer calibration In Date?

  • In Date To 6.6.2020

    tooting thermometer 6.6.20.jpg

Annual Calorifer Inspection External-April If yes take a picture of the worksheet or Certificate when sent via email.

  • Is The Annual external calorifier inspection In Date?-Advance

  • In Date To 6.6.2020

    tooting water heater 6.6.19.jpg

Annual Tank Inspection External-April If yes take a picture of the worksheet or Certificate when sent via email.

  • Is The Annual external tank inspection In Date?-Advance

  • In Date To 6.6.2020

    tooting water tanks 6.6.19.jpg

LPHW-Bi-Annual/Annual-April/October

  • Are Bi-Annual/Annual LPHW Inspections In Date? If yes take a picture of the worksheet or Certificate when sent via email.

  • In Date To 08.07.2020

    TOOTING HEATING SYSTEM CHECK 8.JAN 20.jpg

Annual tank Inspection Site-July

  • Annual tank Inspection-Site

  • Tank 1 Far left Pool Water mains Incoming Water Temp

  • Tank 1 Far left Pool Water Temp Away From Incoming?

  • Tank 2 Near Right Utility water mains Incoming Water Temp

  • Tank 2 Near Right Utility Water Temp Away From Incoming?

  • Tank 3 Dryside Utility mains Incoming Water Temp

  • Tank 3 Drysid Utility Water Temp Away From Incoming?

Training

  • Has any additional Legionella awareness training been completed this month either via Mylearning or External training? If yes make log of name and date on note.

  • Monthly Inspections Sign-Off

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