Pfp Leisure Legionella Inspections 2020 - Tooting

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• 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?

  Yes

  No

  N/A

• 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)

  Yes

  No

  N/A

• 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?

  Yes

  No

  N/A

• 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?

  Yes

  No

  N/A

• 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?

  Yes

  No

  N/A

• Outlet 1 Flushed- Staff Male Toilet Sink

  Yes

  No

  N/A

• Outlet 2 Flushed-Staff Female Toilet Sink

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Outlet 6 Flushed Village Change Disabled Sink/Shower

  Yes

  No

  N/A

• Outlet 7 Flushed Lola Jones Kitchen Sinks

  Yes

  No

  N/A

• Outlet 8 Flushed Lola Jones Food Prep Sink

  Yes

  No

  N/A

• Outlet 9 Flushed Village Change Cleaners Sink

  Yes

  No

  N/A

• Outlet 10 Flushed-Dryside Male Disabled Sink/Shower

  Yes

  No

  N/A

• Outlet 11 Flushed-Dryside Female Disabled Sink/Shower

  Yes

  No

  N/A

• Outlet 12 Flushed-First Aid Room Sink

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Week 1 Sign-Off

  Sign

Week 2 low Use Outlet Flush (3Min)

• Is Week 2 Flushing Completed?

  Yes

  No

  N/A

• Outlet 1 Flushed- Staff Male Toilet Sink

  Yes

  No

  N/A

• Outlet 2 Flushed-Staff Female Toilet Sink

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Outlet 6 Flushed Village Change Disabled Sink/Shower

  Yes

  No

  N/A

• Outlet 7 Flushed Lola Jones Kitchen Sinks

  Yes

  No

  N/A

• Outlet 8 Flushed Lola Jones Food Prep Sink

  Yes

  No

  N/A

• Outlet 9 Flushed Village Change Cleaners Sink

  Yes

  No

  N/A

• Outlet 10 Flushed-Dryside Male Disabled Sink/Shower

  Yes

  No

  N/A

• Outlet 11 Flushed-Dryside Female Disabled Sink/Shower

  Yes

  No

  N/A

• Outlet 12 Flushed-First Aid Room Sink

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Week 2 Sign-Off

  Sign

Week 3 low Use Outlet Flush (3 Min)

• Is Week 3 Flushing Completed?

  Yes

  No

  N/A

• Outlet 1 Flushed- Staff Male Toilet Sink

  Yes

  No

  N/A

• Outlet 2 Flushed-Staff Female Toilet Sink

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Outlet 6 Flushed Village Change Disabled Sink/Shower

  Yes

  No

  N/A

• Outlet 7 Flushed Lola Jones Kitchen Sinks

  Yes

  No

  N/A

• Outlet 8 Flushed Lola Jones Food Prep Sink

  Yes

  No

  N/A

• Outlet 9 Flushed Village Change Cleaners Sink

  Yes

  No

  N/A

• Outlet 10 Flushed-Dryside Male Disabled Sink/Shower

  Yes

  No

  N/A

• Outlet 11 Flushed-Dryside Female Disabled Sink/Shower

  Yes

  No

  N/A

• Outlet 12 Flushed-First Aid Room Sink

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Week 3 Sign-Off

  Sign

Week 4 low Use Outlet Flush (3 Min)

• Is Week 4 Flushing Completed?

  Yes

  No

  N/A

• Outlet 1 Flushed- Staff Male Toilet Sink

  Yes

  No

  N/A

• Outlet 2 Flushed-Staff Female Toilet Sink

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Outlet 6 Flushed Village Change Disabled Sink/Shower

  Yes

  No

  N/A

• Outlet 7 Flushed Lola Jones Kitchen Sinks

  Yes

  No

  N/A

• Outlet 8 Flushed Lola Jones Food Prep Sink

  Yes

  No

  N/A

• Outlet 9 Flushed Village Change Cleaners Sink

  Yes

  No

  N/A

• Outlet 10 Flushed-Dryside Male Disabled Sink/Shower

  Yes

  No

  N/A

• Outlet 11 Flushed-Dryside Female Disabled Sink/Shower

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Week 4 Sign-Off

  Sign

Week 5 low Use Outlet Flush (3 Min)

• Is Week 5 Flushing completed?

  Yes

  No

  N/A

• Outlet 1 Flushed- Staff Male Toilet Sink

  Yes

  No

  N/A

• Outlet 2 Flushed-Staff Female Toilet Sink

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Outlet 6 Flushed Village Change Disabled Sink/Shower

  Yes

  No

  N/A

• Outlet 7 Flushed Lola Jones Kitchen Sinks

  Yes

  No

  N/A

• Outlet 8 Flushed Lola Jones Food Prep Sink

  Yes

  No

  N/A

• Outlet 9 Flushed Village Change Cleaners Sink

  Yes

  No

  N/A

• Outlet 10 Flushed-Dryside Male Disabled Sink/Shower

  Yes

  No

  N/A

• Outlet 11 Flushed-Dryside Female Disabled Sink/Shower

  Yes

  No

  N/A

• Outlet 12 Flushed-First Aid Room Sink

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Week 5 Sign-Off

  Sign

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?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• 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)

  Yes

  No

  N/A

• 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)

  Yes

  No

  N/A

• 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)

  Yes

  No

  N/A

• 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)

  Yes

  No

  N/A

• 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)

  Yes

  No

  N/A

• 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)

  Yes

  No

  N/A

• 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)

  Yes

  No

  N/A

• 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)

  Yes

  No

  N/A

• 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)

  Yes

  No

  N/A

• 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

  Yes

  No

  N/A

• Area 1 heads descaled? Male dry change x 6

  Yes

  No

  N/A

• Area 2 heads descaled? Male dry change disabled x2

  Yes

  No

  N/A

• Area 3 heads descaled? Female dry change x 4

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Area 5 heads descaled? Village wetside male x5

  Yes

  No

  N/A

• Area 6 heads descaled? Village wetside female x5

  Yes

  No

  N/A

• Area 7 heads descaled? Village wetside disabled x2

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Area 9 heads descaled? Village wetside x10

  Yes

  No

  N/A

• Area 10 heads descaled? Boys school change x5

  Yes

  No

  N/A

• Area 11 heads descaled? Girls school change x5

  Yes

  No

  N/A

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

• Tap mixer inspections completed?

  Yes

  No

  N/A

• 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)

  Yes

  No

  N/A

• 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)

  Yes

  No

  N/A

• 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)

  Yes

  No

  N/A

• 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)

  Yes

  No

  N/A

• 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)

  Yes

  No

  N/A

• 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

  Yes

  No

  N/A

• 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)

  Yes

  No

  N/A

• 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)

  Yes

  No

  N/A

• 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)

  Yes

  No

  N/A

• 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)

  Yes

  No

  N/A

• 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

  Yes

  No

  N/A

• 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

  Yes

  No

  N/A

• 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?

  Yes

  No

  N/A

• 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?

  Yes

  No

  N/A

• in date to 23.8.19

  

Annual Thermometer Calibration-April-Advance Will do

• Is The Annual thermometer calibration In Date?

  Yes

  No

  N/A

• In Date To 6.6.2020

  

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

  Yes

  No

  N/A

• In Date To 6.6.2020

  

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

  Yes

  No

  N/A

• In Date To 6.6.2020

  

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.

  Yes

  No

  N/A

• In Date To 08.07.2020

  

Annual tank Inspection Site-July

• Annual tank Inspection-Site

  Yes

  No

  N/A

• 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.

  Yes

  N,A

• Monthly Inspections Sign-Off

  Sign