PFP Leisure Legionella Inspections 2019- Balham

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Each month complete audit and send copy to you and to contract tech manager, save in the Legionella online folder as the month and year for easy view if needed, you need to make sure on the first page you input the date ie day/month/year along with your name and the site. any remedials need putting on the site helpdesk this includes risk assessment remedials and annual external site checks by WCS Group.

Site Duty Holder...Steve Warren..Site Responsible Person..Fin Higgs..Deputy Responsible Person...Barry Wright..

Shower Daily Flushing-See Duty Manager Opening/Daily Building Checks

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

• Monthly Calorifer Inspections Completed?

  Yes

  No

  N/A

• Calorifier 1 Left plantroom Flow Temp

• Calorifer 1 Left plantroom Return Temp

• Calorifer 2 Right plantroom Flow Temp

• Calorifier 2 Right plantroom 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 Temp First Floor Studio Toilet Sinks

• Hot Tap 2 Temp First Floor Ladies Change Sinks

• Hot Tap 3 Temp Ground Floor Poolside Cleaners Sink

• Hot Tap 4 Temp Ground Floor Staff Room Sinks

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 Temp First Floor Studio Toilet Sink

• Cold Tap 2 Temp First Floor Ladies Change Sinks

• Cold Tap 3 Temp First Floor GM office Sink

• Cold Tap 4 Temp Ground Floor Poolside Cleaners Sink

• Cold Tap 5 Temp Ground Floor Staffroom Sinks

Week 1 low Use Outlet Flush (3 Min)

• Is Week 1 Tap Flushing Completed?

  Yes

  No

  N/A

• Outlet 1 Flushed Gym Fountain Drinking Tap

  Yes

  No

  N/A

• Outlet 2 Flushed Fire Hose Outside Plant Room Place head in bucket of water to cover head and flush first part into water to avoid spray

  Yes

  No

  N/A

• Outlet 3 Flushed Fire Hose Gym/Change Walkways Place head in bucket of water to cover head and flush first part into water to avoid spray

  Yes

  No

  N/A

• Outlet 4 Flushed Outside Tap gym exit

  Yes

  No

  N/A

• Outlet 5 Flushed Emergency Shower Plantroom

  Yes

  No

  N/A

• Outlet 6 Flushed GM/OPS Office Sinks

  Yes

  No

  N/A

• Outlet 7 Flushed Poolside Topup in small cupboard

  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 Gym Fountain Drinking Tap

  Yes

  No

  N/A

• Outlet 2 Flushed Fire Hose Outside Plant Room Place head in bucket of water to cover head and flush first part into water to avoid spray

  Yes

  No

  N/A

• Outlet 3 Flushed Fire Hose Gym/Change Walkways Place head in bucket of water to cover head and flush first part into water to avoid spray

  Yes

  No

  N/A

• Outlet 4 Flushed Outside Tap gym exit

  Yes

  No

  N/A

• Outlet 5 Flushed Emergency Shower Plantroom

  Yes

  No

  N/A

• Outlet 6 Flushed GM/OPS Office Sinks

  Yes

  No

  N/A

• Outlet 7 Flushed Poolside Topup in small cupboard

  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 Gym Fountain Drinking Tap

  Yes

  No

  N/A

• Outlet 2 Flushed Fire Hose Outside Plant Room Place head in bucket of water to cover head and flush first part into water to avoid spray

  Yes

  No

  N/A

• Outlet 3 Flushed Fire Hose Gym/Change Walkways Place head in bucket of water to cover head and flush first part into water to avoid spray

  Yes

  No

  N/A

• Outlet 4 Flushed Outside Tap gym exit

  Yes

  No

  N/A

• Outlet 5 Flushed Emergency Shower Plantroom

  Yes

  No

  N/A

• Outlet 6 Flushed GM/OPS Office Sinks

  Yes

  No

  N/A

• Outlet 7 Flushed Poolside Topup in small cupboard

  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 Gym Fountain Drinking Tap

  Yes

  No

  N/A

• Outlet 2 Flushed Fire Hose Outside Plant Room Place head in bucket of water to cover head and flush first part into water to avoid spray

  Yes

  No

  N/A

• Outlet 3 Flushed Fire Hose Gym/Change Walkways Place head in bucket of water to cover head and flush first part into water to avoid spray

  Yes

  No

  N/A

• Outlet 4 Flushed Outside Tap gym exit

  Yes

  No

  N/A

• Outlet 5 Flushed Emergency Shower Plantroom

  Yes

  No

  N/A

• Outlet 6 Flushed GM/OPS Office Sinks

  Yes

  No

  N/A

• Outlet 7 Flushed Poolside Topup in small cupboard

  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 Gym Fountain Drinking Tap

  Yes

  No

  N/A

• Outlet 2 Flushed Fire Hose Outside Plant Room Place head in bucket of water to cover head and flush first part into water to avoid spray

  Yes

  No

  N/A

• Outlet 3 Flushed Fire Hose Gym/Change Walkways Place head in bucket of water to cover head and flush first part into water to avoid spray

  Yes

  No

  N/A

• Outlet 4 Flushed Outside Tap gym exit

  Yes

  No

  N/A

• Outlet 5 Flushed Emergency Shower Plantroom

  Yes

  No

  N/A

• Outlet 6 Flushed GM/OPS Office Sinks

  Yes

  No

  N/A

• Outlet 7 Flushed Poolside Topup in small cupboard

  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 Village left showers x 2 Showers Does the water shut off when the cold is isolated (Mixer within cupboard left of shower)

  Yes

  No

  N/A

• Mixer 1 Village left showers x 2 Showers hot inlet pipe temp

• Mixer 1 Village left showers x 2 Showers cold inlet pipe temp

• Mixer 1 Village left showers x 2 Showers mixed water temp

• Mixer 2 Village Right Showers x 3 Does the water shut off when the cold is isolated (Mixer Within locker next to shower)

  Yes

  No

  N/A

• Mixer 2 Village Right Showers x 3 hot inlet pipe temp

• Mixer 2 Village Right Showers x 3 cold inlet pipe temp

• Mixer 2 Village Right Showers x 3 mixed water temp

• Mixer 3 Poolside 1 x Shower Does Shower the water shut off when the cold is isolated (Mixer Above Showers)

  Yes

  No

  N/A

• Mixer 3 Poolside 1x Shower hot inlet pipe temp

• Mixer 3 Poolside 1x Shower cold inlet pipe temp

• Mixer 3 Poolside 1 x Shower mixed water temp

• Mixer 4 Female Change 4 x Showers Does the water shut off when the cold is isolated (Mixer Above Ceiling)

  Yes

  No

  N/A

• Mixer 4 Female Change 4 x Showers hot inlet pipe temp 5 x Showers

• Mixer 4 Female Change 4 x Showers cold inlet pipe temp

• Mixer 4 Female Change 4 x showers mixed water temp

• Mixer 5 Mens Dry Change 2 (right) 3 x Showers Does the water shut off when the cold is isolated (Mixer in Cupboard Wetside Elec Cupboard)

  Yes

  No

  N/A

• Mixer 5 Mens Dry Change 2 (right) 3 x Showers hot inlet pipe temp

• Mixer 5 Mens Dry Change 2 (right) 3 x Showers cold inlet pipe temp

• Mixer 5 Mens Dry Change 2 (right) 3 x Showers mixed water temp

• Mixer 6 Male Dry Change 2 (right) 2 x Showers Does the water shut off when the cold is isolated (Mixer Behind Toilet Panel)

  Yes

  No

  N/A

• Mixer 6 Male Dry Change 2 (right) 2 x Showers Dry Change 2 (right) 2 x hot inlet pipe temp

• Mixer 6 Male Dry Change 2 (right) 2 x Showers cold inlet pipe temp

• Mixer 6 Male Dry Change 2 (right) 2 x Showers mixed water temp

• Mixer 7 Male Dry Change 1 (Left) 5 x showers Does the water shut off when the cold is isolated (Mixer Within Cubby Hole In Corridor)

  Yes

  No

  N/A

• Mixer 7 Male Dry Change 1 (Left) 5 x showers hot inlet pipe temp

• Mixer 7 Male Dry Change 1 (Left) 5 x showers cold inlet pipe temp

• Mixer 7 Male Dry Change 1 (Left) 5 x showers mixed water temp

Quarterly Shower Descale-Mar/Jun/Sep/Dec

• Shower Head Descale Completed

  Yes

  No

  N/A

• Area 1 Village x 5 heads descaled?

  Yes

  No

  N/A

• Area 2 Poolside x 1 heads descaled?

  Yes

  No

  N/A

• Area 3 Female Change x 5 heads descaled?

  Yes

  No

  N/A

• Area 4 Male Change Left x 5 heads descaled?

  Yes

  No

  N/A

• Area 5 male Change Right x 5 heads descaled?

  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 Village Male and Female Toilet x 2 basins Does the water shut off when the cold is isolated (behind panel behind toilet)

  Yes

  No

  N/A

• Mixer 1 hot inlet pipe temp

• Mixer 1 cold inlet pipe temp

• Mixer 1 mixed water temp

• Mixer 2 Poolside male Toilet x 2 basins Does the water shut off when the cold is isolated (behind panel under sink)

  Yes

  No

  N/A

• Mixer 2 hot inlet pipe temp

• Mixer 2 cold inlet pipe temp

• Mixer 2 mixed water temp

• Mixer 3 Poolside Female Toilte x 2 basin Does the water shut off when the cold is isolated (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 Reception Disabled Change 1 x Basin Does the water shut off when the cold is isolated (Mixer behind tiled access hatch low level left of toilet)

  Yes

  No

  N/A

• Mixer 4 hot inlet pipe temp

• Mixer 4 cold inlet pipe temp

• Mixer 4 mixed water temp

• Mixer 5 Dryside Male Change 1 (left) x 2 basins 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 Dryside Male Change 2 (Right) x2 basins Does the water shut off when the cold is isolated (Mixer behind panel under sink)

  Yes

  No

  N/A

• Mixer 6 hot inlet pipe temp

• Mixer 6 cold inlet pipe temp

• Mixer 6 mixed water temp

• Mixer 7 Dryside Female Change x 2 basins Does the water shut off when the cold is isolated (Mixer behind panel under sink)

  Yes

  No

  N/A

• Mixer 7 hot inlet pipe temp

• Mixer 7 cold inlet pipe temp

• Mixer 7 mixed water temp

• Mixer 8 First Floor Studio Male/Female Toilet x 2 basins Does the water shut off when the cold is isolated (Mixer behind panel behind toilet)

  Yes

  No

  N/A

• Mixer 8 hot inlet pipe temp

• Mixer 8 cold inlet pipe temp

• Mixer 8 mixed water temp

Annual Tap Temp Inspections-Nov (Hot greater than 50oC Cold less than 20oC)

• Annual tap temp inspections completed?

  Yes

  No

  N/A

• Tap 1 Hot - Reception Disabled Toilet

• Tap 1 Cold - Reception Disabled Toilet

• Tap 1a Cold - Water Fountain By staff room

• Tap 2 Hot - Staff Room Kitchen

• Tap 2 Cold - Staff Room Kitchen

• Tap 3 Hot - Staff Room Toilet sink left

• Tap 3 Cold - Staff Room Toilet sink left

• Tap 4 Hot - Staff Room Toilet sink Right

• Tap 4 Cold - Staff Room Toilet sink Right

• Tap 5 Hot - Plantroom Sink

• Tap 5 Cold - Plantroom Sink

• Tap 6 Hot - Poolside Male Sink left

• Tap 6 Cold - Poolside Male Sink left

• Tap 7 Hot - Poolside Male sink right

• Tap 7 Cold - Poolside Male sink right

• Tap 8 Hot - Female Poolside Sink left

• Tap 8 Cold - Female Poolside Sink left

• Tap 9 Hot - Female Poolside Sink right

• Tap 9 Cold - Female Poolside Sink right

• Tap 10 Hot - Poolside Cleaning Sink

• Tap 10 Cold - Poolside Cleaning Sink

• Tap 10a Cold - Gym Water Fountain

• Tap 11 Hot Male Dryside 1 (left) Sink left

• Tap 11 Cold Male Dryside 1 (Left) Sink left

• Tap 12 Hot Male Dryside 1 (left) Sink Right

• Tap 12 Cold Male Dryside 1 (left) Sink Right

• Tap 13 Hot - Male Dryside 2 (Right) Sink left

• Tap 13 Cold - Male Dryside 2 (Right) Sink left

• Tap 14 Hot - Male Dryside 2 (Right) Sink Right

• Tap 14 Cold - Male Dryside 2 (Right) Sink Right

• Tap 15 Hot - Female Dryside Sink left

• Tap 15 Cold - Female Dryside Sink left

• Tap 16 Hot - Female Dryside Sink Right

• Tap 16 Cold - Female Dryside Sink Right

• Tap 17 Hot - First Floor Studio Sink 1 (Left)

• Tap 17 Cold - First Floor Studio Sink 1 (Left)

• Tap 18 Hot - First Floor Studio Sink 1 (Right)

• Tap 18 Cold -First Floor Studio Sink 1 (Right)

• Tap 19 Hot - Ops Office Sink

• Tap 19 Cold - Ops Office Sink

• Tap 20 Hot - GM Office Sink

• Tap 20 Cold - GM Office Sink

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

• Annual Mixer Service-Filter Clean/Replacement In Date?

  Yes

  No

  N/A

• In Date 22 May 19

  

Annual Thermometer Calibration -April-Advance -If yes take a picture of the worksheet or certificate when sent via email

• Thermometer calibration In Date? Advance

  Yes

  No

  N/A

• In Date To 21st Nov 19

  

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

• Annual external calorifier inspection In date?-Advance

  Yes

  No

  N/A

• In Date to 30th May 19

  

Annual tank Inspection Site-July

• Annual tank Inspection-Site

  Yes

  No

  N/A

• Tank 1 mains Incoming Water Temp

• Tank 1 Water Temp Away From Incoming?

• Tank 2 mains Incoming Water Temp

• Tank 2 Water Temp Away From Incoming?

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

• Annual external Tank inspection In date?-Advance

  Yes

  No

  N/A

• In Date to 31st May 19

  

LPHW-Bi-Annual/Annual-April/October-Advance If yes take a picture of the worksheet or Certificate when sent via email.

• Are Bi-Annual/Annual LPHW Inspection In date? Advance

  Yes

  No

  N/A

• In Date to 19th Nov 19

  

Training

• Has any additional Legionella awareness training been complete 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