PFP Leisure Legionella Inspections 2020- Latchmere

• 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...Sam Glassett..Site Responsible Person..Adam Makawski..Deputy Responsible Person...Barry Wright..

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

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

• Monthly PHE Inspections Completed?

  Yes

  No

  N/A

• PHE 1 Wetside Lower Plantroom Left Flow Temp

• PHE 1 Wetside Lower Plantroom Left Return Temp

• PHE 2 Wetside Lower Plantroom Right Flow Temp

• PHE 2 Wetside Lower Plantroom Right Return Temp

• PHE 3 Dryside Upper Plantroom Left Flow Temp

• PHE 3 Dryside Upper Plantroom Left Return Temp

• PHE Calorifer 4 Dryside Upper Plantroom Right Flow Temp

• PHE 4 Dryside Upper Plantroom Right 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 Crèche Toilet

• Hot Tap 2 Temp Female Change Dry Side

• Hot Tap 3 Temp Disabled Shower Room Wet Side Ground Floor

• Hot Tap 4 Temp Café Kitchen 2 Wet Side First Floor

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 Dance Studio Dry Side MAINS COLD TAP

• Cold Tap 2 Temp Crèche Toilet Dry Side

• Cold Tap 3 Temp Female Change Dry Side

• Cold Tap 4 Temp Disabled Shower Room Wet Side Ground Floor

• Cold Tap 5 Temp Café Kitchen 2 Wet Side First Floor MAINS COLD TAP

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

• Week 1 Hot Water Heater Inspections Completed?

  Yes

  No

  N/A

• Water Heater 1 Hot Temp Check

• Weekly Sign-off name and Date

  Sign

• Week 2 Hot Water Heater Inspections Completed?

  Yes

  No

  N/A

• Water Heater 1 Hot Temp Check

• Weekly Sign-off name and Date

  Sign

• Week 3 Hot Water Heater Inspections Completed?

  Yes

  No

  N/A

• Water Heater 1 Hot Temp Check

• Weekly Sign-off name and Date

  Sign

• Week 4 Hot Water Heater Inspections Completed?

  Yes

  No

  N/A

• Water Heater 1 Hot Temp Check

• Weekly Sign-off and Date

  Sign

• Week 5 Hot Water Heater Inspections Completed?

  Yes

  No

  N/A

• Water Heater 1 Hot Temp Check

• Weekly Sign-off name and Date

  Sign

Week 1 low Use Outlet Flush (3 Min)

• Is Week 1 Tap Flushing Completed?

  Yes

  No

  N/A

• Outlet 1 Flushed Lower Plant Room Spray taps for bunds

  Yes

  No

  N/A

• Outlet 2 Flushed Lower Plant Room Sink taps

  Yes

  No

  N/A

• Outlet 3 Flushed Lower Plant Room Emergency Shower

  Yes

  No

  N/A

• Outlet 4 Flushed Staff Room Sinks

  Yes

  No

  N/A

• Outlet 5 Flushed First Aid Room Sinks

  Yes

  No

  N/A

• Outlet 6 Flushed Outside Acid/Hypo Store Rinse Hose Points

  Yes

  No

  N/A

• Outlet 7 Flushed Sports Hall Fire Hoses x 3

  Yes

  No

  N/A

• ALL taps/shower outlets including above flushed for 3 min in emergency shutdown of 5-60 days (see low use list, mixer tap/shower list, Annual tap temp) complete as part of the temp checks

  Yes

  No

  N/A

• Week 1 Sign-Off name and date

  Sign

Week 2 low Use Outlet Flush (3Min)

• Is Week 2 Flushing Completed?

  Yes

  No

  N/A

• Outlet 1 Flushed Lower Plant Room Spray taps for bunds

  Yes

  No

  N/A

• Outlet 2 Flushed Lower Plant Room Sink taps

  Yes

  No

  N/A

• Outlet 3 Flushed Lower Plant Room Emergency Shower

  Yes

  No

  N/A

• Outlet 4 Flushed Staff Room Sinks

  Yes

  No

  N/A

• Outlet 5 Flushed First Aid Room Sinks

  Yes

  No

  N/A

• Outlet 6 Flushed Outside Acid/Hypo Store Rinse Hose Points

  Yes

  No

  N/A

• Outlet 7 Flushed Sports Hall Fire Hoses x3

  Yes

  No

  N/A

• ALL taps/shower outlets including above flushed for 3 min in emergency shutdown of 5-60 days (see low use list, mixer tap/shower list, Annual tap temp) complete as part of the temp checks

  Yes

  No

  N/A

• Week 2 Sign-Off name and date

  Sign

Week 3 low Use Outlet Flush (3 Min)

• Is Week 3 Flushing Completed?

  Yes

  No

  N/A

• Outlet 1 Flushed Lower Plant Room Spray taps for bunds

  Yes

  No

  N/A

• Outlet 2 Flushed Lower Plant Room Sink taps

  Yes

  No

  N/A

• Outlet 3 Flushed Lower Plant Room Emergency Shower

  Yes

  No

  N/A

• Outlet 4 Flushed Staff Room Sinks

  Yes

  No

  N/A

• Outlet 5 Flushed First Aid Room Sinks

  Yes

  No

  N/A

• Outlet 6 Flushed Outside Acid/Hypo Store Rinse Hose Points

  Yes

  No

  N/A

• Outlet 7 Flushed Sports Hall Fire Hoses x3

  Yes

  No

  N/A

• ALL taps/shower outlets including above flushed for 3 min in emergency shutdown of 5-60 days (see low use list, mixer tap/shower list, Annual tap temp) complete as part of the temp checks

  Yes

  No

  N/A

• Week 3 Sign-Off name and date

  Sign

Week 4 low Use Outlet Flush (3 Min)

• Is Week 4 Flushing Completed?

  Yes

  No

  N/A

• Outlet 1 Flushed Lower Plant Room Spray taps for bunds

  Yes

  No

  N/A

• Outlet 2 Flushed Lower Plant Room Sink taps

  Yes

  No

  N/A

• Outlet 3 Flushed Lower Plant Room Emergency Shower

  Yes

  No

  N/A

• Outlet 4 Flushed Staff Room Sinks

  Yes

  No

  N/A

• Outlet 5 Flushed First Aid Room Sinks

  Yes

  No

  N/A

• Outlet 6 Flushed Outside Acid/Hypo Store Rinse Hose Points

  Yes

  No

  N/A

• Outlet 7 Flushed Sports Hall Fire Hoses x3

  Yes

  No

  N/A

• ALL taps/shower outlets including above flushed for 3 min in emergency shutdown of 5-60 days (see low use list, mixer tap/shower list, Annual tap temp) complete as part of the temp checks

  Yes

  No

  N/A

• Week 4 Sign-Off name and date

  Sign

Week 5 low Use Outlet Flush (3 Min)

• Is Week 5 Flushing completed?

  Yes

  No

  N/A

• Outlet 1 Flushed Lower Plant Room Spray taps for bunds

  Yes

  No

  N/A

• Outlet 2 Flushed Lower Plant Room Sink taps

  Yes

  No

  N/A

• Outlet 3 Flushed Lower Plant Room Emergency Shower

  Yes

  No

  N/A

• Outlet 4 Flushed Staff Room Sinks

  Yes

  No

  N/A

• Outlet 5 Flushed First Aid Room Sinks

  Yes

  No

  N/A

• Outlet 6 Flushed GM/OPS Office Sinks

  Yes

  No

  N/A

• Outlet 7 Flushed Sports Hall Fire Hoses

  Yes

  No

  N/A

• ALL taps/shower outlets including above flushed for 3 min in emergency shutdown of 5-60 days (see low use list, mixer tap/shower list, Annual tap temp) complete as part of the temp checks

  Yes

  No

  N/A

• Week 5 Sign-Off name and date

  Sign

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

• Week 1 Shower Mixer Inspections Completed?

  Yes

  No

  N/A

• Mixer 1 Village showers x 3 open shower left hand side far end, Showers Does the water shut off when the cold is isolated (Mixer within Left Cupboard )

  Yes

  No

  N/A

• Mixer 1 Village showers x 3 Showers hot inlet pipe temp

• Mixer 1 Village showers x 3 Showers cold inlet pipe temp

• Mixer 1 Village showers x 3 mixed water temp

• Mixer 2 Village Showers x 4 2 open showers and 2 cubicle close to valves , Does the water shut off when the cold is isolated (Mixer located in middle cupboard)

  Yes

  No

  N/A

• Mixer 2 Village Showers x 4 hot inlet pipe temp

• Mixer 2 Village Showers x 4 cold inlet pipe temp

• Mixer 2 Village Showers x 4 mixed water temp

• Mixer 3 Village Showers x 3 showers cubicle far end Showers, Does Shower the water shut off when the cold is isolated (Mixer Located in Right cupboard)

  Yes

  No

  N/A

• Mixer 3 Village Showers x 3 Shower hot inlet pipe temp

• Mixer 3 Village Shower x 3 Shower cold inlet pipe temp

• Mixer 3 Village Showers x 3 Shower mixed water temp

• Mixer 4 Teaching Pool Showers x 3 Showers Does the water shut off when the cold is isolated (Mixer Above Cubicals)

  Yes

  No

  N/A

• Mixer 4 Teaching Pool Showers x 3 Showers hot inlet pipe temp 5 x Showers

• Mixer 4 Teaching Pool Showers x 3 Showers cold inlet pipe temp

• Mixer 4 Teaching Pool Showers x 3 showers mixed water temp

• Mixer Disabled Showers x 1 Shower Does the water shut off when the cold is isolated (Mixer shower fixed)

  Yes

  No

  N/A

• Mixer 5 Disabled Shower x 1 Shower hot inlet pipe temp

• Mixer 5 Disabled Showers x 1 Shower cold inlet pipe temp

• Mixer 5 Disabled Showers x 1 Shower mixed water temp

• Mixer 6 Male dryside x 5 Showers Does the water shut off when the cold is isolated (Mixer Above Showers)

  Yes

  No

  N/A

• Mixer 6 Male dryside x 5 Showers hot inlet pipe temp

• Mixer 6 Male dryside x 5 Showers cold inlet pipe temp

• Mixer 6 Male dryside x 5 Showers mixed water temp

• Mixer 7 Female dryside 5 x showers Does the water shut off when the cold is isolated (Mixer Above Showers)

  Yes

  No

  N/A

• Mixer 7 Female dryside x 5 showers hot inlet pipe temp

• Mixer 7 Female dryside x 5 showers cold inlet pipe temp

• Mixer 7 Female dryside x 5 showers mixed water temp

• Weekly Sign-off name and date

• Week 2 Shower Mixer Inspections Completed?

  Yes

  No

  N/A

• Mixer 1 Village showers x 3 open shower left hand side far end, Showers Does the water shut off when the cold is isolated (Mixer within Left Cupboard )

  Yes

  No

  N/A

• Mixer 1 Village showers x 3 Showers hot inlet pipe temp

• Mixer 1 Village showers x 3 Showers cold inlet pipe temp

• Mixer 1 Village showers x 3 mixed water temp

• Mixer 2 Village Showers x 4 2 open showers and 2 cubicle close to valves , Does the water shut off when the cold is isolated (Mixer located in middle cupboard)

  Yes

  No

  N/A

• Mixer 2 Village Showers x 4 hot inlet pipe temp

• Mixer 2 Village Showers x 4 cold inlet pipe temp

• Mixer 2 Village Showers x 4 mixed water temp

• Mixer 3 Village Showers x 3 showers cubicle far end Showers, Does Shower the water shut off when the cold is isolated (Mixer Located in Right cupboard)

  Yes

  No

  N/A

• Mixer 3 Village Showers x 3 Shower hot inlet pipe temp

• Mixer 3 Village Shower x 3 Shower cold inlet pipe temp

• Mixer 3 Village Showers x 3 Shower mixed water temp

• Mixer 4 Teaching Pool Showers x 3 Showers Does the water shut off when the cold is isolated (Mixer Above Cubicals)

  Yes

  No

  N/A

• Mixer 4 Teaching Pool Showers x 3 Showers hot inlet pipe temp 5 x Showers

• Mixer 4 Teaching Pool Showers x 3 Showers cold inlet pipe temp

• Mixer 4 Teaching Pool Showers x 3 showers mixed water temp

• Mixer Disabled Showers x 1 Shower Does the water shut off when the cold is isolated (Mixer shower fixed)

  Yes

  No

  N/A

• Mixer 5 Disabled Shower x 1 Shower hot inlet pipe temp

• Mixer 5 Disabled Showers x 1 Shower cold inlet pipe temp

• Mixer 5 Disabled Showers x 1 Shower mixed water temp

• Mixer 6 Male dryside x 5 Showers Does the water shut off when the cold is isolated (Mixer Above Showers)

  Yes

  No

  N/A

• Mixer 6 Male dryside x 5 Showers hot inlet pipe temp

• Mixer 6 Male dryside x 5 Showers cold inlet pipe temp

• Mixer 6 Male dryside x 5 Showers mixed water temp

• Mixer 7 Female dryside 5 x showers Does the water shut off when the cold is isolated (Mixer Above Showers)

  Yes

  No

  N/A

• Mixer 7 Female dryside x 5 showers hot inlet pipe temp

• Mixer 7 Female dryside x 5 showers cold inlet pipe temp

• Mixer 7 Female dryside x 5 showers mixed water temp

• Weekly Sign-off name and date

• Week 3 Shower Mixer Inspections Completed?

  Yes

  No

  N/A

• Mixer 1 Village showers x 3 open shower left hand side far end, Showers Does the water shut off when the cold is isolated (Mixer within Left Cupboard )

  Yes

  No

  N/A

• Mixer 1 Village showers x 3 Showers hot inlet pipe temp

• Mixer 1 Village showers x 3 Showers cold inlet pipe temp

• Mixer 1 Village showers x 3 mixed water temp

• Mixer 2 Village Showers x 4 2 open showers and 2 cubicle close to valves , Does the water shut off when the cold is isolated (Mixer located in middle cupboard)

  Yes

  No

  N/A

• Mixer 2 Village Showers x 4 hot inlet pipe temp

• Mixer 2 Village Showers x 4 cold inlet pipe temp

• Mixer 2 Village Showers x 4 mixed water temp

• Mixer 3 Village Showers x 3 showers cubicle far end Showers, Does Shower the water shut off when the cold is isolated (Mixer Located in Right cupboard)

  Yes

  No

  N/A

• Mixer 3 Village Showers x 3 Shower hot inlet pipe temp

• Mixer 3 Village Shower x 3 Shower cold inlet pipe temp

• Mixer 3 Village Showers x 3 Shower mixed water temp

• Mixer 4 Teaching Pool Showers x 3 Showers Does the water shut off when the cold is isolated (Mixer Above Cubicals)

  Yes

  No

  N/A

• Mixer 4 Teaching Pool Showers x 3 Showers hot inlet pipe temp 5 x Showers

• Mixer 4 Teaching Pool Showers x 3 Showers cold inlet pipe temp

• Mixer 4 Teaching Pool Showers x 3 showers mixed water temp

• Mixer Disabled Showers x 1 Shower Does the water shut off when the cold is isolated (Mixer shower fixed)

  Yes

  No

  N/A

• Mixer 5 Disabled Shower x 1 Shower hot inlet pipe temp

• Mixer 5 Disabled Showers x 1 Shower cold inlet pipe temp

• Mixer 5 Disabled Showers x 1 Shower mixed water temp

• Mixer 6 Male dryside x 5 Showers Does the water shut off when the cold is isolated (Mixer Above Showers)

  Yes

  No

  N/A

• Mixer 6 Male dryside x 5 Showers hot inlet pipe temp

• Mixer 6 Male dryside x 5 Showers cold inlet pipe temp

• Mixer 6 Male dryside x 5 Showers mixed water temp

• Mixer 7 Female dryside 5 x showers Does the water shut off when the cold is isolated (Mixer Above Showers)

  Yes

  No

  N/A

• Mixer 7 Female dryside x 5 showers hot inlet pipe temp

• Mixer 7 Female dryside x 5 showers cold inlet pipe temp

• Mixer 7 Female dryside x 5 showers mixed water temp

• Weekly Sign-off name and date

• Week 4 Shower Mixer Inspections Completed?

  Yes

  No

  N/A

• Mixer 1 Village showers x 3 open shower left hand side far end, Showers Does the water shut off when the cold is isolated (Mixer within Left Cupboard )

  Yes

  No

  N/A

• Mixer 1 Village showers x 3 Showers hot inlet pipe temp

• Mixer 1 Village showers x 3 Showers cold inlet pipe temp

• Mixer 1 Village showers x 3 mixed water temp

• Mixer 2 Village Showers x 4 2 open showers and 2 cubicle close to valves , Does the water shut off when the cold is isolated (Mixer located in middle cupboard)

  Yes

  No

  N/A

• Mixer 2 Village Showers x 4 hot inlet pipe temp

• Mixer 2 Village Showers x 4 cold inlet pipe temp

• Mixer 2 Village Showers x 4 mixed water temp

• Mixer 3 Village Showers x 3 showers cubicle far end Showers, Does Shower the water shut off when the cold is isolated (Mixer Located in Right cupboard)

  Yes

  No

  N/A

• Mixer 3 Village Showers x 3 Shower hot inlet pipe temp

• Mixer 3 Village Shower x 3 Shower cold inlet pipe temp

• Mixer 3 Village Showers x 3 Shower mixed water temp

• Mixer 4 Teaching Pool Showers x 3 Showers Does the water shut off when the cold is isolated (Mixer Above Cubicals)

  Yes

  No

  N/A

• Mixer 4 Teaching Pool Showers x 3 Showers hot inlet pipe temp 5 x Showers

• Mixer 4 Teaching Pool Showers x 3 Showers cold inlet pipe temp

• Mixer 4 Teaching Pool Showers x 3 showers mixed water temp

• Mixer Disabled Showers x 1 Shower Does the water shut off when the cold is isolated (Mixer shower fixed)

  Yes

  No

  N/A

• Mixer 5 Disabled Shower x 1 Shower hot inlet pipe temp

• Mixer 5 Disabled Showers x 1 Shower cold inlet pipe temp

• Mixer 5 Disabled Showers x 1 Shower mixed water temp

• Mixer 6 Male dryside x 5 Showers Does the water shut off when the cold is isolated (Mixer Above Showers)

  Yes

  No

  N/A

• Mixer 6 Male dryside x 5 Showers hot inlet pipe temp

• Mixer 6 Male dryside x 5 Showers cold inlet pipe temp

• Mixer 6 Male dryside x 5 Showers mixed water temp

• Mixer 7 Female dryside 5 x showers Does the water shut off when the cold is isolated (Mixer Above Showers)

  Yes

  No

  N/A

• Mixer 7 Female dryside x 5 showers hot inlet pipe temp

• Mixer 7 Female dryside x 5 showers cold inlet pipe temp

• Mixer 7 Female dryside x 5 showers mixed water temp

• Weekly Sign-off name and date

• Week 5 Shower Mixer Inspections Completed?

  Yes

  No

  N/A

• Mixer 1 Village showers x 3 open shower left hand side far end, Showers Does the water shut off when the cold is isolated (Mixer within Left Cupboard )

  Yes

  No

  N/A

• Mixer 1 Village showers x 3 Showers hot inlet pipe temp

• Mixer 1 Village showers x 3 Showers cold inlet pipe temp

• Mixer 1 Village showers x 3 mixed water temp

• Mixer 2 Village Showers x 4 2 open showers and 2 cubicle close to valves , Does the water shut off when the cold is isolated (Mixer located in middle cupboard)

  Yes

  No

  N/A

• Mixer 2 Village Showers x 4 hot inlet pipe temp

• Mixer 2 Village Showers x 4 cold inlet pipe temp

• Mixer 2 Village Showers x 4 mixed water temp

• Mixer 3 Village Showers x 3 showers cubicle far end Showers, Does Shower the water shut off when the cold is isolated (Mixer Located in Right cupboard)

  Yes

  No

  N/A

• Mixer 3 Village Showers x 3 Shower hot inlet pipe temp

• Mixer 3 Village Shower x 3 Shower cold inlet pipe temp

• Mixer 3 Village Showers x 3 Shower mixed water temp

• Mixer 4 Teaching Pool Showers x 3 Showers Does the water shut off when the cold is isolated (Mixer Above Cubicals)

  Yes

  No

  N/A

• Mixer 4 Teaching Pool Showers x 3 Showers hot inlet pipe temp 5 x Showers

• Mixer 4 Teaching Pool Showers x 3 Showers cold inlet pipe temp

• Mixer 4 Teaching Pool Showers x 3 showers mixed water temp

• Mixer Disabled Showers x 1 Shower Does the water shut off when the cold is isolated (Mixer shower fixed)

  Yes

  No

  N/A

• Mixer 5 Disabled Shower x 1 Shower hot inlet pipe temp

• Mixer 5 Disabled Showers x 1 Shower cold inlet pipe temp

• Mixer 5 Disabled Showers x 1 Shower mixed water temp

• Mixer 6 Male dryside x 5 Showers Does the water shut off when the cold is isolated (Mixer Above Showers)

  Yes

  No

  N/A

• Mixer 6 Male dryside x 5 Showers hot inlet pipe temp

• Mixer 6 Male dryside x 5 Showers cold inlet pipe temp

• Mixer 6 Male dryside x 5 Showers mixed water temp

• Mixer 7 Female dryside 5 x showers Does the water shut off when the cold is isolated (Mixer Above Showers)

  Yes

  No

  N/A

• Mixer 7 Female dryside x 5 showers hot inlet pipe temp

• Mixer 7 Female dryside x 5 showers cold inlet pipe temp

• Mixer 7 Female dryside x 5 showers mixed water temp

• Weekly Sign-off name and date

Quarterly Shower Descale-Mar/Jun/Sep/Dec

• Shower Head Descale Completed

  Yes

  No

  N/A

• Area 1 Village x 13 heads descaled?

  Yes

  No

  N/A

• Area 2 Disabled x 2 heads descaled?

  Yes

  No

  N/A

• Area 3 Female Dry Change x 5 heads descaled?

  Yes

  No

  N/A

• Area 4 Male Dry Change 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 Reception DIsabled Toilet x 1 basins Does the water shut off when the cold is isolated (Mixer Under Sink)

  Yes

  No

  N/A

• Mixer 1 hot inlet pipe temp

• Mixer 1 cold inlet pipe temp

• Mixer 1 mixed water temp

• Mixer 2 Wetside Disabled Change Toilet x 1 basins Does the water shut off when the cold is isolated (Mixer 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 Wetside Male/Female Toilet x 3 basins (nearest sink x 2 male and 1 sink nearest female)Does the water shut off when the cold is isolated (In cupboard between toilets nearest mixer)

  Yes

  No

  N/A

• Mixer 3 hot inlet pipe temp

• Mixer 3 cold inlet pipe temp

• Mixer 3 mixed water temp

• Mixer 4 Wetside Male/Female Toilet x 3 basins (far sink male x 1 and 2 x sink female middle/far )Does the water shut off when the cold is isolated (In cupboard between toilets Middle mixer)

  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 Toilet 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 Female Toilet x 2 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 First Floor Cafe Male/Female Toilet (nearest staffroom) x 1 basins Does the water shut off when the cold is isolated (Mixer tap)

  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 Cafe Male/Female Toilet (Nearest Bridge) x 1 Does the water shut off when the cold is isolated (Mixer tap)

  Yes

  No

  N/A

• Mixer 8 hot inlet pipe temp

• Mixer 8 cold inlet pipe temp

• Mixer 8 mixed water temp

• Mixer 9 Creche Toilets x 2 sinks Does the water shut off when the cold is isolated (Mixer tap)

  Yes

  No

  N/A

• Mixer 9 hot inlet pipe temp

• Mixer 9 cold inlet pipe temp

• Mixer 9 mixed water temp

• Mixer 10 Creche Kitchen x 1 sink Does the water shut off when the cold is isolated (Mixer Tap)

  Yes

  No

  N/A

• Mixer 10 hot inlet pipe temp

• Mixer 10 cold inlet pipe temp

• Mixer 10 mixed water temp

• Mixer 11 Male Dryside disabled toilet (Mixer Tap)

  Yes

  No

  N/A

• Mixer 11 hot inlet pipe temp

• Mixer 11 cold inlet pipe temp

• Mixer 11 mixed water temp

• Mixer 12 Female Dryside disabled toilet (Mixer Tap)

  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 (Hot greater than 50oC Cold less than 20oC)

• Week 1 tap temp inspections completed?

  Yes

  No

  N/A

• Tap 1 Hot - Reception Disabled Toilet

• Tap 1 Cold - Reception Disabled Toilet

• Tap 2 Hot - Female wet change sink 1 nearest

• Tap 2 Cold - Female wet change sink 1 nearest

• Tap 3 Hot - Female wet change sink 2 middle

• Tap 3 Cold - Female wet change sink 2 middle

• Tap 4 Hot - Female wet change sink 3 furthest

• Tap 4 Cold - Female wet change sink 3 furthest

• Tap 5 Hot - Male wet change sink 1 nearest

• Tap 5 Cold - Male wet change sink 1 Nearest

• Tap 6 Hot - Male wet change sink 2 middle

• Tap 6 Cold - Male wet change sink 2 middle

• Tap 7 Hot - Male wet change sink 3 furthest

• Tap 7 Cold - Male wet change sink 3 Furthest

• Tap 7a Cold - Cleaners tap village in cupboard between male/female toilet

• Tap 8 Hot - Disabled Change Sink

• Tap 8 Cold - Disabled Change Sink

• Tap 9 Hot - First Aid room sink

• Tap 9 Cold - First aid room sink

• Tap 10 Hot - Cleaners sink next to first aid

• Tap 10 Cold - Cleaners sink next to first aid

• Tap 11 GM office Sink

• Tap 11 GM office Sink

• Tap 12 Creche Kitchen Sink

• Tap 12 Creche kitchen sink

• Tap 13 Hot - Creche Toilet Sink 1 Left

• Tap 13 Cold - Creche Toilet Sink 1 Left

• Tap 14 Hot - Creche Toilet Sink 2 Right

• Tap 14 Cold - Creche Toilet Sink 2 Right

• Tap 14a Cold - Dance Studio water fountain

• Tap 15 Hot - Female Dryside Sink 1 left

• Tap 15 Cold - Female Dryside Sink 1 left

• Tap 16 Hot - Female Dryside Sink 2 Right

• Tap 16 Cold - Female Dryside Sink 2 Right

• Tap 17 Hot - Female Dryside Disabled toilet sink

• Tap 17 Cold - Female Dryside Disabled toilet sink

• Tap 17 A Cold - Female dry changer shower cleaners hose tap

• Tap 18 Hot - Male Dryside Sink 1 Left

• Tap 18 Cold -Male Dryside Sink 1 Left

• Tap 19 Hot - Male Dryside Sink 2 Right

• Tap 19 Cold - Male Dryside Sink 2 Right

• Tap 20 Hot - Male Dryside Disabled toilet sink

• Tap 20 Cold - Male Dryside Disabled toilet sink

• Tap 20 A Cold - Male dry changer shower cleaners hose tap

• Tap 21 Hot - Staff Change Kitchen Sink

• Tap 21 Cold - Staff Change Kitchen Sink

• Tap 22 Hot - Staff Change Male Toilet

• Tap 22 Cold - Staff Change Female Toilet

• Tap 23 Hot - Pepe Kitchen Hand wash sink

• Tap 23 Cold - Pepe Kitchen Hand wash sink

• Tap 24 Hot - Pepe Kitchen Sink 1 left

• Tap 24 Cold - Pepe Kitchen Sink 1 left

• Tap 25 Hot - Pepe Kitchen Sink 2 right

• Tap 25 Cold - Pepe Kitchen Sink 2 right

• Tap 26 Hot - Cafe Toilet nearest staffroom Sink

• Tap 26 Cold - Cafe Toilet nearest staffroom Sink

• Tap 27 Hot - Cafe Toilet nearest Bridge Sink

• Tap 27 Cold - Cafe Toilet nearest Bridge Sink

• Tap 27a Cold - Water Fountain Gym

• Tap 28 Hot - Lower Plantroom Sink

• Tap 27 Cold - Lower Plantroom Sink

• Tap 28 Cold - Middle Plant room hose point

• Weekly Sign-Off name and date

  Sign

• Week 2 tap temp inspections completed?

  Yes

  No

  N/A

• Tap 1 Hot - Reception Disabled Toilet

• Tap 1 Cold - Reception Disabled Toilet

• Tap 2 Hot - Female wet change sink 1 nearest

• Tap 2 Cold - Female wet change sink 1 nearest

• Tap 3 Hot - Female wet change sink 2 middle

• Tap 3 Cold - Female wet change sink 2 middle

• Tap 4 Hot - Female wet change sink 3 furthest

• Tap 4 Cold - Female wet change sink 3 furthest

• Tap 5 Hot - Male wet change sink 1 nearest

• Tap 5 Cold - Male wet change sink 1 Nearest

• Tap 6 Hot - Male wet change sink 2 middle

• Tap 6 Cold - Male wet change sink 2 middle

• Tap 7 Hot - Male wet change sink 3 furthest

• Tap 7 Cold - Male wet change sink 3 Furthest

• Tap 7a Cold - Cleaners tap village in cupboard between male/female toilet

• Tap 8 Hot - Disabled Change Sink

• Tap 8 Cold - Disabled Change Sink

• Tap 9 Hot - First Aid room sink

• Tap 9 Cold - First aid room sink

• Tap 10 Hot - Cleaners sink next to first aid

• Tap 10 Cold - Cleaners sink next to first aid

• Tap 11 GM office Sink

• Tap 11 GM office Sink

• Tap 12 Creche Kitchen Sink

• Tap 12 Creche kitchen sink

• Tap 13 Hot - Creche Toilet Sink 1 Left

• Tap 13 Cold - Creche Toilet Sink 1 Left

• Tap 14 Hot - Creche Toilet Sink 2 Right

• Tap 14 Cold - Creche Toilet Sink 2 Right

• Tap 14a Cold - Dance Studio water fountain

• Tap 15 Hot - Female Dryside Sink 1 left

• Tap 15 Cold - Female Dryside Sink 1 left

• Tap 16 Hot - Female Dryside Sink 2 Right

• Tap 16 Cold - Female Dryside Sink 2 Right

• Tap 17 Hot - Female Dryside Disabled toilet sink

• Tap 17 Cold - Female Dryside Disabled toilet sink

• Tap 17 A Cold - Female dry changer shower cleaners hose tap

• Tap 18 Hot - Male Dryside Sink 1 Left

• Tap 18 Cold -Male Dryside Sink 1 Left

• Tap 19 Hot - Male Dryside Sink 2 Right

• Tap 19 Cold - Male Dryside Sink 2 Right

• Tap 20 Hot - Male Dryside Disabled toilet sink

• Tap 20 Cold - Male Dryside Disabled toilet sink

• Tap 20 A Cold - Male dry changer shower cleaners hose tap

• Tap 21 Hot - Staff Change Kitchen Sink

• Tap 21 Cold - Staff Change Kitchen Sink

• Tap 22 Hot - Staff Change Male Toilet

• Tap 22 Cold - Staff Change Female Toilet

• Tap 23 Hot - Pepe Kitchen Hand wash sink

• Tap 23 Cold - Pepe Kitchen Hand wash sink

• Tap 24 Hot - Pepe Kitchen Sink 1 left

• Tap 24 Cold - Pepe Kitchen Sink 1 left

• Tap 25 Hot - Pepe Kitchen Sink 2 right

• Tap 25 Cold - Pepe Kitchen Sink 2 right

• Tap 26 Hot - Cafe Toilet nearest staffroom Sink

• Tap 26 Cold - Cafe Toilet nearest staffroom Sink

• Tap 27 Hot - Cafe Toilet nearest Bridge Sink

• Tap 27 Cold - Cafe Toilet nearest Bridge Sink

• Tap 27a Cold - Water Fountain Gym

• Tap 28 Hot - Lower Plantroom Sink

• Tap 27 Cold - Lower Plantroom Sink

• Tap 28 Cold - Middle Plant room hose point

• Weekly Sign-Off name and date

  Sign

• Week 3 tap temp inspections completed?

  Yes

  No

  N/A

• Tap 1 Hot - Reception Disabled Toilet

• Tap 1 Cold - Reception Disabled Toilet

• Tap 2 Hot - Female wet change sink 1 nearest

• Tap 2 Cold - Female wet change sink 1 nearest

• Tap 3 Hot - Female wet change sink 2 middle

• Tap 3 Cold - Female wet change sink 2 middle

• Tap 4 Hot - Female wet change sink 3 furthest

• Tap 4 Cold - Female wet change sink 3 furthest

• Tap 5 Hot - Male wet change sink 1 nearest

• Tap 5 Cold - Male wet change sink 1 Nearest

• Tap 6 Hot - Male wet change sink 2 middle

• Tap 6 Cold - Male wet change sink 2 middle

• Tap 7 Hot - Male wet change sink 3 furthest

• Tap 7 Cold - Male wet change sink 3 Furthest

• Tap 7a Cold - Cleaners tap village in cupboard between male/female toilet

• Tap 8 Hot - Disabled Change Sink

• Tap 8 Cold - Disabled Change Sink

• Tap 9 Hot - First Aid room sink

• Tap 9 Cold - First aid room sink

• Tap 10 Hot - Cleaners sink next to first aid

• Tap 10 Cold - Cleaners sink next to first aid

• Tap 11 GM office Sink

• Tap 11 GM office Sink

• Tap 12 Creche Kitchen Sink

• Tap 12 Creche kitchen sink

• Tap 13 Hot - Creche Toilet Sink 1 Left

• Tap 13 Cold - Creche Toilet Sink 1 Left

• Tap 14 Hot - Creche Toilet Sink 2 Right

• Tap 14 Cold - Creche Toilet Sink 2 Right

• Tap 14a Cold - Dance Studio water fountain

• Tap 15 Hot - Female Dryside Sink 1 left

• Tap 15 Cold - Female Dryside Sink 1 left

• Tap 16 Hot - Female Dryside Sink 2 Right

• Tap 16 Cold - Female Dryside Sink 2 Right

• Tap 17 Hot - Female Dryside Disabled toilet sink

• Tap 17 Cold - Female Dryside Disabled toilet sink

• Tap 17 A Cold - Female dry changer shower cleaners hose tap

• Tap 18 Hot - Male Dryside Sink 1 Left

• Tap 18 Cold -Male Dryside Sink 1 Left

• Tap 19 Hot - Male Dryside Sink 2 Right

• Tap 19 Cold - Male Dryside Sink 2 Right

• Tap 20 Hot - Male Dryside Disabled toilet sink

• Tap 20 Cold - Male Dryside Disabled toilet sink

• Tap 20 A Cold - Male dry changer shower cleaners hose tap

• Tap 21 Hot - Staff Change Kitchen Sink

• Tap 21 Cold - Staff Change Kitchen Sink

• Tap 22 Hot - Staff Change Male Toilet

• Tap 22 Cold - Staff Change Female Toilet

• Tap 23 Hot - Pepe Kitchen Hand wash sink

• Tap 23 Cold - Pepe Kitchen Hand wash sink

• Tap 24 Hot - Pepe Kitchen Sink 1 left

• Tap 24 Cold - Pepe Kitchen Sink 1 left

• Tap 25 Hot - Pepe Kitchen Sink 2 right

• Tap 25 Cold - Pepe Kitchen Sink 2 right

• Tap 26 Hot - Cafe Toilet nearest staffroom Sink

• Tap 26 Cold - Cafe Toilet nearest staffroom Sink

• Tap 27 Hot - Cafe Toilet nearest Bridge Sink

• Tap 27 Cold - Cafe Toilet nearest Bridge Sink

• Tap 27a Cold - Water Fountain Gym

• Tap 28 Hot - Lower Plantroom Sink

• Tap 27 Cold - Lower Plantroom Sink

• Tap 28 Cold - Middle Plant room hose point

• Weekly Sign-Off name and date

  Sign

• Week 4 tap temp inspections completed?

  Yes

  No

  N/A

• Tap 1 Hot - Reception Disabled Toilet

• Tap 1 Cold - Reception Disabled Toilet

• Tap 2 Hot - Female wet change sink 1 nearest

• Tap 2 Cold - Female wet change sink 1 nearest

• Tap 3 Hot - Female wet change sink 2 middle

• Tap 3 Cold - Female wet change sink 2 middle

• Tap 4 Hot - Female wet change sink 3 furthest

• Tap 4 Cold - Female wet change sink 3 furthest

• Tap 5 Hot - Male wet change sink 1 nearest

• Tap 5 Cold - Male wet change sink 1 Nearest

• Tap 6 Hot - Male wet change sink 2 middle

• Tap 6 Cold - Male wet change sink 2 middle

• Tap 7 Hot - Male wet change sink 3 furthest

• Tap 7 Cold - Male wet change sink 3 Furthest

• Tap 7a Cold - Cleaners tap village in cupboard between male/female toilet

• Tap 8 Hot - Disabled Change Sink

• Tap 8 Cold - Disabled Change Sink

• Tap 9 Hot - First Aid room sink

• Tap 9 Cold - First aid room sink

• Tap 10 Hot - Cleaners sink next to first aid

• Tap 10 Cold - Cleaners sink next to first aid

• Tap 11 GM office Sink

• Tap 11 GM office Sink

• Tap 12 Creche Kitchen Sink

• Tap 12 Creche kitchen sink

• Tap 13 Hot - Creche Toilet Sink 1 Left

• Tap 13 Cold - Creche Toilet Sink 1 Left

• Tap 14 Hot - Creche Toilet Sink 2 Right

• Tap 14 Cold - Creche Toilet Sink 2 Right

• Tap 14a Cold - Dance Studio water fountain

• Tap 15 Hot - Female Dryside Sink 1 left

• Tap 15 Cold - Female Dryside Sink 1 left

• Tap 16 Hot - Female Dryside Sink 2 Right

• Tap 16 Cold - Female Dryside Sink 2 Right

• Tap 17 Hot - Female Dryside Disabled toilet sink

• Tap 17 Cold - Female Dryside Disabled toilet sink

• Tap 17 A Cold - Female dry changer shower cleaners hose tap

• Tap 18 Hot - Male Dryside Sink 1 Left

• Tap 18 Cold -Male Dryside Sink 1 Left

• Tap 19 Hot - Male Dryside Sink 2 Right

• Tap 19 Cold - Male Dryside Sink 2 Right

• Tap 20 Hot - Male Dryside Disabled toilet sink

• Tap 20 Cold - Male Dryside Disabled toilet sink

• Tap 20 A Cold - Male dry changer shower cleaners hose tap

• Tap 21 Hot - Staff Change Kitchen Sink

• Tap 21 Cold - Staff Change Kitchen Sink

• Tap 22 Hot - Staff Change Male Toilet

• Tap 22 Cold - Staff Change Female Toilet

• Tap 23 Hot - Pepe Kitchen Hand wash sink

• Tap 23 Cold - Pepe Kitchen Hand wash sink

• Tap 24 Hot - Pepe Kitchen Sink 1 left

• Tap 24 Cold - Pepe Kitchen Sink 1 left

• Tap 25 Hot - Pepe Kitchen Sink 2 right

• Tap 25 Cold - Pepe Kitchen Sink 2 right

• Tap 26 Hot - Cafe Toilet nearest staffroom Sink

• Tap 26 Cold - Cafe Toilet nearest staffroom Sink

• Tap 27 Hot - Cafe Toilet nearest Bridge Sink

• Tap 27 Cold - Cafe Toilet nearest Bridge Sink

• Tap 27a Cold - Water Fountain Gym

• Tap 28 Hot - Lower Plantroom Sink

• Tap 27 Cold - Lower Plantroom Sink

• Tap 28 Cold - Middle Plant room hose point

• Weekly Sign-Off name and date

  Sign

• Week 5 tap temp inspections completed?

  Yes

  No

  N/A

• Tap 1 Hot - Reception Disabled Toilet

• Tap 1 Cold - Reception Disabled Toilet

• Tap 2 Hot - Female wet change sink 1 nearest

• Tap 2 Cold - Female wet change sink 1 nearest

• Tap 3 Hot - Female wet change sink 2 middle

• Tap 3 Cold - Female wet change sink 2 middle

• Tap 4 Hot - Female wet change sink 3 furthest

• Tap 4 Cold - Female wet change sink 3 furthest

• Tap 5 Hot - Male wet change sink 1 nearest

• Tap 5 Cold - Male wet change sink 1 Nearest

• Tap 6 Hot - Male wet change sink 2 middle

• Tap 6 Cold - Male wet change sink 2 middle

• Tap 7 Hot - Male wet change sink 3 furthest

• Tap 7 Cold - Male wet change sink 3 Furthest

• Tap 7a Cold - Cleaners tap village in cupboard between male/female toilet

• Tap 8 Hot - Disabled Change Sink

• Tap 8 Cold - Disabled Change Sink

• Tap 9 Hot - First Aid room sink

• Tap 9 Cold - First aid room sink

• Tap 10 Hot - Cleaners sink next to first aid

• Tap 10 Cold - Cleaners sink next to first aid

• Tap 11 GM office Sink

• Tap 11 GM office Sink

• Tap 12 Creche Kitchen Sink

• Tap 12 Creche kitchen sink

• Tap 13 Hot - Creche Toilet Sink 1 Left

• Tap 13 Cold - Creche Toilet Sink 1 Left

• Tap 14 Hot - Creche Toilet Sink 2 Right

• Tap 14 Cold - Creche Toilet Sink 2 Right

• Tap 14a Cold - Dance Studio water fountain

• Tap 15 Hot - Female Dryside Sink 1 left

• Tap 15 Cold - Female Dryside Sink 1 left

• Tap 16 Hot - Female Dryside Sink 2 Right

• Tap 16 Cold - Female Dryside Sink 2 Right

• Tap 17 Hot - Female Dryside Disabled toilet sink

• Tap 17 Cold - Female Dryside Disabled toilet sink

• Tap 17 A Cold - Female dry changer shower cleaners hose tap

• Tap 18 Hot - Male Dryside Sink 1 Left

• Tap 18 Cold -Male Dryside Sink 1 Left

• Tap 19 Hot - Male Dryside Sink 2 Right

• Tap 19 Cold - Male Dryside Sink 2 Right

• Tap 20 Hot - Male Dryside Disabled toilet sink

• Tap 20 Cold - Male Dryside Disabled toilet sink

• Tap 20 A Cold - Male dry changer shower cleaners hose tap

• Tap 21 Hot - Staff Change Kitchen Sink

• Tap 21 Cold - Staff Change Kitchen Sink

• Tap 22 Hot - Staff Change Male Toilet

• Tap 22 Cold - Staff Change Female Toilet

• Tap 23 Hot - Pepe Kitchen Hand wash sink

• Tap 23 Cold - Pepe Kitchen Hand wash sink

• Tap 24 Hot - Pepe Kitchen Sink 1 left

• Tap 24 Cold - Pepe Kitchen Sink 1 left

• Tap 25 Hot - Pepe Kitchen Sink 2 right

• Tap 25 Cold - Pepe Kitchen Sink 2 right

• Tap 26 Hot - Cafe Toilet nearest staffroom Sink

• Tap 26 Cold - Cafe Toilet nearest staffroom Sink

• Tap 27 Hot - Cafe Toilet nearest Bridge Sink

• Tap 27 Cold - Cafe Toilet nearest Bridge Sink

• Tap 27a Cold - Water Fountain Gym

• Tap 28 Hot - Lower Plantroom Sink

• Tap 27 Cold - Lower Plantroom Sink

• Tap 28 Cold - Middle Plant room hose point

• Weekly Sign-Off name and date

  Sign

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 To 31.12.20

  

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

• Thermometer calibration In Date? WCS

  Yes

  No

  N/A

• In Date To 7.6.19

  

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

• Annual external calorifier inspection In date?-WCS

  Yes

  No

  N/A

• In Date To 24.4.20

  

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 (drained)

• Tank 2 Water Temp Away From Incoming? (drained)

• Tank 3 mains Incoming Water Temp

• Tank 3 Water Temp Away From Incoming?

• Tank 4 mains Incoming Water Temp (drained)

• Tank 4 Water Temp Away From Incoming? (drained)

• Tank 5 mains Incoming Water Temp

• Tank 5 Water Temp Away From Incoming?

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

• Annual external Tank inspection In date?-WCS

  Yes

  No

  N/A

• In Date To 24.4.20

  

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

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

  Yes

  No

  N/A

• In Date to 2.6.20

  

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. Duty Holder Sam Glassett 24th Jan 2020 Pass 100% Responsible person Adam makowski 9th oct 2017 Pass 83% Deputy Responsible person Barry Wright 4th Oct 2017 Pass 83%

  Yes

  N,A

• Monthly Inspections Sign-Off

  Sign