Title Page
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Site Address
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Conducted on
This audit is to be used to record the flushing of water supplies inline guidance and advice within the Water Hygiene Tool Box Talk, Water Hygiene Task Risk Assessment and inline with the Management of Legionella Policy. If you identify a water outlet on site not identified on the list provided use this form to log the location but do not test.
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Location 1
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Location within the site?
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Photo of water supply
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Have you flushed the water system inline with guidance provided. (If unsure speak with your line manager)
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Please state why flushing was not possible, actions and who this has been raised with?
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Photo of damage or issue
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Location 2
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Location within the site?
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Photo of water supply
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Have you flushed the water system inline with guidance provided. (If unsure speak with your line manager)
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Please state why flushing was not possible, actions and who this has been raised with?
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Location 3
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Location within the site?
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Photo of water supply
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Have you flushed the water system inline with guidance provided. (If unsure speak with your line manager)
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Please state why flushing was not possible, actions and who this has been raised with?
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Location 4
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Location within the site?
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Photo of water supply
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Have you flushed the water system inline with guidance provided. (If unsure speak with your line manager)
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Please state why flushing was not possible, actions and who this has been raised with?
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Location 5
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Location within the site?
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Photo of water supply
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Have you flushed the water system inline with guidance provided. (If unsure speak with your line manager)
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Please state why flushing was not possible, actions and who this has been raised with?
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Signature
