Audit

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.

Location 1

Location within the site?

Photo of water supply

Have you flushed the water system inline with guidance provided. (If unsure speak with your line manager)

Please state why flushing was not possible, actions and who this has been raised with?

Photo of damage or issue

Location 2

Location within the site?

Photo of water supply

Have you flushed the water system inline with guidance provided. (If unsure speak with your line manager)

Please state why flushing was not possible, actions and who this has been raised with?

Location 3

Location within the site?

Photo of water supply

Have you flushed the water system inline with guidance provided. (If unsure speak with your line manager)

Please state why flushing was not possible, actions and who this has been raised with?

Location 4

Location within the site?

Photo of water supply

Have you flushed the water system inline with guidance provided. (If unsure speak with your line manager)

Please state why flushing was not possible, actions and who this has been raised with?

Location 5

Location within the site?

Photo of water supply

Have you flushed the water system inline with guidance provided. (If unsure speak with your line manager)

Please state why flushing was not possible, actions and who this has been raised with?

Have all outlets on this site been flushed?

If no, please state why all outlets have not been flushed, what's the location and who have you raised this with?

Signature
Please note that this checklist is a hypothetical example and provides basic information only. It is not intended to take the place of, among other things, workplace, health and safety advice; medical advice, diagnosis, or treatment; or other applicable laws. You should also seek your own professional advice to determine if the use of such checklist is permissible in your workplace or jurisdiction.