Information

  • Audit Title

  • Premises name

  • Location
  • Application Number

  • Conducted on

  • Prepared by

  • Number of cooling towers

  • Inspection Result

  • Reinspection

  • Invoice

Premises Details

  • Premises name

  • Owners name

  • ABN Number

  • Occupiers name

  • Contact Person

  • Contacts Phone Number

  • Contacts Position

  • Contacts Email

  • Emergency contact

  • Emergency number

  • No. of Water Cooling Systems

  • Microbial System Service Company

  • Service Company Contact Phone Number

  • Service Company Email Address

  • Cleaning Company

  • Cleaning Company Contact Phone Number

  • Cleaning Company Email Address

Cooling Tower Inspections

Cooling Tower 1

  • Documentation

  • Photo of cooling tower

  • Cooling Tower Model

  • Cooling Tower Serial Number

  • Operation manual provided on site

  • Maintenance manual and records provided on site

  • Manuals comply with AS/NZS 3666.2:2011?

  • Drawings, suppliers recommendations, cleaning and dismantling instructions, set up and shut down procedures, maintenance management program.

  • Certificate of disinfection

  • Certificate of disinfection expiry date

  • Photo of Certificate of Disinfection

  • System inspected monthly?

  • Date of last monthly inspection

  • Photo of most recent months inspection report

  • Cleaning interval not exceeding 6 months?

  • Date of last system cleaning

  • Photo of most recent system cleaning

  • Microbiological test results satisfactory (recommended 3 monthly):<br>(a) the level of Legionella in the system is not more than 10 colony-forming units per millilitre, and<br>(b) the heterotrophic plate count in the system is not more than 100,000 colony-forming units per millilitre.

  • Date of last microbiological test

  • Photo of most recent microbiological test results

  • Tower Inspection

  • Does access to the tower appear safe and easy?

  • Condition of exterior of tower

  • Condition of water in the basin

  • Condition of drift eliminators

  • Tower free of rust, biofilm, sludge and algae

  • Disinfectant chemical drums located on bunded trays

  • Do biocide drums contain adequate product

Cooling tower 2

  • Documentation

  • Photo of cooling tower

  • Cooling Tower Model

  • Cooling Tower Serial Number

  • Operation manual provided on site

  • Maintenance manual and records provided on site

  • Manuals comply with AS/NZS 3666.2:2011?

  • Drawings, suppliers recommendations, cleaning and dismantling instructions, set up and shut down procedures, maintenance management program.

  • Certificate of disinfection

  • Certificate of Disinfection expiry date

  • Photo of Certificate of Disinfection

  • System inspected monthly?

  • Date of last monthly inspection

  • Photo of most recent months inspection report

  • Cleaning interval not exceeding 6 months?

  • Date of last system cleaning

  • Photo of most recent system cleaning

  • Microbiological test results satisfactory (recommended 3 monthly):<br>(a) the level of Legionella in the system is not more than 10 colony-forming units per millilitre, and<br>(b) the heterotrophic plate count in the system is not more than 100,000 colony-forming units per millilitre.

  • Date of last microbiological test

  • Photo of most recent microbiological test results

  • Tower Inspection

  • Does access to the tower appear safe and easy?

  • Condition of exterior of tower

  • Condition of water in the basin

  • Condition of drift eliminators

  • Tower free of rust, biofilm, sludge and algae

  • Disinfectant chemical drums located on bunded trays

Cooling tower 3

  • Documentation

  • Photo of cooling tower

  • Cooling Tower Model

  • Cooling Tower Serial Number

  • Operation manual provided on site

  • Maintenance manual and records provided on site

  • Manuals comply with AS/NZS 3666.2:2011?

  • Drawings, suppliers recommendations, cleaning and dismantling instructions, set up and shut down procedures, maintenance management program.

  • Certificate of disinfection

  • Certificate of Disinfection expiry date

  • Photo of Certificate of Disinfection

  • System inspected monthly?

  • Date of last monthly inspection

  • Photo of most recent months inspection report

  • Cleaning interval not exceeding 6 months?

  • Date of last system cleaning

  • Photo of most recent system cleaning

  • Microbiological test results satisfactory (recommended 3 monthly):<br>(a) the level of Legionella in the system is not more than 10 colony-forming units per millilitre, and<br>(b) the heterotrophic plate count in the system is not more than 100,000 colony-forming units per millilitre.

  • Date of last microbiological test

  • Photo of most recent microbiological test results

  • Condition of water in the basin

  • Tower Inspection

  • Does access to the tower appear safe and easy?

  • Condition of exterior of tower

  • Condition of drift eliminators

  • Tower free of rust, biofilm, sludge and algae

  • Disinfectant chemical drums located on bunded trays

Cooling tower 4

  • Documentation

  • Photo of cooling tower

  • Cooling Tower Model

  • Cooling Tower Serial Number

  • Operation manual provided on site

  • Maintenance manual and records provided on site

  • Manuals comply with AS/NZS 3666.2:2011?

  • Drawings, suppliers recommendations, cleaning and dismantling instructions, set up and shut down procedures, maintenance management program.

  • Certificate of disinfection

  • Certificate of Disinfection expiry date

  • Photo of Certificate of Disinfection

  • System inspected monthly?

  • Date of last monthly inspection

  • Photo of most recent months inspection report

  • Cleaning interval not exceeding 6 months?

  • Date of last system cleaning

  • Photo of most recent system cleaning

  • Microbiological test results satisfactory (recommended 3 monthly):<br>(a) the level of Legionella in the system is not more than 10 colony-forming units per millilitre, and<br>(b) the heterotrophic plate count in the system is not more than 100,000 colony-forming units per millilitre.

  • Date of last microbiological test

  • Photo of most recent microbiological test results

  • Tower Inspection

  • Does access to the tower appear safe and easy?

  • Condition of exterior of tower

  • Condition of water in the basin

  • Condition of drift eliminators

  • Tower free of rust, biofilm, sludge and algae

  • Disinfectant chemical drums located on bunded trays

Cooling tower 5

  • Documentation

  • Photo of cooling tower

  • Cooling Tower Model

  • Cooling Tower Serial Number

  • Operation manual provided on site

  • Maintenance manual and records provided on site

  • Manuals comply with AS/NZS 3666.2:2011?

  • Drawings, suppliers recommendations, cleaning and dismantling instructions, set up and shut down procedures, maintenance management program.

  • Certificate of disinfection

  • Certificate of Disinfection expiry date

  • Photo of Certificate of Disinfection

  • System inspected monthly?

  • Date of last monthly inspection

  • Photo of most recent months inspection report

  • Cleaning interval not exceeding 6 months?

  • Date of last system cleaning

  • Photo of most recent system cleaning

  • Microbiological test results satisfactory (recommended 3 monthly):<br>(a) the level of Legionella in the system is not more than 10 colony-forming units per millilitre, and<br>(b) the heterotrophic plate count in the system is not more than 100,000 colony-forming units per millilitre.

  • Date of last microbiological test

  • Photo of most recent microbiological test results

  • Tower Inspection

  • Does access to the tower appear safe and easy?

  • Condition of exterior of tower

  • Condition of water in the basin

  • Condition of drift eliminators

  • Tower free of rust, biofilm, sludge and algae

  • Disinfectant chemical drums located on bunded trays

Signature

  • Site manager/owner name

  • Environmental Health Officer

  • Select date

  • Phone: (02) 9748 9999 Fax: (02) 9764 1034 Email: council@strathfield.nsw.gov.au

Inspection Outcome

  • Inspection Rating

  • Further Action Required

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