Information
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Premises Name
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Location
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Conducted on
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Prepared by
- Erin Hogan P: 9748 9625 Email: erin.hogan@strathfield.nsw.gov.au
- Sarah Kacir. P: 9748 9948 Email: sarah.kacir@strathfield.nsw.gov.au
- Bradley Pope. P: 9748 9999 Email: bradley.pope@strathfield.nsw.gov.au
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Inspection Result
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Reinspection
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Invoice
Premises Details
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Premises name
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Owners name
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ABN Number
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Occupiers name
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Contact Person
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Contacts Phone Number
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Contacts Position
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Contacts Email
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Emergency contact
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Emergency number
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Microbial System Service Company
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Service Company Contact Phone Number
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Service Company Email Address
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Cleaning Company
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Cleaning Company Contact Phone Number
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Cleaning Company Email Address
Risk Management Plan (RMP)
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Does each Water Cooling System have a Risk Management Plan?
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Risk Ranking
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Annual Independent Audit of RMP completed and provided on site
Cooling Tower Inspections
Cooling Tower System 1
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Switch
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Photo of cooling tower
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Cooling Tower Model
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Cooling Tower Serial Number
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Each Cooling Tower has a Unique Identifying Number
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Operation manual provided on site
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Maintenance manual and records provided on site
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Manuals comply with AS/NZS 3666.2:2011?
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Drawings, suppliers recommendations, cleaning and dismantling instructions, set up and shut down procedures, maintenance management program.
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System inspected monthly
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Date of last monthly inspection
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Photo of most recent months inspection report
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Cleaning interval not exceeding 6 months?
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Date of last system cleaning
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Photo of most recent system cleaning
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Monthly microbiological test results satisfactory:<br>(a) the level of Legionella in the system is not more than 1000 colony-forming units per millilitre, and<br>(b) the heterotrophic plate count in the system is not more than 5,000,000 colony-forming units per millilitre.
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Occupier has notified Council of any failed microbiological test within 24 hours of receipt by the owner.
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Date of last microbiological test
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Photo of most recent microbiological test results
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Tower Inspection
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Does access to the tower appear safe and easy?
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Condition of exterior of tower
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Condition of water in the basin
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Condition of drift eliminators
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Tower free of rust, biofilm, sludge and algae
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Disinfectant chemical drums located on bunded trays
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Do biocide drums contain adequate product
Cooling Tower System 2
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Switch
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Documentation
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Photo of cooling tower
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Cooling Tower Model
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Cooling Tower Serial Number
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Each Cooling Tower has a Unique Identifying Number
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Operation manual provided on site
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Maintenance manual and records provided on site
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Annual Independent Audit completed and provided on site
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Manuals comply with AS/NZS 3666.2:2011?
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Drawings, suppliers recommendations, cleaning and dismantling instructions, set up and shut down procedures, maintenance management program.
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System inspected monthly?
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Date of last monthly inspection
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Photo of most recent months inspection report
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Cleaning interval not exceeding 6 months?
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Date of last system cleaning
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Photo of most recent system cleaning
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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.
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Date of last microbiological test
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Photo of most recent microbiological test results
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Tower Inspection
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Does access to the tower appear safe and easy?
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Condition of exterior of tower
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Condition of water in the basin
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Condition of drift eliminators
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Tower free of rust, biofilm, sludge and algae
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Disinfectant chemical drums located on bunded trays
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Do biocide drums contain adequate product
Cooling Tower System 3
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Switch
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Documentation
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Photo of cooling tower
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Cooling Tower Model
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Cooling Tower Serial Number
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Each Cooling Tower has a Unique Identifying Number
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Operation manual provided on site
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Maintenance manual and records provided on site
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Annual Independent Audit completed and provided on site
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Manuals comply with AS/NZS 3666.2:2011?
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Drawings, suppliers recommendations, cleaning and dismantling instructions, set up and shut down procedures, maintenance management program.
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System inspected monthly?
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Date of last monthly inspection
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Photo of most recent months inspection report
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Cleaning interval not exceeding 6 months?
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Date of last system cleaning
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Photo of most recent system cleaning
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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.
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Date of last microbiological test
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Photo of most recent microbiological test results
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Condition of water in the basin
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Tower Inspection
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Does access to the tower appear safe and easy?
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Condition of exterior of tower
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Condition of drift eliminators
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Tower free of rust, biofilm, sludge and algae
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Disinfectant chemical drums located on bunded trays
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Do biocide drums contain adequate product
Cooling Tower System 4
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Switch
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Documentation
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Photo of cooling tower
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Cooling Tower Model
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Cooling Tower Serial Number
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Each Cooling Tower has a Unique Identifying Number
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Operation manual provided on site
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Maintenance manual and records provided on site
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Annual Independent Audit completed and provided on site
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Manuals comply with AS/NZS 3666.2:2011?
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Drawings, suppliers recommendations, cleaning and dismantling instructions, set up and shut down procedures, maintenance management program.
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System inspected monthly?
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Date of last monthly inspection
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Photo of most recent months inspection report
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Cleaning interval not exceeding 6 months?
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Date of last system cleaning
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Photo of most recent system cleaning
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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.
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Date of last microbiological test
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Photo of most recent microbiological test results
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Tower Inspection
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Does access to the tower appear safe and easy?
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Condition of exterior of tower
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Condition of water in the basin
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Condition of drift eliminators
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Tower free of rust, biofilm, sludge and algae
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Disinfectant chemical drums located on bunded trays
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Do biocide drums contain adequate product
Cooling Tower System 5
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Switch
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Documentation
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Photo of cooling tower
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Cooling Tower Model
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Cooling Tower Serial Number
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Each Cooling Tower has a Unique Identifying Number
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Operation manual provided on site
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Maintenance manual and records provided on site
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Annual Independent Audit completed and provided on site
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Manuals comply with AS/NZS 3666.2:2011?
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Drawings, suppliers recommendations, cleaning and dismantling instructions, set up and shut down procedures, maintenance management program.
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System inspected monthly?
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Date of last monthly inspection
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Photo of most recent months inspection report
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Cleaning interval not exceeding 6 months?
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Date of last system cleaning
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Photo of most recent system cleaning
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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.
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Date of last microbiological test
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Photo of most recent microbiological test results
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Tower Inspection
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Does access to the tower appear safe and easy?
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Condition of exterior of tower
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Condition of water in the basin
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Condition of drift eliminators
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Tower free of rust, biofilm, sludge and algae
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Disinfectant chemical drums located on bunded trays
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Do biocide drums contain adequate product
Cooling Tower System 6
Cooling Tower System 6
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Switch
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Documentation
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Photo of cooling tower
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Cooling Tower Model
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Cooling Tower Serial Number
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Each Cooling Tower has a Unique Identifying Number
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Operation manual provided on site
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Maintenance manual and records provided on site
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Annual Independent Audit completed and provided on site
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Manuals comply with AS/NZS 3666.2:2011?
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Drawings, suppliers recommendations, cleaning and dismantling instructions, set up and shut down procedures, maintenance management program.
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System inspected monthly?
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Date of last monthly inspection
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Photo of most recent months inspection report
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Cleaning interval not exceeding 6 months?
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Date of last system cleaning
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Photo of most recent system cleaning
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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.
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Date of last microbiological test
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Photo of most recent microbiological test results
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Tower Inspection
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Does access to the tower appear safe and easy?
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Condition of exterior of tower
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Condition of water in the basin
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Condition of drift eliminators
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Tower free of rust, biofilm, sludge and algae
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Disinfectant chemical drums located on bunded trays
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Do biocide drums contain adequate product
Signature
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Site manager/owner name
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Environmental Health Officer
- Erin Hogan P: 9748 9625 Email: erin.hogan@strathfield.nsw.gov.au
- Sarah Kacir. P: 9748 9948 Email: sarah.kacir@strathfield.nsw.gov.au
- Bradley Pope. P: 9748 9999 Email: bradley.pope@strathfield.nsw.gov.au
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Phone: (02) 9748 9999 Fax: (02) 9764 1034 Email: council@strathfield.nsw.gov.au
Inspection Outcome
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Inspection Rating
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Further Action Required