Water treatment service visit

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

L8 temperature monitoring

• Entrance sink hot water temperature > 50C?

  Yes

  No

  N/A

• Entrance sink cold water temperature >20C?

  Yes

  No

  N/A

• Kitchen sink hot water temperature > 50C?

  Yes

  No

  N/A

• Kitchen sink cold water temperature >20C?

  Yes

  No

  N/A

Adiabatic cooling system

• Is the supply water soft (<2ppm hardness)?

  Yes

  No

  N/A

• Dipslide taken?

  Yes

  No

  N/A

• Was the previous dipslide within spec (<1,000)?

  Yes

  No

  N/A

• Free Chlorine ppm

• Is the water clear and free from suspended solids?

  Yes

  No

  N/A

• Legionella sample taken?

  Yes

  No

  N/A

• Is the system operating in a safe condition?

  Safe

  At Risk

  N/A

• Comments

• Actions

• Select date

  Date

• Signed adi

  Sign

• Signed client

  Sign