Lumiform Mobile audits & inspections
Get App Get App

Legionella Checklist Template

This general legionella risk assessment form can be used to evaluate the premises.

Record the cold and hot water temperatures and check that they are properly maintained.
Assess whether the air conditioning and water systems are clean and disinfected. You may not need to take any further action at this time, but you can use the data you collect to periodically review the assessment if something changes in your system.

Make full use of the evaluation possibilities by taking photos of risks in the workplace. Comment on the photos to highlight the underlying factors and report risks to safety managers and officials. Use the temperature field to enter the current temperature values. Generate reports in the field to improve the reporting process.

Downloaded 12 times
Legionella Risk Assessment
Is there any tenant, resident or regular visitor particularly suscetible to legionella due to age, health or lifestyle?
Did the person carrying out the assessment have access to competent help and advice when carrying out the assessment?
Take a photo of the cold water system
Provide a short description
Take a photo of the hot water system
Provide a short description
Water Outlet Temperature
Is the cold water temperature at water outlets below 20° Celsius?
Temperature in Celsius:
Is the hot water temperature at water outlets above 50° Celsius?
Temperature in Celsius:
Cold Water System
Cold water storage tank location (photo)
Is a cold water storage tank present?
Is the cold water tank accessible?
Does the tank have a tight fitting lid?
Is the water in the tank clean and free from rust, debris, scale, and organic matter?
Is the temperature of the water in the tank below 20 ° celsius?
Temperature in Celsius:
Is the cold water tank insulated?
Hot Water System
Is the temperature setting on the boiler and/or hot water tank such that hot water is heated to and stored at a temperature of 60 ° celsius?
Are the hot water distribution pipes insulated?
If more than one calorifier is used, are they connected in parallel?
Is the water heater equipped as follows?
Does it have a drain valve?
Does it have a temperature gauge on the inlet and outlet?
Does it have an access panel?
Little Used Outlets
Are there any water outlets are used less than once per week e.g. guest bathrooms?
Is there any provision to flush them at least once a week?
hotograph the location of the shower.
Take photo of shower location
Dead Legs and Redundant Pipework
Pipeline sections that are superfluous or have low/no flow due to the system design (so-called "dead sections") can cause the water in the system to stagnate.
Are there any dead sections on the property?
Taking pictures.
Unoccupied Properties
Are objects on the property not used for a certain time?
Are there arrangements in place to flush them through on at least a weekly basis?
Full Name and Signature of Landlord
Full Name and Signature of Legionella Responsible Person
Share this template:

This post is also available in: Deutsch

Please note that this checklist template is a hypothetical appuses-hero example and provides only standard information. The template does not aim to replace, among other things, workplace, health and safety advice, medical advice, diagnosis or treatment, or any other applicable law. You should seek your professional advice to determine whether the use of such a checklist is appropriate in your workplace or jurisdiction.
This site is registered on as a development site. Switch to a production site key to remove this banner.