Lumiform
Mobile audits &
inspections

Get an overview of the most important features in Lumiform.
Turn issues into corrective actions by collaborating with team members.
Create custom checklists and use logics to predefine workflows.
Share automatically generated reports and get in-depth analytics.
Quickly conduct inspections with the easy-to-use inspection app.
Easily adapt the Lumiform software to your complex organization structure.

By category

Legionella Risk Review

Downloaded 0 times
Section A - Site Management
Date of original risk assessment or previous review:
Define the scope of the risk assessment being reviewed. I.E. which buildings and water systems
Is the name of the nominated responsible person up to date
Details / Priority /Action By Whom & Date
Is the name of the nominated deputy responsible person up to date
Details / Priority /Action By Whom & Date
Has the occupancy level of the building(s) changed since the assessment was completed
Details / Priority /Action By Whom & Date
Has the building had any change of use since the assessment was completed
Details / Priority /Action By Whom & Date
Has the susceptibility level of the building occupants changed
Details / Priority /Action By Whom & Date
Has there been any local construction of water systems, outside the building(s), that may affect the risk
Details / Priority /Action By Whom & Date
Is there any evidence of site staff being trained in Legionella awareness and their responsibilities within the control scheme
Details / Priority /Action By Whom & Date
Is there a written procedure to define the action to be taken if Legionella bacteria are detected in samples taken from site
Details / Priority /Action By Whom & Date
Is there a written procedure to define the action to be taken if a case of Legionnaire’s disease is suspected from water systems on the site
Details / Priority /Action By Whom & Date
Is there a written procedure regarding when and how to alternate hot or cold water pumps
Details / Priority /Action By Whom & Date
Are the responsibilities for carrying out the tasks within the control scheme clearly defined
Details / Priority /Action By Whom & Date
Section B - Assets, Previous Recommendations & Schematics
By checking the available records, can it be shown that all recommendations of the risk assessment have been implemented
Details / Priority /Action By Whom & Date
Are there schematic diagrams for every water system
Details / Priority /Action By Whom & Date
Are the schematic drawings accurate with regard to the locations that they supply
Details / Priority /Action By Whom & Date
Do the schematic drawings show enough detail so that they are not ambiguous
Details / Priority /Action By Whom & Date
Is the outlet asset register accurate? I.e. are all of the outlet types and number defined in each location where water is used
Details / Priority /Action By Whom & Date
Is the “fixed asset” register accurate? I.e. are all of the cold-water storage tanks and hot water vessels recorded
Details / Priority /Action By Whom & Date
Is a supplementary biocide being dosed into any of the systems and has this been installed since the previous risk assessment
Details / Priority /Action By Whom & Date
Complete inspection sheets for all cold-water tanks and hot water vessels and make recommendations for remedial action as required
Details / bPriority /Action By Whom & Date
Section C - Cold Water Tank Inspections
Is there a secure, close fitting lid fitted
Tank Number / Details / Priority /Action By Whom & Date
Is there a lid vent (tank breather) fitted and is it in good condition
Tank Number / Details / Priority /Action By Whom & Date
Is there an overflow screen fitted and is it in good condition
Tank Number / Details / Priority /Action By Whom & Date
Is the tank well insulated from heat gain
Tank Number / Details / Priority /Action By Whom & Date
Is the tank corroded
Tank Number / Details / Priority /Action By Whom & Date
Is there any evidence of scale deposition
Tank Number / Details / Priority /Action By Whom & Date
Describe the level of sediment on the base of the tank. (Percentage covered)
Does the level control valve shut off before the overflow level is reached
Tank Number / Details / Priority /Action By Whom & Date
Does the inlet supply valve shut off the supply
Tank Number / Details / Priority /Action By Whom & Date
Does the outlet valve shut off the outlet
Tank Number / Details / Priority /Action By Whom & Date
Record the stored water temperature as far away as possible from the inlet valve.
Record the inlet temperature at the mains inlet.
Section D - Hot Water Vessel Inspections
Was an internal inspection of the vessel undertaken
HWS Number / Details / Priority /Action By Whom & Date
Were the internal surfaces of the vessel covered in scale deposits
HWS Number / Details / Priority /Action By Whom & Date
Were there any signs of internal corrosion
HWS Number / Details / Priority /Action By Whom & Date
Is the vessel well insulated to prevent heat loss
HWS Number / Details / Priority /Action By Whom & Date
Does the vessel drain valve operate safely
HWS Number / Details / Priority /Action By Whom & Date
Was the vessel drain flushed until clear water was achieved
HWS Number / Details / Priority /Action By Whom & Date
Is there a flow/storage temperature gauge fitted
HWS Number / Details / Priority /Action By Whom & Date
What is the stored water temperature
Is there a return line temperature gauge fitted
HWS Number / Details / Priority /Action By Whom & Date
What is the return water temperature
Is the return pump operating
HWS Number / Details / Priority /Action By Whom & Date
Section E - Control Scheme Monitoring Records
Are the temperature records for all cold water systems complete
Details / Priority /Action By Whom & Date
Have all non-conformances in cold-water temperature been investigated and addressed
Details / Priority /Action By Whom & Date
Are the temperature records for all hot water systems complete
Details / Priority /Action By Whom & Date
Have all non-conformances in hot water temperature been investigated and addressed
Details / Priority /Action By Whom & Date
Are there full records of flushing for any identified “low use” outlets
Details / Priority /Action By Whom & Date
Has the risk assessment been reviewed and records produced at the agreed frequency
Details / Priority /Action By Whom & Date
Are there records to demonstrate that showers have been inspected and disinfected at least quarterly
Details / Priority /Action By Whom & Date
Are there records of duty/standby pumps being alternated on DHWS return
Details / Priority /Action By Whom & Date
Are there suitable records of any fitted biocide dosing system
Details / Priority /Action By Whom & Date
Are there records of cold-water tank and hot water vessel inspection
Details / Priority /Action By Whom & Date
Summary
Assessors comments and summary
Photographic Evidence ( if applicable )
Description
-
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.