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The Legionella Control Specialists

Birchwoodmoor House,
Roston,
Ashbourne,
Derbyshire DE6 2EH

Tel:07000 723 342

E-Mail:

Fax:01889 591 595

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Risk Assessment: Domestic Water System

Your Name:

E-Mail Address:

Tel:

Fax:

Company Name:

System Ref:

Building Name/No:

Date Surveyed:

Area/Street:

Cistern Size:

/

Town/City:

Calorifier Size:

/

County:

   

Post Code:

   
 

Yes

No

Don't know

1) Temperatures measured between 20°C and 50°C (unless supplementary water treatment regime in operation, eg ionisation or chlorine dioxide)

2) Showers present

3) Thermostatic mixing valves supplying long pipe runs or multiple outlets

4) Hot water supplied from storage calorifier(s)

5) Cold water supplied from cold water storage tank(s)

6) Low turnover of water: excessive storage, vacant areas, and little used outlets

7) Complex system(s)

8) Old system(s)

9) Cold water Storage Tank(s) in poor condition

                                       ©S.A.S (Safe & Secure) 2003