Legionnaires risk assessment template checklist
This legionnaires risk assessment template is according to the health and safety executive (hse) control of legionella bacteria in water systems for auditing cooling towers. use this template to efficiently inspect an unlimited number of cooling towers and evaluate a site’s water treatment program and written scheme for controlling the risk from exposure to legionella bacteria.
What does this form include?
This form contains 10 sections:
Take a photo of the cooling tower, including its make, model, year of manufacture, and type.
The Written Scheme
- Is there a written scheme for controlling the risk from exposure to legionella bacteria?
- Is there any tenant, resident or regular visitor particularly suscetible to legionella due to age, health or lifestyle?
Design & Construction
- Are drift eliminators fitted correctly?
- Are drift eliminators effective in reducing drift?
- Are all visible surfaces free from slime or algae, scale, and corrosion?
- Does the water flow evenly across the fill pack?
- Have dead legs/blind ends and redundant pipework & plant been removed as far as possible?
- Are those parts of the tower that become wet, accessible and/or removable for cleaning?
Operation & Maintenance
- Is the cooling system in regular operation?
Water Treatment Program
- Is there a water treatment program in place?
- Are chemicals/biocides used to control scale, corrosion, fouling, and microbiological activity?
- If non-oxidising biocides are used, are two used alternately?
- Are chemicals dosed automatically?
Monitoring
- Is there a daily check to make sure that the system is operating as described in the operations manual?
- Is there a daily visual check of the cleanliness of the water in the system?
- Is the physical condition of the system checked at least every week?
- Is the chemical composition of the cooling and make-up water monitored on a regular basis?
- Are the safe operating limits for each parameter which is being measured, known and recorded in the operating manual?
- Is the corrective action for out of limit situations known and included in the operations manual?
- Are results of all tests and checks recorded, together with details of any remedial action taken (if required)?
- Are dip slides taken on at least a weekly basis?
- Are slides incubated in an incubator (at 30°C for 48 hours)?
- Are results recorded, so trends over time can be seen?
- Are samples for legionella taken on at least a quarterly basis?
- Have the circumstances when more frequent sampling may be required been identified and recorded?
Cleaning & Disinfection
- Is there a written procedure for regular cleaning and disinfection of the system?
- Does this take place at least every six months?
- Does the cleaning and disinfection procedure include the initial concentration of oxidizing biocide in use for the pre- and post-cleaning disinfection stages?
- Does the cleaning and disinfection procedure include contact time for each disinfection stage and methods for carrying out cleaning, including the removal of packing?
- If packs cannot be removed, are there alternative methods of making sure they remain clean in place?
- Are measures taken to protect staff when carrying out cleaning of the tower?
Additional Observations
Landlord Name & Signature
Legionella-Responsible Person Name & Signature
Use this template