Form template for completion of a documented review of Legionella risk associated with a water system.

This form can be used to complete an initial or periodic assessment of the legionella risk and covers the following areas;

• Inspection of Outlets (logging of water temperature)
• Conformation if outlets in high risk range or issues with water quality
• Inspection of water tanks
• Review of risk factors associated with water tanks
• Review of other Legionella Risk Factors - listing of other checks to be completed
• Overall risks summary / review of risks
• Section to include overview of water system

This form can be used as the basis for a Legionella Risk Assessment or Legionella Management Plan and the structure of the form in intended to help to guide the legionella assessment to be completed effectively and covering all risk factors. 

The GG-7-22 Legionella Safety general guidance document provide additional details and guidance on the use of this form.