date certificate serial no/ref: legionella risk assessment · the risk being assessed this...

A. DETAILS OF THE CLIENT OR PERSON ORDERING THE WORK

B. REASON FOR PRODUCING THIS REPORT

C. DETAILS OF THE INSTALLATION WHICH IS THE SUBJECT OF THIS REPORT

D. EXTENT AND LIMITATIONS OF INSPECTION AND TESTING

E. SUMMARY OF THE CONDITION OF THE INSTALLATION

Date Certificate Serial No/Ref:

Name:

Address:

Date(s) inspection and testing carried out:

C

Address:

Occupier:

Description of premises:

Estimated age of system: Years Evidence of additions of alterations No Yes Not apparent

Installation records available: Date of last

inspection No Yes

Alternative source of supply

(as described in attached

schedule if applicable)

Extent of the water system covered by this report

Agreed limitations, including reasons

Limitations agreed with Position (if applicable)

Operational limitations

including the reasons

General condition of the installation (in terms of legionella safety)

Overall assessment of the installation in terms of its suitability for continued use:

An unsatisfactory indicates that dangerous (code C1) and/or potentially dangerous (code C2) conditions have been identified

LEGIONELLA RISK

ASSESSMENT (Requirements for HSG274 Part 2: Legionella bacteria in

hot & cold water systems)

© Copyright P Cookson Maintenance Ltd of 8

F. RECOMMENDATIONS

G. DECLARATION

H. SCHEDULES The attached schedule(s) are part of this document and this report is valid only when they are attached to it

I. ADVICE FOR DUTY HOLDER

What is Legionnaires' disease?

Legionellosis is a collective term for respiratory illnesses caused by inhalation of vapourised legionella bacteria including the most serious; Legionnaires’ disease. Legionnaires’ disease is a potentially fatal form of pneumonia and everyone is susceptib le to infection. Some people are at higher risk including:

people over 45 years of age

smokers and heavy drinkers

people suffering from chronic respiratory or kidney disease

people with diabetes, lung and/or heart disease

anyone with an impaired immune system

Outbreaks of the disease stem from people inhaling water vapour containing legionella bacteria. This bacteria is found in domestic hot and cold water systems where water is stored within a hospitable temperature range which promotes formation, i.e. 20-50°C.

How do people contract it?

People contract Legionnaires’ disease by inhaling water vapour containing the bacteria. Certain factors increase the risk of legionella bacteria formation in a domestic system, including:

if the water temperature in all or some parts of a system is between 20-50 °C the abundance of vapour producing water outlets e.g. shower heads if stored water is present the availability of contaminants which act as a source of nutrients for the bacteria, promoting formation i.e. rust, sludge,

limescale, organic matter and biofilm

Where the overall assessment of the suitability of the installation for continued use on page 1 is stated as

UNSATISFACTORY, I/we recommend that any observations classified as 'Danger present• (Code C1) or 'Potentially

dangerous• (Code C2) are acted upon as a matter of urgency. Investigation without delay is recommended for

observations identified as 'Further investigation required' (Fl) Observations classified as 'improvement

recommended' (Code C3) should be given due consideration.

Subject to the necessary remedial action being taken, I/we recommend that the installation is further inspected and tested by

I (the assessor) have completed this form in accordance with ‘The Approved Code of Practice: Legionnaires’

disease: The control of Legionella bacteria in water systems (L8)’ and accompanying technical guidance notes

‘HSG274 (Part 2)’.

INSPECTED AND TESTED BY:

Name

(CAPITALS)

Signature

Position

Contact

Date

REPORT AUTHORISED FOR ISSUE BY:

Contractor

Address

Name

Signature

Schedule of inspection attached Schedule(s) of test results attached


What are the symptoms?

The symptoms of Legionnaires' disease are similar to the symptoms of influenza, namely:

high temperature, feverishness and chills

cough

muscle pains

headache

pneumonia

diarrhoea and signs of mental confusion

Legionnaires’ disease is not considered contagious.

How is it treated?

The illness is treatable with an antibiotics in certain cases. Unfortunately however, it can prove fatal.

If your tenant(s) develop one or more of the above symptoms and you are concerned that they may have contracted Legionnaires' disease, urge them to seek medical attention immediately.

Legal requirement

‘It is a legal duty to carry out an assessment [on a domestic property] to identify and assess whether there is a risk posed by exposure to legionella from the hot and cold water system …’ HSG274 - Part 2 (Section 2.6); technical guidance accompaniment to ‘The Approved Code of Practice: Legionnaires’ disease: The control of Legionella bacteria in water systems (L8)’

The risk being assessed

This assessment is designed to determine the risk to tenants and visitors of exposure to legionella bacteria from activities utilising the hot and cold water system on the premises.

The hazard

The hazard is the inhalation of water droplets containing legionella bacteria.

The people at risk

The following parties have been identified as being at risk:

tenants visitors

Of particular risk are:

those with a long term illness, especially if the respiratory system is affected smokers heavy drinkers the elderly

Active parties in this assessment

Duty holder – (person in control of the property i.e. Landlord/letting agent) Assessor – Mr. P Cookson Service Provider – P Cookson Maintenance Ltd

Duty Holder Responsibilities

The duty holder must:

inform tenants of the potential risk of Legionella advise tenants on any actions arising from the findings of this risk assessment flush through all hot/cold outlets for 2 minutes prior to letting the property following a period of no occupancy

The duty holder must instruct tenants they should:

inform duty holder if they believe the hot water temperature is below 50°C orthe hot water cylinder/boiler is defective not adjust the temperature of the hot water advise the duty holder if they believe the cold water temperature is above 20°C clean, disinfect and descale shower heads on a quarterly basis notify the duty holder if they notice any debris or discolouration in the hot/cold water flush through all hot/cold outlets for 2 minutes upon returning from any extended period of absence e.g. holiday


This assessment will consider if:

stored water is present in the system (areas of risk include cold water cisterns, hot water cylinders and dead legs)

system water temperatures are appropriate for location (hot water should be stored at 60°C, cold water at below 20°C

sources of nutrients to aid legionella bacteria replication such as rust, sludge, limescale, organic matter and/or biofilm

it is possible for water droplets to be produced and, if so, whether they could be dispersed, e.g. showers

there are parts of the system that are used infrequently e.g. guest bathrooms

J. PARTICULARS OF INSTALLATION

System type(s) Cold water storage cistern(s)

Plastic

Galvanised steel

Material

Location(s)

Calorifier(s)

Direct

Indirect

Location(s)

Water heating method

Boiler(s)

Brand

Model

\\\\\\\\\\

Is there any tenant, resident or regular visitor particularly susceptible to legionella due to age, health

or lifestyle?

No

Yes

Describe type of cold water system e.g. mains feed, from storage or both

Describe type of hot water system e.g. mains feed via combi boiler or from storage

Is cold water temperature at outlets below 20°C?

No

Yes

Does hot water temperature at outlets achieve 50°C within 1 minute?

No

Yes

Cold water storage cistern (cntd).

Insulation

Tight fitting plastic lid

Presence of rust debris,

scale and/or organic

matter

Water temperature (°C)

Location

Access arrangement

Gravity

Combination boiler

Combination cylinder

Unvented cylinder

POU heater

Community heating

scheme


K. OBSERVATIONS

Referring to the attached schedule of inspection and test results, and subject to the limitations specified at the extent and

limitations of the inspection and testing section

The following observations are made No remedial action is required

ITEM NO OBSERVATION CLASSIFICATION CODE

Additional observations Additional notes/observations attached or to follow ref:

One of the following codes, as appropriate, has been allocated to each of the observations made above to indicate to the person(s) responsible

for the installation the degree of urgency for remedial action.

C1 - Danger present. Risk of injury. Immediate remedial action required

Fl - Further investigation required without delay

C3 - Improvement recommended

C2 - Potentially dangerous - urgent remedial action required


HOT & COLD WATER SYSTEM DETAILS 10t

OUTLET DETAILS TEST RESULTS

Hot Water

System Type

Ho

t w

ate

r >

50°C

Co

ld w

ate

r <

20°C

Tem

pera

ture

(°C

)

Ou

tlet

Refe

ren

ce

Outlet Designation

Tem

pera

ture

(°C

)

Dead

leg

s (Y

/N)

Scale

Pre

sen

t (Y/

N)

Comments

Cold Water


andrew

Underline

TEST INSTRUMENTS USED

IMAGES

Temperature probe

Assessors optional images of C1 or C2 observations if applicable

Date of last

calibration

Calibration

due


1. Whilst we make every effort to ensure that the information provided on this form is accurate and up to date, we will notbe held responsible for any errors, omissions, misleading statements, the use of any information, method or equipmentherein presented, or provided to you, and you must make your own determination as to its accuracy and suitability foryour own use, for the protection of the environment and for health and safety purposes.

2. You assume the entire risk of relying on this information. In no event shall we be liable for damages of any naturewhatsoever resulting from the use of or reliance upon this information.

3. By providing this service, we neither can nor intend to control the method or manner by which you use, handle or storeany services sold by ourselves.

4. Materials generated due to remedial works undertaken which are rendered surplus to the requirements of the watersystem will be left in situ. The disposal of such materials is the responsibility of the duty holder. Materials may include:decommissioned steel cold water storage cisterns, cistern lids, insulating jackets and associated elements.

We pride ourselves on a policy of continual improvement in all aspects of our business. As such, our assessments and associated paperwork evolve over time to accommodate improvements in understanding of the risks associated with legionella.

(This form contains public sector information licensed under the Open Government License v3.0).

Copyright © 2020 - P Cookson Maintenance Ltd.

RISK ASSESSMENT GUIDANCE FOR RECIPIENTS

(to be appended to the report)

This report is an important and valuable document which should be retained for future reference


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