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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 Page 1 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
© Copyright P Cookson Maintenance Ltd Page 2 of 8
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
© Copyright P Cookson Maintenance Ltd Page 3 of 8
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
© Copyright P Cookson Maintenance Ltd Page 4 of 8
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
© Copyright P Cookson Maintenance Ltd Page 5 of 8
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
© Copyright P Cookson Maintenance Ltd Page 6 of 8
TEST INSTRUMENTS USED
IMAGES
Temperature probe
Assessors optional images of C1 or C2 observations if applicable
Date of last
calibration
Calibration
due
© Copyright P Cookson Maintenance Ltd Page 7 of 8
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
© Copyright P Cookson Maintenance Ltd Page 8 of 8