Document name: Maintenance & Operational Procedures for the control of Legionella, water hygiene, ‘safe’ hot water, cold water, drinking water and non-drinking water. Document type



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Procedure:

OUTSIDE CONNECTIONS RECORD SHEET

Frequency:

Annually

Acceptance date:

Oct’12

File Ref:

LEG08

Next review date:

Oct’14

Building:




System ID:




Thermometer No.




Thermometer Calibration no.





Location


Is the outlet secure (tamper proof)?

Is the outlet in good working order?


Adequate protection from weather?


No hoses left attached?


Appears to be in regular use?


RPZ valve installed?


TOC































































































































































































































































































































































































































I, the undersigned, have completed the works outlined above:

Competent Person


Name:

Signature:


Date:

Authorised Person [Water]


Name:

Signature:

Date:

Additional docket numbers issued:





PPM:

INSIDE CONNECTIONS

PPM Ref:

C – LEG09

Frequency:

Annually

This form is used to identify what inside connections exist on the drinking water system. The types of devices to be identified are:


All these devices should have a double check valve fitted to them to prevent back flow. The overall length of the supply pipe(s) from the machine to the next nearest high use outlet should not exceed 3 metres. Finally, the supply pipes to the device should not be subject to heat gain i.e. in contact with or in line with the heat exhaust vent from the device itself.




  1. Complete internal walk around each building to check the existence of any such devices.

  2. Where such a device is found then record the location on form C – LEG09 and complete each of the questions on the form.



RECORD SHEET C – LEG09 MUST BE FILLED IN AND RETURNED TO THE AUTHORISED PERSON [WATER]






Procedure:

INSIDE CONNECTIONS RECORD SHEET

Frequency:

Annually

Acceptance date:

Oct’12

File Ref:

LEG09

Next review date:

Oct’14

Location

Type of connection*

Double check valve fitted?

Supply pipe <3meters in length?

Supply not affected from heat gain by vent heat from unit



VM / CD / IM

Yes / No

Yes / No

Yes / No



VM / CD / IM

Yes / No

Yes / No

Yes / No



VM / CD / IM

Yes / No

Yes / No

Yes / No



VM / CD / IM

Yes / No

Yes / No

Yes / No



VM / CD / IM

Yes / No

Yes / No

Yes / No



VM / CD / IM

Yes / No

Yes / No

Yes / No



VM / CD / IM

Yes / No

Yes / No

Yes / No



VM / CD / IM

Yes / No

Yes / No

Yes / No



VM / CD / IM

Yes / No

Yes / No

Yes / No



VM / CD / IM

Yes / No

Yes / No

Yes / No



VM / CD / IM

Yes / No

Yes / No

Yes / No



VM / CD / IM

Yes / No

Yes / No

Yes / No



VM / CD / IM

Yes / No

Yes / No

Yes / No



VM / CD / IM

Yes / No

Yes / No

Yes / No



VM / CD / IM

Yes / No

Yes / No

Yes / No



VM / CD / IM

Yes / No

Yes / No

Yes / No

* VM = Vending machine (plumbed in drinks machine), CD = Chilled water dispenser (plumbed in), IM = Ice Machine.


Observations & Comments:



I, the undersigned, have completed the works outlined above:

Competent Person


Name:

Signature:


Date:

Authorised Person [Water]


Name:

Signature:

Date:

Additional docket numbers issued:






PPM:

WARD / DEPT. INDEFINATE CLOSURE

PPM Ref:

C – LEG11

Frequency:

As necessary

Where relevant - all water tanks associated with the affected area shall be drained, cleaned and dried out.

All pipework and devices shall be drained and where applicable DHW generator [or other storage vessels] shall be opened up, cleaned and left open to the atmosphere.

Pipework shall be disconnected from the mains services and capped off, mains cold water services shall be isolated and capped off from the system and all relevant pipework drained.

Notices shall be posted throughout the affected area stating that all water services are disconnected.

The Estates Department shall be Authorised to ensure that an adequate water seal exists in unused toilets to prevent odours from the foul drain system entering the premises.



Adequate records of actions, and amended water service schematic diagrams shall be produced by the Estates Department showing the relevant modifications and disconnections made to the water systems. The Completed Remedial Works Record Sheet C – LEG** shall be used for record keeping purposes.

RECORD SHEET C – LEG11 MUST BE FILLED IN AND RETURNED TO THE AUTHORISED PERSON [WATER]






Procedure:

WARD / DEPT. INDEFINATE CLOSURE RECORD SHEET

Frequency:

As necessary

Acceptance date:

Oct’12

File Ref:

C – LEG11

Next review date:

Oct’14


Property:




Location:




Closure date:




Docket No:




Work carried out to disconnect and close down water services:



A modified schematic diagram must accompany this report.

Work carried out by:

Signature:

REOCCUPATION OF THE ABOVE AREA

Date:




Docket No:





Work carried out and detail of modifications:

Chlorination & cleaning completed? Yes / No.


I, the undersigned, have completed the works outlined above:

Competent Person


Name:

Signature:


Date:

Authorised Person [Water]


Name:

Signature:

Date:

Additional docket numbers issued:




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