Assessor full name Assessor email Date: Property Address Assessor Telephone Number Duty Holder Cold Water Storage Tank ? YesNo Water Tank Location ? Fitted lid present ? YesNoNA Water tank insulated ? YesNoNA Debris/limescale/rust/organic matter present on Tank ? YesNoNA Photograph taken for auditing purposes ? YesNoNA Tank Risk Assessment Low Risk - No Action neededHigh Risk - Action Needed Total number of cold water outlets ?1234567891018 Temperature measured at all cold outlets ? YesNoNA Temperature at all cold outlets below 20c ? YesNoNA Cold water temperature reading All cold water outlets clean and free running ? YesNoNA Photograph taken for auditing purposes ?YesNoNA Risk Assessment for cold water outlets Low Risk - No Action NeededHigh Risk - Action Needed Total number of hot water outlets 1234567891018 Temperature measured at all hot outlets YesNo Temperature at all hot outlets above 50c YesNo Hot water temperature reading All hot water outlets clean and free running YesNo Photograph taken for auditing purposes YesNo Risk Assessment for hot water outlets Low Risk - Action not neededHigh Risk - Action Needed Total number of showers 1234567891018 All shower heads clean and free flowing ? YesNo Photograph taken for auditing purposes ? YesNo Risk Assessment for showers Low Risk - No Action NeededHigh Risk - Action Needed Dead legs observed in water system YesNo Photograph(s) taken for records. YesNo Risk Assessment for dead legs Low Risk - No Action NeededHigh Risk - Action Needed Notes/Recommendations Your name Your email Subject Your message (optional)
