Water Management Plan Legionella Sampling Log

Inspection log for documenting Legionella water sampling, temperature monitoring, and corrective actions as part of a facility water management program aligned with CMS guidance and ASHRAE 188.

Inspection Details

• Inspection date and time recorded
• Inspector name and role documented
• Facility, building, and water system area identified
• Sampling event type selected
• Reference SOP or water management plan documented

Sampling Locations and Chain of Custody

• Sample point identifier recorded
• Sample location description recorded
• Sample type selected
• Sample collection time recorded
• Sample container labeled and sealed
• Chain-of-custody information completed

Temperature Monitoring

• Cold water temperature at sample point
• Hot water temperature at sample point
• Recirculation loop temperature recorded
• Temperature within facility action limits
• Temperature measurement device calibrated or verified

Sample Handling and Laboratory Submission

• Samples stored and transported within required holding conditions
• Laboratory name and submission ID recorded
• Requested analysis method documented
• Sample submitted within required timeframe

Results Review and Corrective Actions

• Laboratory result received and recorded
• Legionella result value documented
• Result compared to facility action limit
• Corrective action initiated for out-of-range result
• Follow-up sampling or remediation date scheduled

Sign-Off and Program Compliance

• Log reviewed for completeness
• Deficiencies or non-conformances documented
• Responsible person signature