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Run: Water Management Plan Legionella Sampling Log

Log Legionella water samples, temperatures, chain of custody, lab results, and corrective actions in one inspection record. Use it to support a facility wate...

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Inspection Details

Inspection date and time recorded critical (required)

Inspector name and role documented critical (required)

Facility, building, and water system area identified critical (required)

Sampling event type selected

Reference SOP or water management plan documented critical (required)

Sampling Locations and Chain of Custody

Sample point identifier recorded critical (required)

Sample location description recorded critical (required)

Sample type selected critical (required)

Sample collection time recorded critical (required)

Sample container labeled and sealed critical (required)

Yes No N/A

Chain-of-custody information completed critical (required)

Yes No N/A

Temperature Monitoring

Cold water temperature at sample point critical (required)

Hot water temperature at sample point critical (required)

Recirculation loop temperature recorded

Temperature within facility action limits critical (required)

Yes No N/A

Temperature measurement device calibrated or verified critical (required)

Yes No N/A

Sample Handling and Laboratory Submission

Samples stored and transported within required holding conditions critical (required)

Yes No N/A

Laboratory name and submission ID recorded critical (required)

Requested analysis method documented

Sample submitted within required timeframe critical (required)

Yes No N/A

Results Review and Corrective Actions

Laboratory result received and recorded critical (required)

Yes No N/A

Legionella result value documented critical (required)

Result compared to facility action limit critical (required)

Yes No N/A

Corrective action initiated for out-of-range result

Yes No N/A

Follow-up sampling or remediation date scheduled

Sign-Off and Program Compliance

Log reviewed for completeness critical (required)

Yes No N/A

Deficiencies or non-conformances documented

Responsible person signature critical (required)

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