Legionella risk assessment record: free blank PDF
Download a printable legionella risk assessment record for England, Wales, Scotland. The PDF contains the record sections shown below and writing space for the actual findings.
Download the blank printable PDF for free.
Free blank Legionella risk assessment record form
Print the blank record and keep the completed copy with the job. The preview shows the actual blank download.
Blank Legionella Risk Assessment Record form
Record scope and contents
England, Wales, Scotland. A person with the knowledge and competence to assess the actual system, working with the duty-holder.
- Assessment: Record number, Assessment date, Named person's responsibility, Water system description, Occupancy and vacant periods, Cold-water source, Hot-water source, Water at 20-45°C, Droplets can be dispersed, Susceptible people present, Identified potential risk sources, Controls in place, Monitoring and maintenance, Conclusion, When to review
- Work location: Work jurisdiction
- Registered business: Company name, Company address, Company postcode, Phone
- Customer or duty-holder: Customer or duty-holder name, Customer address, Customer postcode
- Site: Installation or site address, Site postcode
- Named person: Named person, Signature, Date signed
Primary source for this record · checked 2 October 2026
What the Legionella risk assessment record covers
Record the water system, who may be exposed, the assessment findings, control measures, responsible person and review triggers. It records an assessment and its actions; it is not a laboratory water-test result or a compulsory annual certificate.
Who needs one
- A person with the knowledge and competence to assess the actual system, working with the duty-holder.
- Record scope: England, Wales, Scotland.
- Keep the completed record with the source documents, findings and job reference.
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