Scheduled
COOLING TOWER Follow up
INSPECTION FORM Complaint
Other
Business Name
Address
Owner
Responsible
person
Position/Title
Phone Business: A/H: Fax:
Water Treatment Contractor
Company
Contact Person Phone
Cooling Tower Details
Make/Brand
Model Number
Application □ Air-conditioning □ Process Cooling □ Other
Location □ Roof □ Ground □ Plant Room □ Other
Period of Operation □ Continuous □ All year □ Seasonal □ Drained when not in use
Registered □ Yes □ No
Tower Maintenance □ Section 2.5 of AS/NZS 3666.2 Operation & Maintenance
□ Section 3 of AS/NZS 3666.3 Performance Based
Changes to System □ Yes □ No
Accessibility X Comments
Accessibility of Fixed access ladders, handrails, platforms,
Tower walkways.
Cleaning Drift eliminator, sumps, anti-splash mats and
Accessibility fill.
Design X Comments
Construction Corrosion resistant. If wood present absence
material of rot, deterioration etc.
Air intake Away from sources of contamination.
Exhaust Air Outlet Away from occupied areas, pedestrian
thoroughfares, air intakes, building openings,
trafficable areas.
Drift Eliminators Fitted, easily accessible, removable or
designed for in situ cleaning
Control of solids and Automatic bleed-off fitted; lock out present to
waste water prevent bleed drain operating while biocide
being added. Wastewater to sewer
Protection from Design, orientation and placement of cooling
Sunlight towers so direct sunlight minimised from
wetted areas.
Water Treatment and Maintenance X Comments
Chemical Water □ Biocide □ Corrosion Inhibitor
Treatment □ Alternate Dosing.
Type, Quantity and frequency of Biocide?
Automatic Dosing □ Installed. Convenient location.
Bunding of liquid □ Yes □ No
chemicals
Tower Cleanliness □ Clean □ Mildly dirty □ Very dirty
Operating and Physical details of the plant, equipment and
Maintenance Manual systems and pre-treatment carried out.
Recommended maintenance including water
treatment maintenance and management.
Recommended cleaning, disinfection and
emergency decontamination procedures.
Shut down/Start up procedures.
Manufactures recommendations for
maintenance including checking, calibrating
and maintaining probes and sensors.
Contains compliant plans of the system.
Available upon request.
Maintenance and Date, item of plant, equipment or system and
Service Records nature of service performed.
Details of defects found and rectification
procedure undertaken.
The name of the person and company
performing the service.
Date of Last / /
Inspection
Inspected at least monthly? Drain flushed?
Date of Last Clean / /
Cleaning interval does not exceed 6 months?
Date of Last Micro. / / Are all results present?
Test TBC: cfu/ml Legionella: cfu/ml
Comments:______________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
Water sample taken □ Yes □ No Time _____ Date ________ Inspector_______________________
Inspector Signature_______________________
System owner/responsible person_____________________
Signature_____________________ I have read and understand the contents of this assessment
