Risk Assessment

Submitted by admin on Mon, 08/16/2010 - 10:20am

As a facility manager, your most important job is to provide for the safety and well-being of your clients and employees.

Clean, safe water is a cornerstone of quality service in any facility.

An honest and comprehensive assessment of your water system will give you an accurate picture of how your facility is meeting this basic need, and identify any risks for potentially dangerous situations, including bacterial outbreak.

Liquitech, a recognized world leader in facility water consultation and analysis, can help give you peace of mind when it comes to your water system.

Fill out the form below with as much information so we may provide you with a free risk assesment analysis for installation of the LiquiTech system on domestic water distribution systems.

* Denotes Required Fields.

Contact Info

Facility: *

Contact Name: *

Address:

City:

State:

ZIP:

Phone: *

Fax:

E-Mail: *

Hot Water Systems

System 1

Age of Plumbing: years

Plumbing Material:

Recirculation Flow Rate & Pressure:

Instantaneous Heater:

Yes

Hot Water Tank Volume:

Loop Service

Number of Beds (per loop):

Number of Floors:

System 2

Age of Plumbing: years

Plumbing Material:

Recirculation Flow Rate & Pressure:

Instantaneous Heater:

Yes

Hot Water Tank Volume:

Loop Service

Number of Beds (per loop):

Number of Floors:

System 3

Age of Plumbing: years

Plumbing Material:

Recirculation Flow Rate & Pressure:

Instantaneous Heater:

Yes

Hot Water Tank Volume:

Loop Service

Number of Beds (per loop):

Number of Floors:

System 4

Age of Plumbing: years

Plumbing Material:

Recirculation Flow Rate & Pressure:

Instantaneous Heater:

Yes

Hot Water Tank Volume:

Loop Service

Number of Beds (per loop):

Number of Floors:

Average temperature of hot water loop?:

Does the water loop service immunocompromised or elderly patients?:

Yes

What type of disinfection is currently used?:

What additional types of disinfection have been used in the past?:

Does the facility test for Legionella?:

Yes

Have there been any confirmed cases of Legionnaires Disease in the past two years?:

Yes

Additional Notes:

Risk Assessment

Solutions