SAMPLE DETAILS Sample results Corrective actions At least 1 of these boxes must be completed. provide specific detail regarding actions undertaken to manage risk to vulnerable Where result is less than the limit of detection people and the water infrastructure. Do not state per WRMP”. “As (e.g. <10 cfu/mL), leave the box blank. Detection Sample type Was the Collection method Water sample Outlet Location where Type of care Legionella Legionella not Patient exposure Water supply infrastructure number (choose from sample taken (e.g. flush water sample (which means type description sample was taken provided to pneumophila pneumophila (specify immediate actions taken to manage patient (specify immediate corrective actions taken, or to be the dropdown first catch or grab); second flush or flushed exposure to water contaminated with Legionella) taken, with respect to the affected water supply (choose from (choose from the (e.g. basin tap, (e.g. shower 23 Ward patients or (enter the (enter the number options) water sample (15, 30 sec or 2 min etc.)) infrastructure and/or the affected fixture to address from the dropdown showerhead, ice 7) number of of colony forming infrastructure residents at the presence of Legionella in the water system) dropdown options) machine). N.B. this colony forming units present per or a fixture affected options) is not an units present per millilitre of water covered by location exhaustive list millilitre of water (cfu/mL)) the facility’s (cfu/mL)) WRMP? (choose from the dropdown options) Other information considered relevant to this notification such as, but not limited to, a statement on the frequency of use of the outlet, chlorine residual at outlet if taken at time of the sample collection and at incoming supply. Be sure to relate any comments to the relevant detection number.
SAMPLE DETAILS Sample results At least 1 of these boxes must be completed. Where result is less than the limit of detection (e.g. <10 cfu/mL), leave the box blank. Corrective actions provide specific detail regarding actions undertaken to manage risk to vulnerable people and the water infrastructure. Do not state “As per WRMP”. Detection number (choose from the dropdown options) Sample type (choose from the dropdown options) Was the sample taken from infrastructure or a fixture covered by the facility’s WRMP? (choose from the dropdown options) Collection method (e.g. flush water sample (which means first catch or grab); second flush or flushed water sample (15, 30 sec or 2 min etc.)) Water sample type (choose from the dropdown options) Outlet description (e.g. basin tap, showerhead, ice machine). N.B. this is not an exhaustive list Location where sample was taken (e.g. shower 23 Ward 7) Type of care provided to patients or residents at affected location Legionella pneumophila (enter the number of colony forming units present per millilitre of water (cfu/mL)) Legionella not pneumophila (enter the number of colony forming units present per millilitre of water (cfu/mL)) Patient exposure (specify immediate actions taken to manage patient exposure to water contaminated with Legionella) Water supply infrastructure (specify immediate corrective actions taken, or to be taken, with respect to the affected water supply infrastructure and/or the affected fixture to address the presence of Legionella in the water system) Other information considered relevant to this notification such as, but not limited to, a statement on the frequency of use of the outlet, chlorine residual at outlet if taken at time of the sample collection and at incoming supply. Be sure to relate any comments to the relevant detection number.
notify-legionella-detection.docx