Checklist on Water Tank Cleansing and Plumbing Inspection (This form can be used for more than one building) Name of Building(s) inspected Source of Supply (Please indicate the flushing supply source by checking ONE of the boxes listed below): Sea (Salt) water supplied by the Water Authority □ Temporary mains fresh water for flushing supplied by the Water Authority □ Sea (Salt) water supplied by own private source □ Well water supplied by own private source □ Others, please specify: _______________________________________ □ Cleansing of Water Tanks Date of last 2 No. of Name of person / inspections flushing agent cleansing the Name of building(s) water tanks flushing water Date 1 Date 2 cleansed tanks Please attach documentary support on the frequency of cleansing with dates. Any notification served to the affected consumers? Yes / No* Any complaint caused by cleansing? Yes / No* If yes, actions taken to handle complaints: Actions taken to prevent future complaints: D. Inspection of Plumbing related to Flushing Supply No. of flushing Communal Date of last 3 water tanks / riser / downfeed Name of building(s) inspections pumps inspected ( / ) pumps downfeed Date 1 Date 2 Date 3
Checklist on Water Tank Cleansing and Plumbing Inspection (This form can be used for more than one building) Name of Building(s) inspected Source of Supply (Please indicate the flushing supply source by checking ONE of the boxes listed below): □ Sea (Salt) water supplied by the Water Authority □ Temporary mains fresh water for flushing supplied by the Water Authority □ Sea (Salt) water supplied by own private source □ Well water supplied by own private source □ Others, please specify: _______________________________________ Cleansing of Water Tanks Name of building(s) Date of last 2 inspections No. of flushing water tanks cleansed Name of person / agent cleansing the flushing water tanks Date 1 Date 2 Please attach documentary support on the frequency of cleansing with dates. Any notification served to the affected consumers? Yes / No* Any complaint caused by cleansing? Yes / No* If yes, actions taken to handle complaints: Actions taken to prevent future complaints: D. Inspection of Plumbing related to Flushing Supply Name of building(s) No. of flushing water tanks / pumps inspected Communal riser / downfeed ( / ) Date of last 3 inspections pumps downfeed Date 1 Date 2 Date 3
qwsb_form_c_annex_I_e.docx