Disinfection / chlorination certificate
A certificate and record of any system disinfection - chemical (chlorination) or thermal - capturing the method, concentration, contact time and post-disinfection verification.
Print-ready PDF with the columns laid out, or the CSV to fill in on a computer.
| Date | System/area treated | Method | Disinfectant & conc. | Contact time | Post-flush result | Contractor | Cert ref |
|---|---|---|---|---|---|---|---|
| 2026-06-16 | CWST & distribution | Chlorination | Chlorine, target per procedure | Per procedure | Residual neutralised; OK | Competent contractor | DIS-2026-031 |
| 2026-06-16 | Hot water service | Thermal | N/A (heat) | Per procedure | Outlets reached target temp | Competent contractor | DIS-2026-032 |
Sample rows are illustrative. Download the PDF for a clean print-ready form, or the CSV to fill in digitally.
How to use it
- Complete a certificate whenever a system is disinfected - after remedial works, a positive result, commissioning, or following a shutdown.
- Record the method, the disinfectant and target concentration (or temperature for thermal), and the contact time achieved, following a written procedure.
- Record the verification step (e.g. neutralisation and confirmation of normal residual, or confirmation of target temperatures) before the system is returned to use.
- Keep the signed certificate with your logbook; follow the disinfectant concentrations and contact times in your procedure and BS/HSG guidance rather than assumed figures.
Background: Certificate of disinfection: what it is, what it should show and when you need one