Flushing record sheet (low-use outlets)
A flushing record for infrequently used outlets, capturing flush duration and post-flush temperatures so stagnant water is kept under control.
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- List only outlets covered by the approved little-used-outlet control and follow its safe method.
- Use the specified endpoint, such as temperature stabilisation, and record exceptions rather than applying a universal duration.
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Enter the date.
Enter the outlet id / location, or leave it blank if not known.
Enter the outlet type, or leave it blank if not known.
Enter the flushed (y/n), or leave it blank if not known.
Enter the flush duration (min), or leave it blank if not known.
Enter the reading in °C.
Enter the reading in °C.
Keep it short and avoid personal data.
Enter the initials, or leave it blank if not known.
| Date | Outlet ID / location | Outlet type | Flushed (Y/N) | Flush duration (min) | Hot after flush °C | Cold after flush °C | Comments | Initials |
|---|---|---|---|---|---|---|---|---|
| 2026-06-08 | RM 1.12 hand basin (little-used) | Mixer tap | Y | 2 | 55 | 18 | Ran hot then cold until temperatures stabilised | AB |
| 2026-06-08 | Cleaner's sink, B basement | Sink tap | Y | 2 | 48 | 19 | Hot slow to reach temperature: reported for investigation | CD |
Sample rows are illustrative. Download the PDF for a clean print-ready form, or the CSV to fill in digitally.
How to use it
- Use for the infrequently used (little-used) outlets identified in your risk assessment that are not in regular use.
- Flush each outlet on the planned schedule (commonly weekly), running it until the temperature stabilises while keeping aerosol release to a minimum.
- Record the flush duration and post-flush hot and cold temperatures so you can spot outlets that are slow to reach temperature.
- Note any faults in the comments, raise them for investigation, and initial each entry.
Background: Legionella flushing record sheet: free template for little-used outlets
"Flushing record sheet (low-use outlets) (free template)." Legionella.io. https://legionella.io/templates/flushing-record-sheet/
Free to reuse under CC BY 4.0: quote, adapt or republish with attribution and a link back to the original.