Legionella sampling record
A record for legionella water sampling, capturing sample details, laboratory results and the action taken in response.
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- Use the approved sampling plan and laboratory instructions, including point identity, method, neutraliser and chain of custody.
- Sampling and results require competent interpretation in system context; this record is not a result interpretation tool.
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Enter the date sampled.
Enter the sample id / ref, or leave it blank if not known.
Enter the outlet / location, or leave it blank if not known.
Enter the type (pre/post-flush), or leave it blank if not known.
Enter the reading in °C.
Enter the laboratory (ukas), or leave it blank if not known.
Enter the result received, or leave it blank if not known.
Enter the result (cfu/l), or leave it blank if not known.
Keep it short and avoid personal data.
| Date sampled | Sample ID / ref | Outlet / location | Type (pre/post-flush) | Sample temp °C | Laboratory (UKAS) | Result received | Result (CFU/L) | Action taken |
|---|---|---|---|---|---|---|---|---|
| 2026-06-08 | S-2026-014 | 2/F shower 204 | Pre-flush | 42 | Example UKAS lab | 2026-06-18 | <100 | Within expected range; continue routine monitoring |
| 2026-06-08 | S-2026-015 | G/F kitchen tap | Post-flush | 54 | Example UKAS lab | 2026-06-18 | Not detected | No action required |
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 when legionella sampling forms part of your monitoring regime, planning samples in line with BS 7592.
- Record the sample reference, location, whether it is pre- or post-flush, and the water temperature at the time of sampling.
- Use a UKAS-accredited laboratory and record the date results are received and the reported count.
- Note the action taken in response to each result and review your control measures against HSG274 guidance.
Background: Keeping records of flushing and sampling activities
"Legionella sampling record (free template)." Legionella.io. https://legionella.io/templates/sampling-record/
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