Water Management Levels ground, 4 & 5

Reporter

First

Last

Date

Safety Declaration

Notification of testing was made at least 24 hours ago
Hazard signs have been placed on all taps

Ground (Djarlma)

	Hot Tap -Yes	Cold Tap -Yes	Hot Tap -No	Cold Tap-No	Not Applicable
Staff Room (Tea preparation)	Hot Tap -YesStaff Room (Tea preparation) Hot Tap -Yes	Cold Tap -YesStaff Room (Tea preparation) Cold Tap -Yes	Hot Tap -NoStaff Room (Tea preparation) Hot Tap -No	Cold Tap-NoStaff Room (Tea preparation) Cold Tap-No	Not ApplicableStaff Room (Tea preparation) Not Applicable
Staff toilets- Male	Hot Tap -YesStaff toilets- Male Hot Tap -Yes	Cold Tap -YesStaff toilets- Male Cold Tap -Yes	Hot Tap -NoStaff toilets- Male Hot Tap -No	Cold Tap-NoStaff toilets- Male Cold Tap-No	Not ApplicableStaff toilets- Male Not Applicable
Staff toilets- Female	Hot Tap -YesStaff toilets- Female Hot Tap -Yes	Cold Tap -YesStaff toilets- Female Cold Tap -Yes	Hot Tap -NoStaff toilets- Female Hot Tap -No	Cold Tap-NoStaff toilets- Female Cold Tap-No	Not ApplicableStaff toilets- Female Not Applicable
Universal Access Toilet	Hot Tap -YesUniversal Access Toilet Hot Tap -Yes	Cold Tap -YesUniversal Access Toilet Cold Tap -Yes	Hot Tap -NoUniversal Access Toilet Hot Tap -No	Cold Tap-NoUniversal Access Toilet Cold Tap-No	Not ApplicableUniversal Access Toilet Not Applicable
Cleaners' room	Hot Tap -YesCleaners' room Hot Tap -Yes	Cold Tap -YesCleaners' room Cold Tap -Yes	Hot Tap -NoCleaners' room Hot Tap -No	Cold Tap-NoCleaners' room Cold Tap-No	Not ApplicableCleaners' room Not Applicable
Cleaners' room Sluice	Hot Tap -YesCleaners' room Sluice Hot Tap -Yes	Cold Tap -YesCleaners' room Sluice Cold Tap -Yes	Hot Tap -NoCleaners' room Sluice Hot Tap -No	Cold Tap-NoCleaners' room Sluice Cold Tap-No	Not ApplicableCleaners' room Sluice Not Applicable
Pathology	Hot Tap -YesPathology Hot Tap -Yes	Cold Tap -YesPathology Cold Tap -Yes	Hot Tap -NoPathology Hot Tap -No	Cold Tap-NoPathology Cold Tap-No	Not ApplicablePathology Not Applicable
Registrar office	Hot Tap -YesRegistrar office Hot Tap -Yes	Cold Tap -YesRegistrar office Cold Tap -Yes	Hot Tap -NoRegistrar office Hot Tap -No	Cold Tap-NoRegistrar office Cold Tap-No	Not ApplicableRegistrar office Not Applicable
TMS	Hot Tap -YesTMS Hot Tap -Yes	Cold Tap -YesTMS Cold Tap -Yes	Hot Tap -NoTMS Hot Tap -No	Cold Tap-NoTMS Cold Tap-No	Not ApplicableTMS Not Applicable

This section refers to the basins, water trough (sluice room) and faucets located throughout Ground Floor. Testing is of hot and cold taps.

If you selected Not Applicable, what was the reason?

Level 4 (Bilya)

	Hot Tap -Yes	Cold Tap -Yes	Hot Tap -No	Cold Tap-No	Not Applicable
Corporate Staff Room (Tea preparation)	Hot Tap -YesCorporate Staff Room (Tea preparation) Hot Tap -Yes	Cold Tap -YesCorporate Staff Room (Tea preparation) Cold Tap -Yes	Hot Tap -NoCorporate Staff Room (Tea preparation) Hot Tap -No	Cold Tap-NoCorporate Staff Room (Tea preparation) Cold Tap-No	Not ApplicableCorporate Staff Room (Tea preparation) Not Applicable
Corporate Staff Toilet	Hot Tap -YesCorporate Staff Toilet Hot Tap -Yes	Cold Tap -YesCorporate Staff Toilet Cold Tap -Yes	Hot Tap -NoCorporate Staff Toilet Hot Tap -No	Cold Tap-NoCorporate Staff Toilet Cold Tap-No	Not ApplicableCorporate Staff Toilet Not Applicable
Corporate Staff Shower	Hot Tap -YesCorporate Staff Shower Hot Tap -Yes	Cold Tap -YesCorporate Staff Shower Cold Tap -Yes	Hot Tap -NoCorporate Staff Shower Hot Tap -No	Cold Tap-NoCorporate Staff Shower Cold Tap-No	Not ApplicableCorporate Staff Shower Not Applicable
Day Patient Tea Preparation	Hot Tap -YesDay Patient Tea Preparation Hot Tap -Yes	Cold Tap -YesDay Patient Tea Preparation Cold Tap -Yes	Hot Tap -NoDay Patient Tea Preparation Hot Tap -No	Cold Tap-NoDay Patient Tea Preparation Cold Tap-No	Not ApplicableDay Patient Tea Preparation Not Applicable
Day Patient toilets- Male #1	Hot Tap -YesDay Patient toilets- Male #1 Hot Tap -Yes	Cold Tap -YesDay Patient toilets- Male #1 Cold Tap -Yes	Hot Tap -NoDay Patient toilets- Male #1 Hot Tap -No	Cold Tap-NoDay Patient toilets- Male #1 Cold Tap-No	Not ApplicableDay Patient toilets- Male #1 Not Applicable
Day Patient toilets- Male #2	Hot Tap -YesDay Patient toilets- Male #2 Hot Tap -Yes	Cold Tap -YesDay Patient toilets- Male #2 Cold Tap -Yes	Hot Tap -NoDay Patient toilets- Male #2 Hot Tap -No	Cold Tap-NoDay Patient toilets- Male #2 Cold Tap-No	Not ApplicableDay Patient toilets- Male #2 Not Applicable
Day Patient toilets- Female #1	Hot Tap -YesDay Patient toilets- Female #1 Hot Tap -Yes	Cold Tap -YesDay Patient toilets- Female #1 Cold Tap -Yes	Hot Tap -NoDay Patient toilets- Female #1 Hot Tap -No	Cold Tap-NoDay Patient toilets- Female #1 Cold Tap-No	Not ApplicableDay Patient toilets- Female #1 Not Applicable
Day Patient toilets- Female #2	Hot Tap -YesDay Patient toilets- Female #2 Hot Tap -Yes	Cold Tap -YesDay Patient toilets- Female #2 Cold Tap -Yes	Hot Tap -NoDay Patient toilets- Female #2 Hot Tap -No	Cold Tap-NoDay Patient toilets- Female #2 Cold Tap-No	Not ApplicableDay Patient toilets- Female #2 Not Applicable
Day Patient Universal Access Toilet	Hot Tap -YesDay Patient Universal Access Toilet Hot Tap -Yes	Cold Tap -YesDay Patient Universal Access Toilet Cold Tap -Yes	Hot Tap -NoDay Patient Universal Access Toilet Hot Tap -No	Cold Tap-NoDay Patient Universal Access Toilet Cold Tap-No	Not ApplicableDay Patient Universal Access Toilet Not Applicable
Inpatient toilets- Male #1	Hot Tap -YesInpatient toilets- Male #1 Hot Tap -Yes	Cold Tap -YesInpatient toilets- Male #1 Cold Tap -Yes	Hot Tap -NoInpatient toilets- Male #1 Hot Tap -No	Cold Tap-NoInpatient toilets- Male #1 Cold Tap-No	Not ApplicableInpatient toilets- Male #1 Not Applicable
Inpatient toilets- Male #2	Hot Tap -YesInpatient toilets- Male #2 Hot Tap -Yes	Cold Tap -YesInpatient toilets- Male #2 Cold Tap -Yes	Hot Tap -NoInpatient toilets- Male #2 Hot Tap -No	Cold Tap-NoInpatient toilets- Male #2 Cold Tap-No	Not ApplicableInpatient toilets- Male #2 Not Applicable
Inpatient toilets- Female #1	Hot Tap -YesInpatient toilets- Female #1 Hot Tap -Yes	Cold Tap -YesInpatient toilets- Female #1 Cold Tap -Yes	Hot Tap -NoInpatient toilets- Female #1 Hot Tap -No	Cold Tap-NoInpatient toilets- Female #1 Cold Tap-No	Not ApplicableInpatient toilets- Female #1 Not Applicable
Inpatient toilets- Female #2	Hot Tap -YesInpatient toilets- Female #2 Hot Tap -Yes	Cold Tap -YesInpatient toilets- Female #2 Cold Tap -Yes	Hot Tap -NoInpatient toilets- Female #2 Hot Tap -No	Cold Tap-NoInpatient toilets- Female #2 Cold Tap-No	Not ApplicableInpatient toilets- Female #2 Not Applicable
Inpatient Universal Access Toilet	Hot Tap -YesInpatient Universal Access Toilet Hot Tap -Yes	Cold Tap -YesInpatient Universal Access Toilet Cold Tap -Yes	Hot Tap -NoInpatient Universal Access Toilet Hot Tap -No	Cold Tap-NoInpatient Universal Access Toilet Cold Tap-No	Not ApplicableInpatient Universal Access Toilet Not Applicable
Art Room	Hot Tap -YesArt Room Hot Tap -Yes	Cold Tap -YesArt Room Cold Tap -Yes	Hot Tap -NoArt Room Hot Tap -No	Cold Tap-NoArt Room Cold Tap-No	Not ApplicableArt Room Not Applicable

This section refers to the basins, sink (Art Room & Tea Preparation) and faucets located throughout Level 4 (Bilya). Testing is of hot and cold taps.

If you selected Not Applicable, what was the reason?

Level 5 (Ngangk)

	Hot Tap -Yes	Cold Tap -Yes	Hot Tap -No	Cold Tap-No	Not Applicable
Tea Preparation	Hot Tap -YesTea Preparation Hot Tap -Yes	Cold Tap -YesTea Preparation Cold Tap -Yes	Hot Tap -NoTea Preparation Hot Tap -No	Cold Tap-NoTea Preparation Cold Tap-No	Not ApplicableTea Preparation Not Applicable
Toilet- Male	Hot Tap -YesToilet- Male Hot Tap -Yes	Cold Tap -YesToilet- Male Cold Tap -Yes	Hot Tap -NoToilet- Male Hot Tap -No	Cold Tap-NoToilet- Male Cold Tap-No	Not ApplicableToilet- Male Not Applicable
Toilets- Female	Hot Tap -YesToilets- Female Hot Tap -Yes	Cold Tap -YesToilets- Female Cold Tap -Yes	Hot Tap -NoToilets- Female Hot Tap -No	Cold Tap-NoToilets- Female Cold Tap-No	Not ApplicableToilets- Female Not Applicable
Universal Access Toilet	Hot Tap -YesUniversal Access Toilet Hot Tap -Yes	Cold Tap -YesUniversal Access Toilet Cold Tap -Yes	Hot Tap -NoUniversal Access Toilet Hot Tap -No	Cold Tap-NoUniversal Access Toilet Cold Tap-No	Not ApplicableUniversal Access Toilet Not Applicable
Laundry Hand Basin	Hot Tap -YesLaundry Hand Basin Hot Tap -Yes	Cold Tap -YesLaundry Hand Basin Cold Tap -Yes	Hot Tap -NoLaundry Hand Basin Hot Tap -No	Cold Tap-NoLaundry Hand Basin Cold Tap-No	Not ApplicableLaundry Hand Basin Not Applicable
Laundry Sink	Hot Tap -YesLaundry Sink Hot Tap -Yes	Cold Tap -YesLaundry Sink Cold Tap -Yes	Hot Tap -NoLaundry Sink Hot Tap -No	Cold Tap-NoLaundry Sink Cold Tap-No	Not ApplicableLaundry Sink Not Applicable

This section refers to the basins, sink (laundry & Tea Preparation) and faucets located throughout Level 5 (Ngangk). Testing is of hot and cold taps.

If you selected Not Applicable, what was the reason?