Water Management

Reporter

First

Last

Date

Safety Declaration

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

Location *

Level 1 (Galup)
Level 2 (Kep)
Level 3 (Djinda)

Patient Bathrooms

	Basin (Hot) - Yes	Shower (Hot)- Yes	Basin (Cold) -No	Shower- (Cold) - No	Room in Use
#01	Basin (Hot) - Yes#01 Basin (Hot) - Yes	Shower (Hot)- Yes#01 Shower (Hot)- Yes	Basin (Cold) -No#01 Basin (Cold) -No	Shower- (Cold) - No#01 Shower- (Cold) - No	Room in Use#01 Room in Use
#02	Basin (Hot) - Yes#02 Basin (Hot) - Yes	Shower (Hot)- Yes#02 Shower (Hot)- Yes	Basin (Cold) -No#02 Basin (Cold) -No	Shower- (Cold) - No#02 Shower- (Cold) - No	Room in Use#02 Room in Use
#03	Basin (Hot) - Yes#03 Basin (Hot) - Yes	Shower (Hot)- Yes#03 Shower (Hot)- Yes	Basin (Cold) -No#03 Basin (Cold) -No	Shower- (Cold) - No#03 Shower- (Cold) - No	Room in Use#03 Room in Use
#04	Basin (Hot) - Yes#04 Basin (Hot) - Yes	Shower (Hot)- Yes#04 Shower (Hot)- Yes	Basin (Cold) -No#04 Basin (Cold) -No	Shower- (Cold) - No#04 Shower- (Cold) - No	Room in Use#04 Room in Use
#05	Basin (Hot) - Yes#05 Basin (Hot) - Yes	Shower (Hot)- Yes#05 Shower (Hot)- Yes	Basin (Cold) -No#05 Basin (Cold) -No	Shower- (Cold) - No#05 Shower- (Cold) - No	Room in Use#05 Room in Use
#06	Basin (Hot) - Yes#06 Basin (Hot) - Yes	Shower (Hot)- Yes#06 Shower (Hot)- Yes	Basin (Cold) -No#06 Basin (Cold) -No	Shower- (Cold) - No#06 Shower- (Cold) - No	Room in Use#06 Room in Use
#07	Basin (Hot) - Yes#07 Basin (Hot) - Yes	Shower (Hot)- Yes#07 Shower (Hot)- Yes	Basin (Cold) -No#07 Basin (Cold) -No	Shower- (Cold) - No#07 Shower- (Cold) - No	Room in Use#07 Room in Use
#08	Basin (Hot) - Yes#08 Basin (Hot) - Yes	Shower (Hot)- Yes#08 Shower (Hot)- Yes	Basin (Cold) -No#08 Basin (Cold) -No	Shower- (Cold) - No#08 Shower- (Cold) - No	Room in Use#08 Room in Use
#09	Basin (Hot) - Yes#09 Basin (Hot) - Yes	Shower (Hot)- Yes#09 Shower (Hot)- Yes	Basin (Cold) -No#09 Basin (Cold) -No	Shower- (Cold) - No#09 Shower- (Cold) - No	Room in Use#09 Room in Use
#10	Basin (Hot) - Yes#10 Basin (Hot) - Yes	Shower (Hot)- Yes#10 Shower (Hot)- Yes	Basin (Cold) -No#10 Basin (Cold) -No	Shower- (Cold) - No#10 Shower- (Cold) - No	Room in Use#10 Room in Use
#11	Basin (Hot) - Yes#11 Basin (Hot) - Yes	Shower (Hot)- Yes#11 Shower (Hot)- Yes	Basin (Cold) -No#11 Basin (Cold) -No	Shower- (Cold) - No#11 Shower- (Cold) - No	Room in Use#11 Room in Use
#12	Basin (Hot) - Yes#12 Basin (Hot) - Yes	Shower (Hot)- Yes#12 Shower (Hot)- Yes	Basin (Cold) -No#12 Basin (Cold) -No	Shower- (Cold) - No#12 Shower- (Cold) - No	Room in Use#12 Room in Use
#13	Basin (Hot) - Yes#13 Basin (Hot) - Yes	Shower (Hot)- Yes#13 Shower (Hot)- Yes	Basin (Cold) -No#13 Basin (Cold) -No	Shower- (Cold) - No#13 Shower- (Cold) - No	Room in Use#13 Room in Use
#14	Basin (Hot) - Yes#14 Basin (Hot) - Yes	Shower (Hot)- Yes#14 Shower (Hot)- Yes	Basin (Cold) -No#14 Basin (Cold) -No	Shower- (Cold) - No#14 Shower- (Cold) - No	Room in Use#14 Room in Use
#15	Basin (Hot) - Yes#15 Basin (Hot) - Yes	Shower (Hot)- Yes#15 Shower (Hot)- Yes	Basin (Cold) -No#15 Basin (Cold) -No	Shower- (Cold) - No#15 Shower- (Cold) - No	Room in Use#15 Room in Use
#16	Basin (Hot) - Yes#16 Basin (Hot) - Yes	Shower (Hot)- Yes#16 Shower (Hot)- Yes	Basin (Cold) -No#16 Basin (Cold) -No	Shower- (Cold) - No#16 Shower- (Cold) - No	Room in Use#16 Room in Use
#17	Basin (Hot) - Yes#17 Basin (Hot) - Yes	Shower (Hot)- Yes#17 Shower (Hot)- Yes	Basin (Cold) -No#17 Basin (Cold) -No	Shower- (Cold) - No#17 Shower- (Cold) - No	Room in Use#17 Room in Use
#18	Basin (Hot) - Yes#18 Basin (Hot) - Yes	Shower (Hot)- Yes#18 Shower (Hot)- Yes	Basin (Cold) -No#18 Basin (Cold) -No	Shower- (Cold) - No#18 Shower- (Cold) - No	Room in Use#18 Room in Use
#19	Basin (Hot) - Yes#19 Basin (Hot) - Yes	Shower (Hot)- Yes#19 Shower (Hot)- Yes	Basin (Cold) -No#19 Basin (Cold) -No	Shower- (Cold) - No#19 Shower- (Cold) - No	Room in Use#19 Room in Use

Please note that rooms are listed as #01, #02, #03 etc. The # is reflective of the Location Number

Other Areas

	Basin (Hot)-Yes	Basin (Cold)- Yes	Basin (Hot)- No	Basin (Cold)- No	Not Applicable
Staff Room	Basin (Hot)-YesStaff Room Basin (Hot)-Yes	Basin (Cold)- YesStaff Room Basin (Cold)- Yes	Basin (Hot)- NoStaff Room Basin (Hot)- No	Basin (Cold)- NoStaff Room Basin (Cold)- No	Not ApplicableStaff Room Not Applicable
Staff toilets	Basin (Hot)-YesStaff toilets Basin (Hot)-Yes	Basin (Cold)- YesStaff toilets Basin (Cold)- Yes	Basin (Hot)- NoStaff toilets Basin (Hot)- No	Basin (Cold)- NoStaff toilets Basin (Cold)- No	Not ApplicableStaff toilets Not Applicable
Clean utility	Basin (Hot)-YesClean utility Basin (Hot)-Yes	Basin (Cold)- YesClean utility Basin (Cold)- Yes	Basin (Hot)- NoClean utility Basin (Hot)- No	Basin (Cold)- NoClean utility Basin (Cold)- No	Not ApplicableClean utility Not Applicable
Cleaners' room (inside)	Basin (Hot)-YesCleaners' room (inside) Basin (Hot)-Yes	Basin (Cold)- YesCleaners' room (inside) Basin (Cold)- Yes	Basin (Hot)- NoCleaners' room (inside) Basin (Hot)- No	Basin (Cold)- NoCleaners' room (inside) Basin (Cold)- No	Not ApplicableCleaners' room (inside) Not Applicable
Cleaners' room (external corridor)	Basin (Hot)-YesCleaners' room (external corridor) Basin (Hot)-Yes	Basin (Cold)- YesCleaners' room (external corridor) Basin (Cold)- Yes	Basin (Hot)- NoCleaners' room (external corridor) Basin (Hot)- No	Basin (Cold)- NoCleaners' room (external corridor) Basin (Cold)- No	Not ApplicableCleaners' room (external corridor) Not Applicable
Dirty Utility	Basin (Hot)-YesDirty Utility Basin (Hot)-Yes	Basin (Cold)- YesDirty Utility Basin (Cold)- Yes	Basin (Hot)- NoDirty Utility Basin (Hot)- No	Basin (Cold)- NoDirty Utility Basin (Cold)- No	Not ApplicableDirty Utility Not Applicable
Universal Access Toilet	Basin (Hot)-YesUniversal Access Toilet Basin (Hot)-Yes	Basin (Cold)- YesUniversal Access Toilet Basin (Cold)- Yes	Basin (Hot)- NoUniversal Access Toilet Basin (Hot)- No	Basin (Cold)- NoUniversal Access Toilet Basin (Cold)- No	Not ApplicableUniversal Access Toilet Not Applicable
Examination Room	Basin (Hot)-YesExamination Room Basin (Hot)-Yes	Basin (Cold)- YesExamination Room Basin (Cold)- Yes	Basin (Hot)- NoExamination Room Basin (Hot)- No	Basin (Cold)- NoExamination Room Basin (Cold)- No	Not ApplicableExamination Room Not Applicable
Kitchenette	Basin (Hot)-YesKitchenette Basin (Hot)-Yes	Basin (Cold)- YesKitchenette Basin (Cold)- Yes	Basin (Hot)- NoKitchenette Basin (Hot)- No	Basin (Cold)- NoKitchenette Basin (Cold)- No	Not ApplicableKitchenette Not Applicable
Corridor basin near #19	Basin (Hot)-YesCorridor basin near #19 Basin (Hot)-Yes	Basin (Cold)- YesCorridor basin near #19 Basin (Cold)- Yes	Basin (Hot)- NoCorridor basin near #19 Basin (Hot)- No	Basin (Cold)- NoCorridor basin near #19 Basin (Cold)- No	Not ApplicableCorridor basin near #19 Not Applicable

Please note that rooms/ areas are listed as #01, #02, #03 etc. The # is reflective of the Location Number

If you selected Not Applicable, what was the reason?