This fillable form can be used to document a facility’s water systems, help determine whether to conduct Legionella environmental sampling, and, if so, develop a sampling plan. An accompanying guide provides instructions and additional considerations for using the fillable form. The guide helps the evaluation team to understand form questions and also more fully assess potential risks in the facility’s water system. The form is available at: https://www.cdc.gov/legionella/downloads/legionella-environmental-assessment-marking-guide-508.pdf
3 – Intermediate
Acute Care Hospital
Acute Care Rehabilitation or Long-Term Care Acute Hospital (LTACH)
Adult Day Care
All settings
Ambulatory (Outpatient) Care
Ambulatory Surgery
Any Practice Setting
Assisted Living Facility (ALF)
Auditing / Observation / Monitoring / Assessment Tools
Behavioral Health Facilities
CDC
Checklist
Cleaning and Disinfection
Clinical / Direct Healthcare Personnel
Construction
Dental
Department of Health
Dialysis
Downloadable
Emergency Medical Services (EMS)
English
Free
Home Health
Hospice and Palliative Care
Infection Preventionists
Mobile Clinic
Non-Clinical / Indirect Healthcare Personnel
Nursing Home / Skilled Nursing Facility (SNF)
Pediatric / NICU
Physical Environment / Environment of Care (EOC)
Print Resources
Quality Improvement
Respiratory Infections
Risk Assessment
Select pathogens of public health concern
Water Management