Document1

Example Data Collection Form

System

Date/Time Started

Date/Time Finished

Free Chlorine (if cold) – as ppm Chlorine (must be greater than 0.5 ppm)

Temperature (if hot) > 118 F

Filter change out (yes/no)

Sink in Bathroom 1205 Shower in Bathroom 1205 Drinking Fountain – Asset number 65234

6/1/20 - 8:30 am

6/1/20 – 9:00 am

1.0 ppm

6/1/20 8:35 am

6/1/20 – 9:10 am

118F

6/1/20 9:20 am

6/1/20 10:10 am

1.0 ppm

Yes

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