Risk Assessment for legionella – A debate about whether every outlet should be included or documented.
We have been part of a debate about whether a list of every outlet is required to be included in the legionella risk assessment. The debate has been so interesting that we felt we had to blog about it.
Firstly it was really interesting the way the discussion morphed from – do you need a list of every outlet in the risk assessment, to do you need to check every outlet? Then do you need to record the temperature at every outlet and then to Point of use filtration which seemed to be a real curve ball in the discussion.
As such we thought it best to submit this blog for clarity of our opinions for the wider community and prospective clients.
Risk Assessment of outlets Point 1
The main purpose of a risk assessment is to assess the likelihood or potential for legionella bacteria to colonise and proliferate in the system, the potential for legionella to be disseminated in aerosol form and the subsequent risk of exposure including the susceptibility of those exposed. It should also provide actions to take to reduce the foreseeable risks identified.
If we are honest about the nature of our work, “in the real world” it is not always possible to gain access to every outlet at the time of survey. As such, the importance of access needs to be clarified upfront as failure to gain access to all of the water services will mean it is not possible to identify or list every outlet.
However, in our opinion the intentions of any good risk assessor must always be to visibly check and flush test every accessible outlet if possible. This action means each outlet is assessed for its potential to cause colonisation, (dead leg, broken, isolated, temp gain or loss etc) it’s potential to disseminate a breathable aerosol and it’s potential for subsequent exposure.
Failing to have this fundamental intention from the offset of the legionella risk assessment means there is a compromise in quality and the risk assessment process.
In line with the Legionella Control Association (LCA) standards for risk assessment, this type of issue should be discussed upfront with the client and an agreement documented on what is to be included in the risk assessment to demonstrate that a sufficient assessment has been done.
The Legionella Control Association requires documented clarification and a detailed scope of works to be drafted prior to the commencement of the works. This acts as an agreement between the client and service provider and will define the detail to be included in the risk assessment and indeed whether a full list of every outlet is required etc.
In real terms it is not enough just to say in compliance with L8 or BS8580! and to be totally frank, a very simple assessment without a full asset register can and has been in the past considered compliant by Regulatory Authorities.
In our opinion, the devil is in the detail and the detail should be identified in the agreed scope of works. In our opinion, it is the difference in the scope of works offered between organisations that can partly explain the variable prices available in the market. As such we feel the industry would benefit from a standard but very simple minimum scope of works to be included as part of a risk assessment agreement. In doing this we would have a unified scope from the Regulators that define clearly whether every outlet must or should be listed in the risk assessment.
In our opinion, whilst failing to gain access and list every outlet does not mean a poor assessment was done, we believe failing to try and gain access to every outlet does mean there is a compromise in quality and the risk assessment process. Therefore the intention of the risk assessor must always be to at least try to list every accessible outlet inspected.
An asset register and schematic should be produced where required not only to provide a guide on the system but also to confirm the assets identified and assessed as part of the survey. In our opinion a sincere attempt to must be made to collect and record this data within the risk assessment.
Again, missing assets can mean the assessor failed to gain access at the time of survey for a justifiable reason. Nonetheless where access was denied, not possible, or additional services are suspected to be present this needs to be stated in the report with a recommendation to facilitate access to certain identified restricted areas for assessment going forward.
Risk Assessment of outlets Point 2
Taking temperatures from every outlet is by no means absolutely essential particularly if you have already confirmed there is a single source. However any good Assessor will know and be aware that temperature checking every accessible outlet will provide them with a great deal of information about the system as a whole and the individual asset they are inspecting. It will indicate suspect areas of a system, any anomalies to be investigated further, and help to build a picture for the provision of rational recommendations in direct context to the site being risk assessed.
In our view, temperature checking every accessible outlet is one of the assessors most valuable tools whilst onsite and holds more importance for the Assessor to formulate the risk rating and rational recommendations than it does for the client.
Whilst a list of assets and temperatures may mean little to the client. This information is essential to enable the development of a control regime, schematics and provision of rational explanations and recommendations for actions or remedial works etc going forward.
All our assessments are initially priced to risk assess and temp check every asset and outlet where access is provided. This is only compromised where there is an agreement between the client and ourselves to curtail the requirement to do this whilst ensuring the assessment itself will still be deemed adequate.
Nonetheless there is a big difference between an adequate or sufficient risk assessment and a comprehensive one and what type is required should be clarified before works are undertaken. Further to this, there is naturally a difference in price between what is considered an adequate risk assessment and a comprehensive risk assessment
As such defining the scope of works prior to commencement of the assessment or as part of the proposal phase provides an agreed level of service between client and service provider.
The price offered by an organisation big or small should be based on the level of service provided and or expected and the expertise of the individual providing that service. With risk assessments the price is normally based on time allocated and expertise required to complete the job competently. The assessment process itself is typically a low overhead process regardless of the organisations size.
In real terms price should be defined by how much time and material or resource is spent executing the work from start to finish alongside expertise of the individual executing the work, additionally the margin the organisation needs to continue offering a progressive and effective service to the client should be considered and that’s about it.
When other factors creep in like greed (as it does for some) then it distorts the focus and purpose of the service and this is a different ball game altogether. Nonetheless we all know there are rouge traders out there so who you choose to conduct your risk assessment is a very important decision. In our opinion it is vital that the organisation is both independent and registered with the legionella control association as a minimum.
If any Organisation is worth its weight and understands its own liability in providing the risk assessment, then the assessment should always be sufficient enough to demonstrate compliance.
Curtailing the scope or works so far as to render the assessment useless increases the assessors and or organisations liability greatly so any curtailing from the standard fully comprehensive approach needs to be discussed up front and agreed by both parties.
In some cases the assessor or organisation may decline such work if the curtailing of essential elements mean the assessment will be useless or non compliant and this does happen.
However, like I said earlier a sufficient or adequate assessment does not necessarily mean a comprehensive one.
If I didn’t make it clear, price does not reflect quality. However, the execution of certain tasks as part of the assessment and identification and provision of certain issues and information included in the assessment does and considering that all assessors should be “competent” the time spent onsite to identify the issues is the thing that often makes the difference in report quality.
In an honest and ideal world, the time and resources needed and allocated to the work should be the fundamental issue that reflects the price paid.
The scope of work in our opinion is what defines the time and detail to be provided and needed to complete the service competently and therefore the scope will enable the organisation to price the work appropriately. Consequently the scope of works will normally always define the price to be paid.
This is why we say an industry standard scope of work for risk assessment would be useful from the Regulators to support the Industry. This would support organisations and assessors in ensuring that there is not this debate on whether you need to check every outlet or not or whether a temperature check should be done from every outlet or not. It would standardise the items that must be included as a minimum and allow for a more standardised pricing structure for the industry would product a minimum level of risk assessment quality.
In reflection of the debate it is easy to understand that the time it takes to check and list every outlet in a large hotel for example against checking an obligatory 10% the outlets which tends to be the minimum acceptable level when using a more pragmatic approach will have a significant reflection on the time spent doing the survey and subsequently the price.
Halls of residents or social housing for example can be priced to inspect and list every outlet or priced for the more pragmatic approach of 10% of outlets, rooms or apartments for example. The cost will be clearly defined by the strategy taken as this defines the time allocation needed to complete the service.
The time allocation can vary from a day or even a few hours to a week or months work for the same site depending on the scope and strategy being used and this is the point being raised within the industry as some companies will initially price to take a pragmatic approach and some a comprehensive one.
As such we think it is important for the client to understand upfront what type of service or risk assessment they require. Is a basic risk assessment, sufficient or adequate assessment required or is a more pragmatic approach needed due to the size of the portfolio or does the assessment need to be fully comprehensive. Understanding what type of assessment is needed should dictate the price the client is prepared to pay.
However, it is important to confirm that the strategy implemented or type of assessment needed will depend on the expertise and competence of the client and risk assessor or organisations involved. It will depend on the size of the portfolio or property and whether the 10% approach for example can be justified as reasonably practical in the context of the site.
If the client only requires a basic or adequate risk assessment to tick the box then this will be reflected in the price they are prepared to pay and believe us there are purchasers who are prepared to pay no more than £100 for the complete job! Unfortunately it is unlikely to provide a risk assessment that would be deemed adequate or comprehensive and simply not enough time could be allocated to the service at this price.
We cannot emphasise enough that there are many sub standard risk assessments out there but the industry should ask itself why. Is it because the assessors are incompetent? Is it because the client curtailed the requirements of the assessment due to budget constraints? Or is it because the organisation covertly cut corners to create the margin?
If you look deep enough into the service there is normally a reason for the poor risk assessments out there and from our experience it is often a combination of the above that result in the substandard risk assessments we see out there.
However, whilst we can all mud sling at one another and believe me it’s very easy to do so, the truth is that if the scope of works is defined prior to commencement of work, then the reasons for sub standard risk assessments would be much more obvious to the industry.