Sample Water Audit Forms Page 12
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15❑ Yes
❑ No
Are kitchen floors hosed clean?
How often? _____
Are hoses equipped with high-pressure, water efficient nozzles? ❑ Yes
❑ No
❑ Yes
❑ No
Are linens washed on-site?
How often? _____
Laboratory Consumption
Number of Labs (total in facility): ____
Number of sinks/ faucets: ______
Faucet flow rate: ________ gpm
❑ Yes
❑ No
Are faucets equipped with aerators?
List lab equipment that uses water in any way:
Equipment
Amount used
Closed-loop?
Potable? Reused?
❑ Y ❑ N
_____________________
________
_______________
❑ Y ❑ N
_____________________
________
_______________
❑ Y ❑ N
_____________________
________
_______________
❑ Y ❑ N
_____________________
________
_______________
❑ Y ❑ N
_____________________
________
_______________
❑ Y ❑ N
_____________________
________
_______________
Describe lab procedural/clean-up practices that consume water. __________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
___________________________________________________
❑ Yes
❑ No
Are procedures and clean-up practices posted in the lab?
Mechanical Consumption
Number of water heater(s): _____
Size: _________
Are water softeners in use? ❑ Yes ❑ No
Number: ______
Backwash?
Frequency: ______
Duration: _______
Are drink machines in vending areas ❑ air-cooled or ❑ water-cooled?
❑ Yes
❑ No
Are cooling towers in use at your facility?
Number: _____
For each cooling tower, approximate how much make-up water is needed or used to replace water
lost to blow-down, evaporation, and other process inefficiencies.
Check settings for level of total dissolved solids (TDS) at blow-down and frequency.
❑ Yes
❑ No
Are boilers in use at your facility?
Number: _____
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Parent category: Business