Risk Management Programme Template Page 20
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23Risk Management Programme
Record 1
ASSESSMENT OF WATER SUPPLY STATUS
PAGE: 4 OF 7
DATE:
/
/
B3: ROOF WATER
Tick the appropriate boxes in the table below and then move on to the relevant parts of the checklist as appropriate to the
responses given.
Yes
No
Question
Roofing Materials:
Are any of the following materials used on the water collection surfaces?
Galvanised iron?
Lead materials (lead nails, flashings, paint)?
Asbestos materials?
Paint or other surface treatment in poor condition?
Roof environment:
Is the roof overhung by trees?
Are there any other factors that could encourage birds or other pests to move about
or settle on the roof?
Atmospheric fall out:
Are there industrial (including agricultural chemicals) or natural sources of
atmospheric fall out?
Is there any ash/soot deposit on the roof?
Roof maintenance:
Are the gutterings left for more than a month before cleaning them out?
If all responses are NO, go to C, Water Storage.
If any response is YES, record details of problem in row B3 of Table D and then
go to C, Water Storage.
C: WATER STORAGE
Describe Water Storage Facilities
Do not have holding tanks – Go to Table D if problems have been identified in the
previous parts, or E if no problems have been identified in the previous parts.
Have holding tanks – Go to C1.
C1: HOLDING TANKS
If there is more than one storage facility, copy and fill out this section for each storage facility.
Yes
No
Question
Is the outlet of the holding tank below or level with the base of the tank, allowing
any debris that has settled to be sucked out with the water?
Is the water in holding tanks prone to stagnation that results in deterioration of
water quality?
Are holding tanks inspected and maintained less than once per year?
Are holding tanks dirty and not cleaned when necessary?
Are holding tanks uncovered allowing access by animals, or other debris or other
contaminants into the tanks?
If all responses are NO, the water STORAGE is satisfactory. Go to table D and check
that any other problems identified in the checklist are followed up.
If any response is YES, the water STORAGE is not satisfactory. Record
details of problem in row C1 of Table D then fill out rest of Table D.
Egg Template issued by NZFSA in June 07
Initial:
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