DAILY FLUSHING RECORD - Flushing Internal Water Lines at Schools Lambton Kent District School Board

Name of School: Mailing Address: Ministry of Education SFIS Number:

Name of Principal: Telephone No.: Ministry of Environment DWIS No.

NOTE: Flushing must be completed as outlined in Administrative Procedure NO: A-BU-507-07, Flushing Internal Water Lines at Schools. All flushing carried out under this procedure must be logged on
this Daily Flushing Record.
Enter Revision date of Flush Point Drawing :_______________. If you receive a newer revision print the date in the comment column for the day that you begin using it. Retain copies of all revisions.

The number of flush locations must be logged in under the "Flushing locations" columns for that particular date. For example, if there are four 5-min. flush points marked on the Flush Point Drawing, each of
those four must be flushed for at least 5 minutes and the person doing the flushing must enter "4" under the 5-Minute "Flushing locations" column.
Each column of the log entry must be printed neatly; the use of quotes or arrows or any other replication to imply the information in not permitted.
DAILY FLUSHING
RECORD - O. Reg.
243/07 5-Minute Flush (minimum) 10-Second Flush
Name
Comments
DATE (print first and last name)
(DD/MMM/YYYY) Start Time End Time # of Flush locations Start Time End Time # of Flush locations

FLUSHING INTERNAL WATER LINES AT SCHOOLS PROCEDURE NO: A-BU-507-07 Revision Date: May 4, 2009