GUDIAN Water / WORKSHEETS
Campus drinking-water incident record
Use one record per incident. Record response, arrival, repair completion and verification times separately, with supporting evidence and follow-up responsibilities.
Complete the downloaded file locally. This page does not collect or automatically upload entries. Remove unrelated personal information, trade secrets and access credentials before sharing.
Write ‘to be confirmed’ when evidence is missing. A blank field does not mean a task is complete.
Print or save as PDF using your browser. Wide tables can be scrolled horizontally.
Incident record
| Record item | What to record | Entry |
|---|---|---|
| Incident reference and location | Record the reference, building or outlet; do not enter student, patient or similar personal identifiers | |
| Equipment and service scope | Equipment ID, model and relevant contract or maintenance scope | |
| Discovery or report time | Record the date, time, time zone and reporting channel | |
| Observed issue and affected scope | Record observations, affected outlets and whether use was suspended; do not assume an unverified cause | |
| Response time and receiving role | Record the actual reply time and responsible role, with the work-order reference | |
| Site arrival time | Record actual arrival; for remote support, describe the method | |
| Temporary suspension and alternative water supply | Record the affected scope, alternative arrangements and responsible role under the school’s plan | |
| Investigation evidence and cause status | Record checks and evidence references; state clearly if the cause remains unconfirmed | |
| Work performed and replacement parts | Record completed work, part references and service records; work must be performed by authorized personnel | |
| Repair completion time | Record repair or functional restoration; this does not itself authorize return to service | |
| Verification time, checks and methods | Record when verification occurred, the responsible role, check or test methods and applicable basis | |
| Verification results and evidence | Record results and report, work-order or photo references; exclude unrelated personal information | |
| Authorization to return to service | Under the school’s procedure, record the confirming role, time and approved scope; write ‘to be confirmed’ if pending | |
| Open issues and temporary restrictions | Record unresolved issues, restrictions and whether alternative water arrangements must continue | |
| Follow-up tasks, owners and due dates | For each task, record the responsible role, next action, agreed deadline and completion evidence | |
| Costs and contract check | Confirm cost responsibilities, warranty and service scope; obtain written agreement for matters not covered | |
| Handover and closure | Record the receiving role, time and closure evidence; do not mark incomplete actions as closed | |
| Record storage and access | Record the storage location, responsible role, and access and retention arrangements under the applicable policy |
This worksheet sets no service deadline and makes no safety determination. Follow the school’s emergency arrangements, contract and applicable requirements. Complete the required verification under the established procedure before returning the system to service.