Attachment E - WSMT Legionella Reporting Template 02.xlsx

This is a Legionella Reporting Template used by the Department of Veterans Affairs Veterans Health Administration (VISN 19) to document water sampling and testing results across multiple VA Medical Center facilities.

The template captures comprehensive environmental water sampling data collected during fiscal year 2021, Quarter 2 at the George E. Wahlen Veterans Medical Center (VISN 19, Station 660) and other VA facilities. Data fields include facility identification (VISN, station number, building number), sample collection details (date, location, source type such as sinks, showers, cooling towers), sample characteristics (water temperature, pH, sample volume, biocide type and residual levels), laboratory analysis information (lab name, sample ID, testing results), and personnel responsible for sample collection. Samples are categorized by occupancy type (inpatient wards, administrative areas, outpatient clinics, mechanical equipment rooms) and sampling purpose (scheduled routine quarterly sampling or post-remediation efficacy testing). The template includes 43 individual sample records from March 25, 2021, with all results showing no Legionella detection. Samples were processed by HGS Engineering, Inc., an affiliated VISN 19 laboratory. The data validation section references multiple approved laboratories across various VISN stations and includes extensive personnel rosters associated with legionella testing programs. This template serves as the standardized reporting mechanism for compliance with VA water safety monitoring protocols and legionella surveillance requirements across the Veterans Health Administration network.