Instructions for Sampling Plan Template

Lead in Drinking Water Sampling Plan Template

These instructions are intended to help schools plan and track sampling actions for both applicable and non-applicable water outlets. It is essential to update this template regularly to ensure accurate monitoring and compliance with PHL §1110, and subsequent Title 10NYCRR Subpart 67-4 guidelines. Please follow the instructions below to effectively utilize the template.

Data Entry Instructions

  1. School Building Name: Replace the placeholder text with your school’s name in the designated area of the template.
  2. Date Last Updated: Ensure that you are updating the date on this sheet each time you make an edit to document the most current information you have on all outlets within the building.
  3. Lead Service Line: Document if the building has a lead service line. A service line is the piping that connects the water main to the building inlet.
  4. School Outlet ID: This is the unique ID that your school gave the water outlet. The ‘School Outlet ID’ should match the ‘School Outlet ID’ on your remedial action plan. All outlets found on the remedial action plan should be able to be found on your sampling plan.
  5. Outlet Location: Note the location of every outlet both inside and outside the building. It may be helpful to create a map or diagram to accompany the sampling plan. The outlet should be able to be easily found when looking at the sampling plan
  6. Outlet Description: Document the type of outlet, including but not limited to: drinking fountain, kitchen sink, bottle filler, bathroom sink, exterior hose, etc.
  7. Outlet Notable Features: Ensure to document any notable features of the outlet, such as aerators, current filters, mixing valves, signage, locks, etc.
  8. Outlet Applicability: Determine whether the outlet is applicable or non-applicable for sampling. Applicable outlets are those used for drinking, cooking, and/or food preparation. Non-applicable outlets should not be utilized for consumption and must have controls, such as engineering controls or signage/supervision/education in place prior to sampling applicable outlets. You should note the exclusion criteria of all non-applicable outlets on your Remedial Action Plan.
  9. Sampling Order: You should understand how water flows through the building. Outlets that receive water first should be tested first and you should follow the flow of water until the outlet that receives water last is tested last. When sampling a combination bottle filler fountain or sink, the fixture that is used most frequently should be sampled first.
  10. Dates & Times: You will need to record the date and time of when all applicable outlets were last used and the date and time of when each outlet was sampled. Outlets must remain motionless for between 8 and 18 hours prior to any sampling event. Pre-sampling flushing is not allowed.