A compiled reference of 41 verified statistics on cooling tower and Legionella requirements across eight jurisdictions read in the publisher's own regulation, statute, memo or dataset, plus three more listed only as reported at second hand. It covers New York State's registration, 30-day and 90-day sampling clocks, 90-day inspections and 1,000 CFU/mL notification rule; an original aggregation of the state's open cooling tower registry (6,692 towers, 3,301 flagged non-compliant); the federal CMS memo that reaches every Medicare-certified facility in all fifty states and declines to require testing; Garland, Texas, which regulated cooling towers in 2005 and has the only published decade of outcome data; and New Jersey's P.L.2024, c.66, whose first deadline falls on September 12, 2026, one week after publication. New York City is covered on our commercial HVAC inspection page and appears here only for comparison.
Key statistics
7 highlights from this report
Key statistics
Key takeaways
Almost every page on this topic is about New York City. This one is about everywhere else: the state rule the city's sits on top of, the federal memo that reaches all fifty states, the Texas suburb that got there ten years first, and the New Jersey deadline landing next week.
3,301 of the 6,692 towers in New York State's own registry are flagged non-compliant, and 1,241 are marked as needing a sample, 22.7 percent of the 5,474 towers that are neither decommissioned nor out of service.
New Jersey's first deadline under P.L.2024, c.66 is September 12, 2026, one week after publication, with implementation due December 12, 2026 and penalties of $2,000, $5,000 and $10,000 available twice over.
Garland, Texas regulated cooling towers ten years before New York City, and is the only jurisdiction with a published decade of outcome data: 7 of 18 towers positive in 2005, 0 of 14 in 2015.
New York State is the only United States jurisdiction with registration, sampling, inspection and annual certification for every cooling tower regardless of building type, and it licenses the laboratory, the inspector and the disinfector separately.
CMS QSO-17-30 reaches every Medicare-certified hospital, critical access hospital and long-term care facility in all fifty states, and explicitly leaves Legionella testing protocols to the provider.
The jurisdictions that do regulate anchor to four different external authorities: New York binds ASHRAE 188-2015, New Jersey and Michigan 188-2018, CMS says consider ASHRAE plus the CDC toolkit, and Ohio is reported to key to CDC guidance.
In the state registry, Monroe County and Erie County each hold more cooling towers than New York County, so the compliance problem is not the one the outbreak coverage describes.
How we built this report
Every figure was compiled in September 2026 from the jurisdiction's own regulation, statute, memo or open dataset, and read in the original before publishing.
- Primary text or nothing
Each requirement was read in the regulation, enacted pamphlet law, statute section or agency memo itself. Where the primary text was behind a bot challenge or a JavaScript portal, the requirement is listed in the unverified section as reported by a secondary source rather than stated as fact.
- The registry aggregated from the raw API
The New York State figures come from querying the state's open cooling tower registry endpoint directly on September 5, 2026 against the weekly extract stamped September 1, 2026. It is a snapshot with no history, so every count is stamped and will drift.
- Intervals and thresholds quoted exactly
Where a rule sets two different clocks, both are given. The 30-day bacteriological and 90-day Legionella intervals in New York State are the most commonly conflated pair in this area and are quoted separately here.
- Registries kept separate
New York State's registry and New York City's registry are both mandatory and overlapping, and their counts disagree by thousands of towers. No combined or national tower count is stated on this page.
- Small denominators shown
Garland's outcome data comes from a program of 18 towers falling to 14. The counts are given as counts, never as a percentage standing alone, and the human case count that did not move is reported alongside the tower positivity that did.
- Independent review
Written by one co-founder, reviewed by the other before publishing.
Scope caveat: this page compiles jurisdictions with a binding requirement, which is a small minority of the United States; the absence of a jurisdiction here means we found no binding rule, not that none exists. New York City's cooling tower regime is compiled on our commercial HVAC inspection statistics page and is summarized here only where a comparison needs it. Registry counts are a September 1, 2026 snapshot of self-reported data and drift weekly. Quebec's sampling interval, and the New Orleans, Michigan and Ohio requirements, are listed as reported rather than verified. ASHRAE Standard 188 is paywalled and is described here only as the quoting regulations describe it. This page compiles regulatory text; it is not legal advice and does not establish whether a specific building is covered.
Every jurisdiction we read in its own primary text
Eight regimes, side by side, with the citation each figure came from| Jurisdiction | What is required | Inspection interval | Sampling frequency | Action level and notification | Penalty | Effective | Citation |
|---|---|---|---|---|---|---|---|
| New York State | Registration of every tower before operation, maintenance program and plan, sampling, inspection, annual certification by November 1 | Every 90 days in use and before seasonal start-up | Bacteriological every 30 days; Legionella within 14 days of start-up then every 90 days | Notify the local health department within 24 hours above 1,000 CFU/mL | Not compiled on this page | Emergency August 2015; permanent July 6, 2016 | 10 NYCRR Subpart 4-1 |
| New York City | Registration, quarterly compliance inspection, cleaning after any shutdown over five days, annual certification | At least every 90 days while in use | Legionella culture at least monthly under the 2026 Health Department rule | Set by city rule; not re-verified here | Up to $2,000 first, $5,000 repeat, $10,000 where a violation causes serious injury or death. Local Law 77 statutory caps, unchanged by the 2026 rule, which doubled the Health Department's separate penalty schedule. | Local Law 77 of 2015; city rule 2026 | Local Law 77 of 2015 |
| New Jersey | ASHRAE 188-2018 water management program for eight building categories, including any building with an open-circuit or closed-circuit cooling tower or evaporative condenser | Not set by the statute | Not set by the statute | Not set by the statute | Up to $2,000 first, $5,000 repeat, $10,000 for serious injury or death, as a court penalty and again as an administrative penalty | Signed September 12, 2024; program due September 12, 2026; implementation due December 12, 2026 | P.L.2024, c.66 |
| Garland, Texas | Annual owner-funded Legionella pneumophila testing at multifamily dwellings and lodging establishments, by a third party approved by the city | Not set by the ordinance | Annual | Report positives within 48 hours and negatives within 10 days | Not compiled on this page | Passed April 19, 2005 | Sec. 32.04(D)(6) |
| Illinois | Nursing facilities and hospitals must develop a Legionella testing policy that states its own frequency | Not set by the statute | Whatever frequency the facility policy states | Not set by the statute | Not set by the statute; policy and results due to the department on request | April 27, 2021 | 210 ILCS 45/3-206.06; 210 ILCS 85/6.29 |
| Virginia (public schools) | Legionnaires' water management program at every public school building, with files available for review | Not set by the statute | Not set by the statute | Not set by the statute | Not set by the statute | Effective date not read in the primary text | Va. Code 22.1-138(C) |
| Medicare-certified facilities, all states | Water management policies and procedures, facility risk assessment, a program considering ASHRAE 188 and the CDC toolkit, testing protocols and acceptable ranges | Enforced through survey and certification | At the provider's discretion; CMS does not require water cultures | Provider-set acceptable ranges | Citation for non-compliance with a condition of participation, not a fine | June 2, 2017, revised July 6, 2018 | QSO-17-30; 42 CFR 482.42, 483.80, 485.635(a)(3)(vi) |
| Quebec | Cooling tower maintenance provisions in the Building Chapter of the Safety Code, with inspection and verification records kept in the building register | Periodic inspections, recorded in the register | Not verified on this page; records kept in the building register | Not verified on this page | Not compiled on this page | Chapter in force March 18, 2013; cooling tower provisions July 12, 2014 | Safety Code, Building Chapter, Division VII |
Blank cells are stated as not set rather than left empty: several of these regimes deliberately impose a duty without an interval. New York City's row carries over from our commercial HVAC inspection statistics page, where it was compiled and verified; it is included for comparison, was not rebuilt here, and the City of New York is therefore not counted among this page's sources. New Orleans, Michigan and Ohio are absent because their primary text could not be read; what a secondary source reports about them is listed in the unverified section below.
The New York State cooling tower registry, decomposed
Weekly extract stamped September 1, 2026, queried September 5, 2026Operational status, all 6,692 rows
Fifteen largest counties by registered towers, 4,980 of 6,692
Counts are the state's own, self-reported by tower operators, from a snapshot dataset with no history: they drift week to week and were re-queried on the morning of publication. New York City towers are under-represented here because the city maintains a separate registry under Local Law 77 of 2015, which 10 NYCRR 4-1.3(c) expressly preserves. The fifteen county counts and the eight status counts charted above are also published as a CSV alongside this page.
Twenty-one years of binding cooling tower rules
Only rules with enacted text behind them, in the order they took effectGarland, Texas passes the first United States ordinance mandating routine Legionella testing of cooling towers, unanimously, covering multifamily dwellings and lodging establishments. Annual testing, third party, positives reported within 48 hours.
Quebec's cooling tower provisions take effect in Division VII of the Building Chapter of its Safety Code, administered by the building regulator, with maintenance and inspection records kept in each building's register.
After the South Bronx outbreak, New York State adopts 10 NYCRR Subpart 4-1 as an emergency rule and New York City enacts Local Law 77 of 2015. The state rule becomes permanent on July 6, 2016: registration, 30-day and 90-day sampling clocks, 90-day inspections, certification by November 1.
Illinois P.A. 102-4 adds a Legionella testing-policy duty to the Nursing Home Care Act and the Hospital Licensing Act.
New Jersey P.L.2024, c.66 is signed, starting a 24-month clock to develop an ASHRAE 188-2018 water management program and a 27-month clock to implement it, with penalties of $2,000, $5,000 and $10,000.
New York City's Health Department rule moves Legionella culture sampling from every 90 days to at least monthly and doubles its penalty schedule. New Jersey's program deadline falls on September 12, 2026 and its implementation deadline on December 12, 2026.
New Jersey's first deadline is seven days after publication. Owners of covered buildings there have until September 12, 2026 to have a written water management program, and until December 12, 2026 to be running it.
If your jurisdiction is not on this page
What still binds when no state, provincial or city cooling tower rule existsThere is probably no cooling tower rule where you are
Every jurisdiction we could find with a binding cooling tower or Legionella requirement is on this page: eight read in their own primary text, three more listed as reported at second hand. That is a small minority of the United States. An absence here means we found no binding rule, not that none exists.
The federal layer still reaches Medicare-certified facilities
Where no local rule applies, CMS memo QSO-17-30 is the binding layer for every Medicare and Medicare/Medicaid certified hospital, critical access hospital and long-term care facility in all fifty states: water management policies and procedures, a facility risk assessment, a program considering ASHRAE 188 and the CDC toolkit, and testing protocols with acceptable ranges, grounded in 42 CFR 482.42, 42 CFR 483.80 and 42 CFR 485.635(a)(3)(vi). Cooling towers are one of the 18 devices the memo names as in scope.
Everything else is a program you set yourself
CMS does not require Legionella water cultures and leaves testing protocols to the provider, and enforcement is a survey citation against a condition of participation rather than a fine. Outside a certified facility, and outside the jurisdictions above, no interval, action level or notification duty on this page applies to you as law. The numbers most often borrowed as a baseline are New York State's: bacteriological sampling at intervals not to exceed 30 days, Legionella sampling within 14 days of seasonal start-up and thereafter not to exceed 90 days, inspection at intervals not exceeding every 90 days, and notification of the local health department within 24 hours above 1,000 CFU/mL.
Cooling tower regulation, by the numbers
All 47 figures, grouped by jurisdiction: 41 read in the jurisdiction's own regulation, statute, memo or dataset and independently verified, plus six RapidEye computations that name their inputs, followed by the requirements we could only find reported at second hand and two circulating errors.
Rates the registry implies
Six figures below are RapidEye arithmetic on the New York State cooling tower registry extract and the Garland outcome data that follow. Each names its inputs and every input appears as its own card further down this page.
Statistic 1
Netting out the 870 decommissioned and 348 out-of-service rows leaves 5,474 towers actively registered in New York State, and the 1,241 towers the registry marks Sample_Required are 22.7 percent of that active base, better than one in five overdue for a sample.
RapidEye Research, computed from the New York State cooling tower registry status counts below
Statistic 2
The registry's compliant and non-compliant flags are almost evenly split: 3,391 against 3,301, a gap of 90 towers, or 1.3 percent of the 6,692 rows. Picking a registered New York State tower at random is close to a coin flip on its compliance flag.
RapidEye Research, computed from the New York State cooling tower registry compliance counts below
Statistic 3
The fifteen largest counties hold 4,980 of the state's 6,692 registered towers, 74.4 percent. The four upstate and suburban counties that outrank New York County (Monroe, Erie, Westchester and Onondaga) hold 2,565 towers between them, 5.8 times New York County's 442.
RapidEye Research, computed from the New York State cooling tower registry county counts below
Statistic 4
6,274 of the 6,692 registry rows carry a Legionella result and 418 carry none. 6,041 of them fall in the registry's under-20 CFU/mL bin, with a further 38 in a legacy under-10 bin. Of the rows with a result, 190 (3.0 percent) are binned at 20 CFU/mL or above and 10 (0.16 percent, about one in 627) are at or above the 1,000 CFU/mL level that triggers a 24-hour notification to the local health department. The registry bins at or above 1,000 CFU/mL while the notification duty attaches above 1,000, so the 10 towers are an upper bound.
RapidEye Research, computed from the New York State cooling tower registry result bins below
Statistic 5
Seasonal towers are 4,091 of the 6,516 rows where the operating duration is filled in, 62.8 percent, so the within-14-days-of-seasonal-start-up Legionella sampling trigger governs roughly three towers in five and concentrates the state's compliance load in the spring.
RapidEye Research, computed from the New York State cooling tower registry operating-duration counts below
Statistic 6
Garland's positivity ran 7 of 18 towers (38.9 percent) in 2005, 2 of 14 (14.3 percent) in 2014 and 0 of 14 in 2015: a fall of 38.9 percentage points across ten years of mandatory annual testing, on a base that never exceeded 18 towers.
RapidEye Research, computed from the Garland ordinance evaluation in the Journal of Public Health Management and Practice, 2017
What this means: The registry's own flags say a coin flip decides whether a registered New York tower is in compliance, and better than one in five active towers is overdue for a sample. Garland's ten-year record says the alternative is possible: under mandatory annual testing, tower positivity fell from 38.9 percent to zero.
New York State: the only full registration, sampling, inspection and certification regime
According to the New York State Department of Health's 10 NYCRR Subpart 4-1 (ny.gov), adopted as an emergency rule in August 2015 and permanent on July 6, 2016 under Public Health Law section 225(5)(a), every cooling tower in the state, in any building type, must be registered in a statewide electronic system before it operates, reported on at intervals of no more than 90 days, sampled on two separate clocks, inspected at intervals not exceeding every 90 days by a licensed professional engineer, certified industrial hygienist, certified water technologist, or an environmental consultant or water treatment professional meeting the standard's training requirements, and certified annually by November 1. It is the template every later United States jurisdiction was measured against, and the one place where the laboratory, the inspector and the disinfector are three separately regulated roles.
Statistic 7
New York State requires every cooling tower owner in the state to register the tower with the Department of Health in a statewide electronic system before the tower ever operates, and again whenever ownership changes.
New York State Department of Health, 10 NYCRR Subpart 4-1, section 4-1.3(a), effective July 6, 2016
Statistic 8
New York State cooling tower owners must file a report to the state registry at intervals of no more than 90 days while the tower is in use, covering the last bacteriological sample, the last Legionella sample, and the dates of last inspection and last certification.
New York State Department of Health, 10 NYCRR Subpart 4-1, section 4-1.3(b), effective July 6, 2016
Statistic 9
New York State sets two different routine sampling clocks: bacteriological culture sampling at intervals not to exceed 30 days, and Legionella culture sampling within 14 days of seasonal start-up and thereafter at intervals not to exceed 90 days.
New York State Department of Health, 10 NYCRR Subpart 4-1, section 4-1.4(b)(1) to (2)
Statistic 10
New York State names five triggers that force immediate Legionella sampling outside the routine 90-day schedule, including power failure, loss of biocide treatment, and failure of conductivity control.
New York State Department of Health, 10 NYCRR Subpart 4-1, section 4-1.4(b)(3)
Statistic 11
New York State requires cleaning and disinfection before startup of any cooling tower that has sat idle without treatment and recirculation for more than five consecutive days.
New York State Department of Health, 10 NYCRR Subpart 4-1, section 4-1.4(b)(8)
Statistic 12
New York State requires cooling towers to be inspected at intervals not exceeding every 90 days while in use and before seasonal start-up, and the inspection must be done by a licensed professional engineer, certified industrial hygienist, certified water technologist, or an environmental consultant or water treatment professional meeting the standard's training requirements.
New York State Department of Health, 10 NYCRR Subpart 4-1, section 4-1.8(a)
Statistic 13
New York State requires an annual certification by November 1 of each year that the tower has a maintenance program and plan and that every activity in it was actually implemented.
New York State Department of Health, 10 NYCRR Subpart 4-1, section 4-1.8(b)
Statistic 14
New York State requires a cooling tower owner to notify the local health department within 24 hours of receiving a Legionella culture result above 1,000 CFU/mL, and to notify the public of the result.
New York State Department of Health, 10 NYCRR Subpart 4-1, section 4-1.6
Statistic 15
All Legionella culture analyses for New York State cooling towers must be performed by a laboratory certified under the state's Environmental Laboratory Approval Program (ELAP).
New York State Department of Health, 10 NYCRR Subpart 4-1, section 4-1.5, and the department's cooling tower requirements page
Statistic 16
A New York State cooling tower owner may apply to the local health department for a variance from any provision of the rule, but only for a period not exceeding 90 days.
New York State Department of Health, 10 NYCRR Subpart 4-1, section 4-1.11, and the department's cooling tower requirements page
Statistic 17
New York State's maintenance program and plan requirement incorporates ANSI/ASHRAE Standard 188-2015 section 7.2 (pages 7-8) directly into law by reference.
New York State Department of Health, 10 NYCRR Subpart 4-1, section 4-1.4(a)
What this means: New York State regulates the tower as a licensed asset rather than as a document. Two details do the most work for an operator: bacteriological sampling every 30 days is a different clock from Legionella sampling every 90 days, which is the single most-garbled fact in vendor content on this topic, and the 1,000 CFU/mL notification threshold in section 4-1.6 is the number other programs copy. Note also that the regulation binds ASHRAE 188-2015 while the department's own page points owners at 188-2018.
Inside the New York State cooling tower registry
New York publishes its entire cooling tower registry as an open dataset on the state open health data portal (ny.gov), one row per registered tower with county, operational status, compliance flag and the binned Legionella result. The figures below were computed by querying that API directly on September 5, 2026 against the weekly extract stamped September 1, 2026. The extract is a snapshot with no history, so these counts drift week to week and every one of them is stamped to that date. As far as we can find, nobody else has aggregated it.
Statistic 18
There are 6,692 cooling towers in the New York State Cooling Tower Registry (snapshot of 2026-09-01). That is the state registry only; New York City operates a separate municipal registry under its own law, so the two counts are not additive and neither is a national figure.
New York State Department of Health, NYS Cooling Tower Registry Weekly Extract, via New York State Open Health Data
Statistic 19
Just under half of all registered New York State cooling towers, 3,301 of 6,692 (49.3%), are flagged "Non-compliant" in the state's own registry. Non-compliant here is the registry's own status flag, which a tower trips by falling behind on reporting as well as by failing a requirement, and every row is operator self-reported.
New York State Department of Health, NYS Cooling Tower Registry Weekly Extract, via New York State Open Health Data
Statistic 20
The state registry's status field shows 1,241 towers with a sample required, 898 needing a registry update, 391 missing a Legionella result and 154 requiring disinfection.
New York State Department of Health, NYS Cooling Tower Registry Weekly Extract, via New York State Open Health Data
Statistic 21
Seasonal towers outnumber year-round towers in New York State by 4,091 to 2,425.
New York State Department of Health, NYS Cooling Tower Registry Weekly Extract, via New York State Open Health Data
Statistic 22
Cooling towers are not a New York City story: Monroe County (Rochester) has 782 registered towers and Erie County (Buffalo) 693, both more than New York County's 442. The comparison is within the state registry, where New York City towers are under-represented because the city runs its own.
New York State Department of Health, NYS Cooling Tower Registry Weekly Extract, via New York State Open Health Data
Statistic 23
Of registered New York State towers with a reported Legionella result, 6,041 fell in the registry's under-20 CFU/mL bin, with a further 38 in a legacy under-10 bin, while 10 towers reported results at or above the 1,000 CFU/mL notification threshold.
New York State Department of Health, NYS Cooling Tower Registry Weekly Extract, via New York State Open Health Data
What this means: The registry is the closest thing in the United States to a census of regulated cooling towers, and it says two uncomfortable things. Half the towers carry a non-compliance flag a decade after the rule took effect. And the geography is not the one the press coverage describes: Monroe County and Erie County each hold more registered towers than New York County. Both statements are about the state registry, which under-counts New York City because the city runs its own.
The federal layer: CMS QSO-17-30 reaches every Medicare-certified facility
There is no federal cooling tower registration law. According to the Centers for Medicare and Medicaid Services memo QSO-17-30 (cms.gov), issued June 2, 2017 and revised July 6, 2018, every Medicare and Medicare/Medicaid certified hospital, critical access hospital and long-term care facility must nonetheless hold water management policies and procedures that reduce Legionella risk, grounded in three existing conditions of participation at 42 CFR 482.42, 42 CFR 483.80 and 42 CFR 485.635(a)(3)(vi). Cooling towers are named in the memo's list of devices in scope. Enforcement is a survey citation, not a fine, which is why this is the widest-reaching requirement on this page.
Statistic 24
CMS requires every Medicare-certified hospital, critical access hospital and long-term care facility to have water management policies and procedures reducing Legionella risk, with a facility risk assessment, a program considering ASHRAE 188 and the CDC toolkit, and specified testing protocols and acceptable ranges.
Centers for Medicare and Medicaid Services, memo QSO-17-30, revised July 6, 2018, pages 3 to 4
Statistic 25
CMS explicitly does NOT require Legionella water cultures; testing protocols are left to the provider's discretion.
Centers for Medicare and Medicaid Services, memo QSO-17-30, revised July 6, 2018, page 4
Statistic 26
CMS grounds the Legionella requirement in three existing conditions of participation, quoted in the memo: 42 CFR 482.42 (hospitals), 42 CFR 483.80 (skilled nursing and nursing facilities), and 42 CFR 485.635(a)(3)(vi) (critical access hospitals).
Centers for Medicare and Medicaid Services, memo QSO-17-30, revised July 6, 2018, page 3
Statistic 27
CMS's own 2018 memo states the memo imposes no new requirements on hospitals and CAHs and is merely clarifying existing expectations.
Centers for Medicare and Medicaid Services, memo QSO-17-30, revised July 6, 2018, page 1
Statistic 28
CMS cites a 286% increase in reported US legionellosis cases during 2000-2014, roughly 5,000 cases reported to CDC in 2014, and approximately 9% case fatality.
Centers for Medicare and Medicaid Services, memo QSO-17-30, revised July 6, 2018, page 2
Statistic 29
CMS reports that of US Legionnaires' outbreaks from 2000-2014, 19% were associated with long-term care facilities and 15% with hospitals.
Centers for Medicare and Medicaid Services, memo QSO-17-30, revised July 6, 2018, page 2
Statistic 30
CMS names cooling towers among the building water system components that can aerosolize Legionella, in a list of 18 devices that defines the scope of a healthcare water management program.
Centers for Medicare and Medicaid Services, memo QSO-17-30, revised July 6, 2018, pages 2 to 3
What this means: Two sentences from this memo matter more than the rest. The requirement is real and applies in all fifty states. And CMS specifically does not require Legionella water cultures, leaving testing protocols to the provider, which is the opposite of what a great deal of compliance marketing says about it.
Garland, Texas: the first United States cooling tower ordinance, and the only one with a published outcome
According to the peer-reviewed evaluation published in the Journal of Public Health Management and Practice in 2017 and hosted open access by the National Library of Medicine (nih.gov), Garland, Texas passed the first ordinance in the country mandating routine Legionella testing of cooling towers on April 19, 2005, ten years before New York City. It covers multifamily dwellings and lodging establishments, requires annual owner-funded testing by an approved third party, and deliberately separates the party that tests the tower from the party that cleans it. It is also the only cooling tower rule anywhere with a decade of published, statistically tested outcome data.
Statistic 31
Garland, Texas became the first city in the United States to mandate routine Legionella testing of cooling towers, in 2005, a decade before New York City's Local Law 77.
Whitney et al., Journal of Public Health Management and Practice, 2017 (via PubMed Central)
Statistic 32
The Garland ordinance requires annual owner-funded Legionella pneumophila testing of cooling towers at multifamily dwellings and lodging establishments, by an approved third party, reported to the City within 10 days for negative results and 48 hours for positive results.
City of Garland Code of Ordinances Sec. 32.04, quoted verbatim in Whitney et al., Journal of Public Health Management and Practice, 2017
Statistic 33
Garland deliberately requires that the party testing the cooling tower be independent of the party cleaning it.
Whitney et al., Journal of Public Health Management and Practice, 2017
Statistic 34
In the first year of the Garland ordinance, 7 of 18 multifamily cooling towers (39%) tested positive for Legionella; positivity then fell about 4.8% per year, reaching 2 of 14 in 2014 and 0 of 14 in 2015. The program is small (18 towers falling to 14 over the decade) and the paper reports the trend as a fitted decline of about 4.8 percent a year, P = 0.0038.
Whitney et al., Journal of Public Health Management and Practice, 2017
Statistic 35
Garland reported 13 legionellosis cases in total between 2007 and 2015, a mean of 1.4 per year, with no clear post-ordinance decline.
Whitney et al., Journal of Public Health Management and Practice, 2017
Statistic 36
The Garland program was found to be cheap to run: the health department reported no implementation barriers and characterized the risk reduction as achievable "at not a great expense".
Whitney et al., Journal of Public Health Management and Practice, 2017
What this means: Garland answers the question every other jurisdiction on this page leaves open: does mandatory testing change anything in the tower? Positivity went from 7 of 18 towers to 0 of 14 over ten years. The honest counterweight, which the paper reports and we repeat, is that the city's human case count did not measurably move over the same period, because 1.4 cases a year in a 230,000-person city has too many other sources to attribute. The separation-of-duties rule is the detail worth copying: the company cleaning the tower should not be the only one grading it.
New Jersey: the September 12, 2026 deadline
According to New Jersey P.L.2024, c.66 (njleg.state.nj.us), signed September 12, 2024 and codified at N.J.S.A. 26:1A-139 to -142 and 58:12A-12.10 et seq., owners of eight categories of building, explicitly including any building with an open-circuit or closed-circuit cooling tower or evaporative condenser, must develop an ASHRAE 188-2018 water management program within 24 months, which lands on September 12, 2026, and implement it within 27 months, on December 12, 2026. New Jersey's structural choice is the opposite of New York's: the state requires the document to exist, and expressly declines to grade its contents unless it is investigating a case.
Statistic 37
New Jersey requires owners of eight categories of building, explicitly including any building with an open-circuit or closed-circuit cooling tower or evaporative condenser, to develop an ASHRAE 188-2018 water management program within 24 months of the law's September 12, 2024 effective date, making the deadline September 12, 2026. P.L.2024, c.66 was approved September 12, 2024 and its final section provides that the act takes effect immediately on enactment, which is what puts the 24-month program deadline on September 12, 2026 and the 27-month implementation deadline on December 12, 2026. A building that qualifies only because it holds a listed device owes a program for that device, not for the whole building.
New Jersey P.L.2024, c.66, section 6(a), codified at N.J.S.A. 26:1A-140
Statistic 38
New Jersey's implementation deadline is 27 months after the effective date (December 12, 2026), and covered owners must keep the written program, all procedure and testing records for at least five years, available to the Department of Health immediately on request.
New Jersey P.L.2024, c.66, section 6(f), codified at N.J.S.A. 26:1A-140(f)
Statistic 39
New Jersey penalties for failing to implement a water management program run to $2,000 for a first violation, $5,000 for a second or subsequent violation, and $10,000 for any violation causing serious injury or death, available both as a civil penalty in court and as a civil administrative penalty assessed by the Department of Health.
New Jersey P.L.2024, c.66, section 6(g), codified at N.J.S.A. 26:1A-140(g)
Statistic 40
New Jersey exempts residential properties with four or fewer dwelling units from the entire water management program requirement.
New Jersey P.L.2024, c.66, section 6(h), codified at N.J.S.A. 26:1A-140(h)
Statistic 41
New Jersey does not require any agency to review a water management program: agencies confirm only that one was developed, and may not evaluate its contents unless investigating a Legionnaires' case.
New Jersey P.L.2024, c.66, section 6(e), codified at N.J.S.A. 26:1A-140
Statistic 42
New Jersey requires the Department of Health to publish a public near-real-time Legionnaires' disease dashboard and to report annually to the Governor and Legislature on cases, positive water samples, and penalties assessed.
New Jersey P.L.2024, c.66, sections 5(g) and 7(b), codified at N.J.S.A. 26:1A-139 and 26:1A-141
Statistic 43
New Jersey also requires the owner of a building suspected as a Legionella source to give notice in both English and a second language where 10 percent or more of a municipality's residents speak it.
New Jersey P.L.2024, c.66, section 5(e), codified at N.J.S.A. 26:1A-139
What this means: The statute sets the program deadline at September 12, 2026 and the implementation deadline at December 12, 2026, for any New Jersey hotel, hospital, senior living community, correctional facility or six-story residential building. Two features are worth flagging beyond the dates: the penalty ladder is available both as a court-imposed civil penalty and as a Department of Health administrative penalty for the same conduct, and the $2,000 / $5,000 / $10,000 rungs are numerically identical to the New York City statutory caps enacted nine years earlier, which the 2026 city rule did not change.
Illinois, Virginia and Quebec: the narrower duties
Three more jurisdictions were verified against their own primary text. According to the Illinois General Assembly (ilga.gov), P.A. 102-4 added a four-sentence Legionella testing-policy duty to both the Nursing Home Care Act and the Hospital Licensing Act on April 27, 2021, in the aftermath of the Illinois Veterans' Home outbreaks at Quincy. According to the Code of Virginia (virginia.gov), Va. Code 22.1-138(C) puts a Legionnaires' water management program duty on every public school building, sitting in the statute between radon testing and mold remediation. According to the Regie du batiment du Quebec (rbq.gouv.qc.ca), Quebec put cooling tower maintenance into the Building Chapter of its Safety Code effective July 12, 2014, administered by the building regulator rather than a health department.
Statistic 44
Illinois requires every nursing facility to develop a policy for testing its water supply for Legionella, including the frequency of testing, and to make the policy and results available to the Department of Public Health on request. The statute sets no interval of its own.
Illinois Nursing Home Care Act, 210 ILCS 45/3-206.06, added by P.A. 102-4, effective April 27, 2021
Statistic 45
Illinois imposes the identical Legionella testing-policy duty on hospitals, in language word-for-word the same as the nursing home provision.
Illinois Hospital Licensing Act, 210 ILCS 85/6.29, added by P.A. 102-4, effective April 27, 2021
Statistic 46
Virginia requires every school board to maintain a Legionnaires' disease water management program at every public school building, and to validate that program at least annually.
Code of Virginia, Va. Code 22.1-138(C)
Statistic 47
Quebec's Safety Code covers "Any building equipped with water cooling towers, for whatever use", making cooling tower coverage universal and occupancy-independent, and requires cooling tower maintenance records to be kept in the building's register.
Regie du batiment du Quebec, Buildings chapter of the Safety Code, cooling tower provisions effective July 12, 2014
What this means: Illinois is the clearest case of a legislature responding to a deadly outbreak by requiring a policy rather than a standard: the statute demands that a facility state a testing frequency without setting one. Virginia is the only jurisdiction found that reaches public schools. Quebec is the only one that files cooling towers as a building-maintenance obligation alongside facade and garage inspection rather than as a public-health matter.
The requirements we could not read in their own primary text, and two errors worth correcting
Everything above was read in the publisher's own regulation, statute, memo or dataset. Everything below was not. Three jurisdictions appear here rather than in the compilation because their primary text is behind a bot challenge or a JavaScript portal, and the last two entries correct claims that circulate widely.
Unverified claim
New Orleans requires monthly inspection, annual cleaning and pretreatment after any shutdown over 72 hours. Reported by a secondary source, primary not read. The Environmental Law Institute summarizes New Orleans Code of Ordinances Sec. 26-17, Section 154.1 this way, with a section citation, but the municipal code host is bot-blocked from our machine and the ordinance text was not read. If confirmed, the 72-hour restart trigger would be the strictest in this compilation, against five days in both New York layers.
Unverified claim
New Orleans requires monthly bacteria dip slides, twice-weekly pH and biocide checks and Legionella sampling every six months. Reported by a secondary source, primary not read. Same Environmental Law Institute summary and the same unread primary. The reported design is the interesting one, since it monitors chemistry more often than New York and samples Legionella less often, but it is not stated here as fact.
Unverified claim
New Orleans can order a cooling tower shut down, and requires notification within 24 hours of any event requiring non-routine sampling. Reported by a secondary source, primary not read. The Environmental Law Institute cites Sections 154.1(9) and 154.4 for a shutdown power rather than a fine schedule. Not verified against the code.
Unverified claim
Michigan requires health facilities to follow ASHRAE Standard 188-2018 by administrative rule. Reported by a secondary source, primary not read. The Environmental Law Institute quotes Mich. Admin. Code R 325.45303, adopted 2020, inside quotation marks, but the state administrative code portal is a JavaScript application that did not return the rule text to us.
Unverified claim
Illinois implementing rules require facility policies to be based on named ASHRAE and CDC publications. Reported by a secondary source, primary not read. The Environmental Law Institute cites 77 Ill. Admin. Code 250.1100, 340.1337 and 330.792. The two Illinois statutes on this page were read in full; these three administrative code sections were not.
Unverified claim
Ohio directs the health director to adopt hospital licensing rules covering Legionella risk conditions. Reported by a secondary source, primary not read. The Environmental Law Institute quotes Ohio Rev. Code 3722.06(B)(7), enacted 2021. Not read at the state code site.
Unverified claim
Ohio hospitals and residential care facilities must run CDC-anchored water management programs. Reported by a secondary source, primary not read. The Environmental Law Institute cites Ohio Admin. Code 3701-22-07(K)(3) and 3701-16-12, both 2024. Not read at the state code site. If confirmed, Ohio would be the clearest CDC-anchored jurisdiction against the ASHRAE-anchored majority.
Unverified claim
A Garland cooling tower sample collected and tested by the city health department rather than an approved third-party lab cost the housing manager $250. Secondary, primary not read. The fee reported in the 2017 evaluation was $250, quoted there from the city's multifamily permitting materials. The City of Garland's own current fee schedule was not read, so this is listed as reported rather than stated as today's price.
Unverified claim
CDC attributes 22 percent of outbreak-related Legionnaires' cases to cooling towers, and OSHA estimates 10,000 to 50,000 United States cases a year. Reported by a secondary source, primary not read. Both figures are quoted inside the peer-reviewed Garland evaluation, which cites CDC and OSHA originals we did not pull. They are listed here rather than used, because a compilation page should not launder a citation.
Unverified claim
Quebec requires Legionella testing at every restart after wintering and every 30 days thereafter, with the laboratory reporting results directly to the regulator. Not verified. The regulator's English page independently confirms the Division VII placement, the July 12, 2014 effective date and the building-register duty, all of which are stated on this page. The sampling interval, the professional-order requirement and the laboratory reporting duty were not read in the regulation, whose detailed cooling tower file is French-only, so no interval is claimed for Quebec here.
Circulating error
New Jersey's Legionella law is Senate Bill 2188. Half right and actively misleading without a session. S2188 of the 2022-2023 session is an education bill establishing a Digital Divide Solutions Grant Program. The Legionella law is S2188 of the 2024-2025 session, identical to A1970, approved as P.L.2024, c.66 on September 12, 2024. The pamphlet law citation is unambiguous; the bill number alone is not.
Circulating error
New Jersey passed the first state law in the country requiring Legionella water management programs for all building types. Wrong twice. It is not all building types: the statute lists eight categories and exempts residential properties with four or fewer dwelling units. And it is not first: New York State's Subpart 4-1 predates it by eight years and Garland's ordinance by nineteen.
Cite this study
Academic or press use: copy a ready-made reference. RapidEye is the publisher.
Quick FAQ
Which states regulate cooling towers for Legionella?
New York State is the only state with a full registration, sampling, inspection and annual certification regime covering every cooling tower regardless of building type, under 10 NYCRR Subpart 4-1. New Jersey requires an ASHRAE 188-2018 water management program for eight categories of building including any with a cooling tower, under P.L.2024, c.66, with deadlines of September 12, 2026 and December 12, 2026. Illinois requires nursing facilities and hospitals to have a Legionella testing policy, and Virginia requires a water management program at every public school building. Michigan and Ohio reportedly regulate health facilities, though we could not read their rule text. Everywhere else, the binding requirement is federal and applies only to Medicare-certified facilities.
When is the New Jersey Legionella deadline?
September 12, 2026 to have developed a water management program, and December 12, 2026 to have implemented it. Those are 24 and 27 months after the law took effect on September 12, 2024. Covered owners must keep the written program and all procedure and testing records on the premises for at least five years, available to the Department of Health immediately on request.
How often does New York State require cooling tower sampling and inspection?
Bacteriological culture sampling at intervals not to exceed 30 days while the tower is in use, and Legionella culture sampling within 14 days of seasonal start-up and thereafter at intervals not to exceed 90 days. Inspection is required before seasonal start-up and at intervals not exceeding every 90 days while in use, by a licensed professional engineer, certified industrial hygienist, certified water technologist, or an environmental consultant or water treatment professional meeting the standard's training requirements. Certification is annual, by November 1.
What Legionella level triggers a notification?
In New York State, a Legionella culture result above 1,000 colony forming units per milliliter requires the owner to notify the local health department within 24 hours, and to notify the public in a manner the health department determines. That threshold is the most widely copied number in this area. New Orleans is reported to tie its response tiers to industrial hygiene guidelines instead, though we could not read that ordinance.
Does CMS require Legionella testing in hospitals and nursing homes?
No. CMS requires water management policies and procedures, a facility risk assessment, a program that considers ASHRAE 188 and the CDC toolkit, and specified testing protocols with acceptable ranges. The same memo then states that CMS does not require water cultures for Legionella and that testing protocols are at the discretion of the provider. Enforcement is a survey citation against a condition of participation rather than a fine.
What are the penalties for cooling tower non-compliance?
New Jersey sets civil penalties of up to $2,000 for a first violation, $5,000 for a second or subsequent violation and $10,000 for a violation causing serious injury or death, available both in court and as a Department of Health administrative penalty for the same conduct. New York City's Local Law 77 of 2015 carries the same three figures as caps. New York State's rule, the Garland ordinance, the Illinois statutes and the Virginia statute set no fine schedule of their own on the text we read.
Data sources
Every figure on this page traces to one of these publishers' own documents, each checked against the original before publishing. Sources are named at the publisher level and shown by root domain.
National Library of Medicine (PubMed Central)Open-access hosting of the peer-reviewed decade evaluation of the Garland, Texas cooling tower ordinance in the Journal of Public Health Management and Practice, 2017nih.gov
New Jersey LegislatureEnacted pamphlet law P.L.2024, c.66 and the bill records for the 2022-2023 and 2024-2025 sessionsnjleg.state.nj.us
Illinois General AssemblyFull text of 210 ILCS 45/3-206.06 and 210 ILCS 85/6.29, both added by P.A. 102-4ilga.gov
Virginia Law Library, Code of VirginiaVa. Code 22.1-138, minimum standards for public school buildingsvirginia.gov