Information

  • Audit Title

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

Risk assessment

  • Required Personal Protective Equipment (PPE) for this activity is available and will be used

  • NOTE: Do not undertake activity if the required PPE is not available for use - Discuss with your supervisor.

  • Risk assessment fronts type of activity has been read and understood.

  • Are there any specific risks identified with the property? If at risk, what action will be taken to eliminate or control the issue?

  • NOTE: If the risk cannot be eliminated/controlled and/or is unsafe, DO NOT undertake the activity - Discuss with your supervisor.
    If during the activity risks are identified and it is unsafe to continue, abandon the activity - Discuss with your supervisor.

  • Trading name

  • Owner/Proprietor

  • Person interviewed

  • ABN

  • Phone

  • Email

  • Emergency contamination plan

  • Frequency of superchlorination

  • Frequency of filter backwash

Pool information

Pool 1

  • Pool type

  • Disinfectant used

  • Location

  • Bathing load (previous hour)

  • Temperature °C

  • Log book maintained and current

  • Dosing

  • Pool clarity

  • Bromine (if used) (mg/L)

  • Free Cl2 (mg/L)

  • Total Cl2 (mg/L)

  • Combined Cl2 (mg/L)

  • pH

  • Alkalinity (mg/L as CaCO3)

  • Comments

  • Add media

  • Select date

Pool 2

  • Pool type

  • Disinfectant used

  • Location

  • Bathing load (previous hour)

  • Temperature °C

  • Log book maintained and current

  • Dosing

  • Pool clarity

  • Bromine (if used) (mg/L)

  • Free Cl2 (mg/L)

  • Total Cl2 (mg/L)

  • Combined Cl2 (mg/L)

  • pH

  • Alkalinity (mg/L as CaCO3)

  • Cyanurate (if used) (mg/L)

  • Comments

  • Add media

  • Select date

Pool 3

  • Pool type

  • Disinfectant used

  • Location

  • Bathing load (previous hour)

  • Temperature °C

  • Log book maintained and current

  • Dosing

  • Pool clarity

  • Bromine (if used) (mg/L)

  • Free Cl2 (mg/L)

  • Total Cl2 (mg/L)

  • Combined Cl2 (mg/L)

  • pH

  • Alkalinity (mg/L as CaCO3)

  • Cyanurate (if used) (mg/L)

  • Comments

  • Add media

  • Select date

Premises inspection

  • Pool surrounds

  • Amenities

  • Chemical storage

Inspection results

  • General comments

  • Add media

  • Inspection rating

  • Further action required

  • Reinspection required

  • Documents to be submitted to Council

Council details

  • Name of officer

  • Phone: (02) 9911 6555 Fax: (02) 9911 6550 Email: council@canadabay.nsw.gov.au

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.