Title Page
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Application Number
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Name of premises
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Address of premises
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Name of manager/ owner
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Contact phone number
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Email of manager/owner
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Trim File No.
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Inspection Started
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Authorised Officer/s
- Shane Pickering
- Mellissa Moyle
- Thelma Marr
- Greg Howarth
- Mark Sneesby
- Kamran Khodaverdi
- Bethany Meehan
- Kate Balding
- Ariana Johnson
Business Details
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Entity Name (Individual/ Partnership/Company/Body Corporate/Trust/Other)
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ABN Number
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Postal Address
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Person/s Interviewed
Unit
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Pool Type
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Photo of Pool
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Disinfectant Dosing System Make/Model
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Photo of Dosing System
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Dosing System Controller
- Free Chlorine Probe
- pH Probe
- ORP Probe
- Meter
- Other
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Dosing System
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Disinfection Type
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Are dosing chemicals APVMA approved?
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Records Sighted?
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Are All Parameters Tested?
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Is Cyanuric Acid Used?
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Bathing Load
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Free Chlorine
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pH
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Total Chlorine
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Total Bromine
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Cyanuric Acid
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Total Alkalinity
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ORP
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Water Temperature
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Weather Conditions On Inspection
- Sunny
- Overcast
- Rain
- Recent Rain
- Dry
- Indoor
Additional Unit
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Additional Unit
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Pool Type
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Photo of Pool
-
Disinfectant Dosing System Make/Model
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Photo of Dosing System
-
Dosing System Controller
-
Dosing System
-
Disinfection Type
-
Records Sighted?
-
Are All Parameters Tested?
-
Is Cyanuric Acid Used?
-
Bathing Load
-
Free Chlorine
-
pH
-
Total Chlorine
-
Total Bromine
-
Cyanuric Acid
-
Total Alkalinity
-
ORP
-
Water Temperature
Inspection Outcome
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Comments
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Inspection Outcome
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Person Interviewed Signature
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Authorised Officers Signature
