ESC Commercial Swimming Pool & Spa Inspection Report

• Name

• PPS File No.

• Address of premises

• Name of manager/ owner

• Contact phone number

• Email of manager/owner

• Inspection Started

• Authorised Officer/s

  Select Renee Hutchinson Bruce Young Colleen Doyle Rebecca Hardwick Dale Sponberg

  • Renee Hutchinson
  • Bruce Young
  • Colleen Doyle
  • Rebecca Hardwick
  • Dale Sponberg

Business Details

• Entity Name (Individual/ Partnership/Company/Body Corporate/Trust/Other)

• ABN Number

• Postal Address

• Person/s Interviewed

Pool

• Pool Type

  Pool

  Spa

  Wading Pool

  Splash Pad

  Other

• Photo of Pool

  Media

• Pool Clarity

  Sparkling

  Clear

  Cloudy

  Debris

• Disinfectant Dosing System Make/Model

• Photo of Dosing System

  Media

• Dosing System Controller

  Select Free Chlorine Probe pH Probe ORP Probe Meter Other

  • Free Chlorine Probe
  • pH Probe
  • ORP Probe
  • Meter
  • Other

• Disinfection Type

  Chlorine

  Bromine

  Other

• Are dosing chemicals AMPV approved?

  Yes

  No

• Records Sighted?

  Yes

  No

• Are All Parameters Tested?

  Yes

  No

• Is Cyanuric Acid Used?

  Yes

  No

• Bathing Load

• Free Chlorine

• pH

• Total Chlorine

• Cyanuric Acid

• Total Alkalinity

• ORP

• Sample Taken

  Select Yes No

  • Yes
  • No

• Total Bromine

• Water Temperature

• Weather Conditions On Inspection

  Select Sunny Overcast Rain Recent Rain Dry Indoor

  • Sunny
  • Overcast
  • Rain
  • Recent Rain
  • Dry
  • Indoor
Additional Unit

• Pool Type

  Pool

  Spa

  Wading Pool

  Splash Pad

  Other

• Photo of Pool

  Media

• Disinfectant Dosing System Make/Model

• Photo of Dosing System

  Media

• Dosing System Controller

  Free Chlorine Probe

  pH Probe

  ORP Probe

  Meter

  Other

• Disinfection Type

  Chlorine

  Bromine

  Other

• Records Sighted?

  Yes

  No

• Are All Parameters Tested?

  Yes

  No

• Is Cyanuric Acid Used?

  Yes

  No

• Bathing Load

• Free Chlorine

• pH

• Total Chlorine

• Cyanuric Acid

• Total Alkalinity

• Total Bromine

• ORP

• Water Temperature

Inspection Outcome

• Comments

• Inspection Outcome

  Pass

  Fail

• Person Interviewed Signature

  Sign

• Authorised Officers Signature

  Sign