Maintenance Facility - Evaluation Form

• Pool Name

• Conducted on

  Date

• Supervisor

General Facility Cleanliness and Maintenance

• Building entrance and perimeter

  3 pts

  2 pts

  1 pt

  0 pts

• Pool deck free of eaves/debris

  3 pts

  2 pts

  1 pt

  0 pts

• Furniture appearance

  3 pts

  2 pts

  1 pt

  0 pts

• Furniture and tables cleanliness

  3 pts

  2 pts

  1 pt

  0 pts

• Trash bags in place and emptied as needed

  3 pts

  2 pts

  1 pt

  0 pts

• Emergency Equipment (AED, Emergency Phone, First-Aid Kit)

  3 pts

  2 pts

  1 pt

  0 pts

Pump Room

• General cleanliness

  Good

  Fair

  Poor

  N/A

• Equipment condition

  Good

  Fair

  Poor

  N/A

• Filter pressure

  Good

  Fair

  Poor

  N/A

• Fan

  Pass

  Fail

  N/A

• Lights

  Pass

  Fail

  N/A

Chemical Room

• General cleanliness

  Good

  Fair

  Poor

  N/A

• Stocked

  Good

  Fair

  Poor

  N/A

• Fan

  Pass

  Fail

  N/A

• Lights

  Pass

  Fail

  N/A

Pool Cleanliness

• Pool bottom

  Good

  Fair

  Poor

  N/A

• Pool surface

  Good

  Fair

  Poor

  N/A

• Skimmers

  Good

  Fair

  Poor

  N/A

• Water Level

  Good

  Fair

  Poor

  N/A

• Tiles

  Good

  Fair

  Poor

  N/A

Log Book

• Chlorine and pH readings

  Safe

  At Risk

  N/A

• Operations log

  Good

  Fair

  Poor

  N/A

• Timestamps

  Pass

  Fail

  N/A

Restrooms

• Men's restroom - operational

  Select Pass Fail N/A

  • Pass
  • Fail
  • N/A

• Women's restroom - operational

  Pass

  Fail

  N/A

• Stocked

  Good

  Fair

  Poor

  N/A

• Toilets

  Good

  Fair

  Poor

  N/A

• Sinks/counters/mirrors

  Good

  Fair

  Poor

  N/A

• Floors

  Good

  Fair

  Poor

  N/A

• Showers

  Good

  Fair

  Poor

  N/A

• Lights

  Pass

  Fail

  N/A