Basic information
Pool location



Children information
Number of resident children (0-4 YO)
Number of resident children (older than 5 YO)
Number of visiting children (0-4 YO)
Number of visiting children (older than 5 YO)
Type of pool

Residential Use Pool

Community Pool Use

Regular Pool

Wading (kiddy) Pool

Safety questions

1. Does a 4-foot barrier surround the entire pool?

2. Does the barrier around the pool limit the open area to pool related activities only? (Unrelated ancillary activities within the pool area are: food stands; play areas; picnic tables; barbecues, etc.)

3. Are all gates self-latching?

If no, how many?

4. Are all gates are self-closing?

If no, how many?

5. Are all gates lockable at 4 and 1/2 feet?

If no, how many?

6. Are locks available for all gates?

If no, how many?

7. Are keys and locks kept where children cannot reach them?

8. Is the wading (kiddy) pool separated from the main pool by a four-foot barrier?

9. Are pH and chlorine tests kits used to test the water quality regularly?

10. Are pools free of entrapment and disembowelment hazards?

11. Is the pool deck non-slip and free of irregularities and fittings on walkway?

12. Are pool rules posted for community use pools?

13. Are depths marked at the side of the pool for each one-foot change?

14. Is diving from the side of the pool prohibited where pool depths are less than 9 feet deep?

15. Is diving from a diving board prohibited where pool depths are less than 11.5 feet and where the distance to the slope for the shallow end is less than 16 feet?

16. Is a certified lifeguard/designated responsible person on duty whenever children 16 years or younger are within the pool area (community use pools)?

17. Is the required rescue and emergency response equipment situated within the pool area?

18. Is there an emergency action plan in effect including plan implementation training?

19. Are all electrical outlets in the pool area covered and GFCI protected?

Please note that this checklist is a hypothetical example and provides basic information only. It is not intended to take the place of, among other things, workplace, health and safety advice; medical advice, diagnosis, or treatment; or other applicable laws. You should also seek your own professional advice to determine if the use of such checklist is permissible in your workplace or jurisdiction.