Title Page

  • Document No.

  • Audit Title

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

Basic information

  • Pool location
  • Name

  • Date

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?

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.