Title Page

  • Business Name

  • Conducted on

Business Details

  • Proprietor/Company

  • ABN/ACN

  • Email Address

  • Postal Address

  • Contact Number

  • Person Interviewed

  • Inspection Type

General Information

  • Number of Outdoor Pools

  • Number of Indoor Pools

  • Number of Spas

  • Is Heterotrophic Plate Testing occuring?

  • Please note that heterotrophic plate testing is not a requirement

  • Is UV Treatment in use?

  • Please note that UV Treatment is not a requirement

  • Facilities in a clean and sanitary condition, including bathrooms/change rooms?

Water Quality Criteria

POOL 1

  • Name (e.g. "Outdoor Pool 1" or "25m")

  • Time of Testing

  • Estimated Bather Load

  • Observations: Notes - Odour, Clarity, Colour, Cleaning of Surrounds/Wastewater Drainage.

  • Add media

  • Water Temperature (MAX 38)

  • Disinfection: Type of Pool?

  • Free Chlorine: Minimum of 2.0mg/L. If pH is above 7.6, minimum is increased to 3.0mg/L. Cyanuric Acid should not be in use.

  • Re-test required?

  • Free Chlorine re-test

  • Total Chlorine: maximum is 10.0mg/L.

  • Re-test required?

  • Total Chlorine re-test

  • Combined Chlorine (Total chlorine minus free chlorine): maximum of 1.0mg/L.

  • Free Chlorine: Minimum of 1.0mg/L. If Cyanuric Acid is in use, minimum is increased to 3.0mg/L. If pH is above 7.6, minimum is increased by a further 1.0mg/L.

  • Re-test required?

  • Free Chlorine re-test

  • Total Chlorine: maximum is 10.0mg/L.

  • Re-test required?

  • Total Chlorine re-test

  • Combined Chlorine (Total chlorine minus free chlorine): maximum of 1.0mg/L.

  • Is the Spa treated with Chlorine or Bromine?

  • Free Chlorine: minimum is 3.0mg/L. If the pH is above 7.6, minimum is increased to 4.0mg/L. Cyanuric acid should not be in use.

  • Re-test required?

  • Free Chlorine re-test

  • Total Chlorine: maximum is 10.0mg/L.

  • Re-test required?

  • Total Chlorine re-test

  • Combined Chlorine (Total chlorine minus free chlorine): maximum of 1.0mg/L.

  • Bromine: minimum is 4.5mg/L and maximum of 9.0mg/L.

  • Re-test required?

  • Bromine re-test

  • pH: chlorine pools between 7.0 and 7.8, bromine pools between 7.0 and 8.0.

  • Cyanuric Acid: Maximum 50mg/L. Must only be used in outdoor, chlorine pools.

  • Total Alkalinity: minimum 80mg/L, Maximum 200mg/L

  • Calcium Hardness: ideally between 200 and 400mg/L.

POOL 2

  • Name (e.g. "Outdoor Pool 1" or "25m")

  • Time of Testing

  • Estimated Bather Load

  • Observations: Notes - Odour, Clarity, Colour, Cleaning of Surrounds/Wastewater Drainage.

  • Add media

  • Water Temperature (MAX 38)

  • Disinfection: Type of Pool?

  • Free Chlorine: Minimum of 2.0mg/L. If pH is above 7.6, minimum is increased to 3.0mg/L. Cyanuric Acid should not be in use.

  • Re-test required?

  • Free Chlorine re-test

  • Total Chlorine: maximum is 10.0mg/L.

  • Re-test required?

  • Total Chlorine re-test

  • Combined Chlorine (Total chlorine minus free chlorine): maximum of 1.0mg/L.

  • Free Chlorine: Minimum of 1.0mg/L. If Cyanuric Acid is in use, minimum is increased to 3.0mg/L. If pH is above 7.6, minimum is increased by a further 1.0mg/L.

  • Re-test required?

  • Free Chlorine re-test

  • Total Chlorine: maximum is 10.0mg/L.

  • Re-test required?

  • Total Chlorine re-test

  • Combined Chlorine (Total chlorine minus free chlorine): maximum of 1.0mg/L.

  • Is the Spa treated with Chlorine or Bromine?

  • Free Chlorine: minimum is 3.0mg/L. If the pH is above 7.6, minimum is increased to 4.0mg/L. Cyanuric acid should not be in use.

  • Re-test required?

  • Free Chlorine re-test

  • Total Chlorine: maximum is 10.0mg/L.

  • Re-test required?

  • Total Chlorine re-test

  • Combined Chlorine (Total chlorine minus free chlorine): maximum of 1.0mg/L.

  • Bromine: minimum is 4.5mg/L and maximum of 9.0mg/L.

  • Re-test required?

  • Bromine re-test

  • pH: chlorine pools between 7.0 and 7.8, bromine pools between 7.0 and 8.0.

  • Cyanuric Acid: Maximum 50mg/L. Must only be used in outdoor, chlorine pools.

  • Total Alkalinity: minimum 80mg/L, Maximum 200mg/L

  • Calcium Hardness: ideally between 200 and 400mg/L.

POOL 3

  • Name (e.g. "Outdoor Pool 1" or "25m")

  • Time of Testing

  • Estimated Bather Load

  • Observations: Notes - Odour, Clarity, Colour, Cleaning of Surrounds/Wastewater Drainage.

  • Add media

  • Water Temperature (MAX 38)

  • Disinfection: Type of Pool?

  • Free Chlorine: Minimum of 2.0mg/L. If pH is above 7.6, minimum is increased to 3.0mg/L. Cyanuric Acid should not be in use.

  • Re-test required?

  • Free Chlorine re-test

  • Total Chlorine: maximum is 10.0mg/L.

  • Re-test required?

  • Total Chlorine re-test

  • Combined Chlorine (Total chlorine minus free chlorine): maximum of 1.0mg/L.

  • Free Chlorine: Minimum of 1.0mg/L. If Cyanuric Acid is in use, minimum is increased to 3.0mg/L. If pH is above 7.6, minimum is increased by a further 1.0mg/L.

  • Re-test required?

  • Free Chlorine re-test

  • Total Chlorine: maximum is 10.0mg/L.

  • Re-test required?

  • Total Chlorine re-test

  • Combined Chlorine (Total chlorine minus free chlorine): maximum of 1.0mg/L.

  • Is the Spa treated with Chlorine or Bromine?

  • Free Chlorine: minimum is 3.0mg/L. If the pH is above 7.6, minimum is increased to 4.0mg/L. Cyanuric acid should not be in use.

  • Re-test required?

  • Free Chlorine re-test

  • Total Chlorine: maximum is 10.0mg/L.

  • Re-test required?

  • Total Chlorine re-test

  • Combined Chlorine (Total chlorine minus free chlorine): maximum of 1.0mg/L.

  • Bromine: minimum is 4.5mg/L and maximum of 9.0mg/L.

  • Re-test required?

  • Bromine re-test

  • pH: chlorine pools between 7.0 and 7.8, bromine pools between 7.0 and 8.0.

  • Cyanuric Acid: Maximum 50mg/L. Must only be used in outdoor, chlorine pools.

  • Total Alkalinity: minimum 80mg/L, Maximum 200mg/L

  • Calcium Hardness: ideally between 200 and 400mg/L.

POOL 4

  • Name (e.g. "Outdoor Pool 1" or "25m")

  • Time of Testing

  • Estimated Bather Load

  • Observations: Notes - Odour, Clarity, Colour, Cleaning of Surrounds/Wastewater Drainage.

  • Add media

  • Water Temperature (MAX 38)

  • Disinfection: Type of Pool?

  • Free Chlorine: Minimum of 2.0mg/L. If pH is above 7.6, minimum is increased to 3.0mg/L. Cyanuric Acid should not be in use.

  • Re-test required?

  • Free Chlorine re-test

  • Total Chlorine: maximum is 10.0mg/L.

  • Re-test required?

  • Total Chlorine re-test

  • Combined Chlorine (Total chlorine minus free chlorine): maximum of 1.0mg/L.

  • Free Chlorine: Minimum of 1.0mg/L. If Cyanuric Acid is in use, minimum is increased to 3.0mg/L. If pH is above 7.6, minimum is increased by a further 1.0mg/L.

  • Re-test required?

  • Free Chlorine re-test

  • Total Chlorine: maximum is 10.0mg/L.

  • Re-test required?

  • Total Chlorine re-test

  • Combined Chlorine (Total chlorine minus free chlorine): maximum of 1.0mg/L.

  • Is the Spa treated with Chlorine or Bromine?

  • Free Chlorine: minimum is 3.0mg/L. If the pH is above 7.6, minimum is increased to 4.0mg/L. Cyanuric acid should not be in use.

  • Re-test required?

  • Free Chlorine re-test

  • Total Chlorine: maximum is 10.0mg/L.

  • Re-test required?

  • Total Chlorine re-test

  • Combined Chlorine (Total chlorine minus free chlorine): maximum of 1.0mg/L.

  • Bromine: minimum is 4.5mg/L and maximum of 9.0mg/L.

  • Re-test required?

  • Bromine re-test

  • pH: chlorine pools between 7.0 and 7.8, bromine pools between 7.0 and 8.0.

  • Cyanuric Acid: Maximum 50mg/L. Must only be used in outdoor, chlorine pools.

  • Total Alkalinity: minimum 80mg/L, Maximum 200mg/L

  • Calcium Hardness: ideally between 200 and 400mg/L.

Record Requirements

  • What kind of disinfection dosing systems are in use?

  • Manual testing of disinfectant level and pH is required once per day, prior to pool opening. Records up to date?

  • Manual testing of disinfectant level and pH is required once per day. Records up to date?

  • System indicated levels of disinfectant and pH must be recorded once per day prior to the pool opening, and a second time during operation. Records up to date?

  • Is the disinfectant in use liquid chlorine (sodium hypochlorite), and/or is a carbon dioxide-based pH control in use?

  • Total alkalinity must be tested and recorded once per month. Records up to date?

  • Total alkalinity must be tested and recorded once per day. Records up to date?

  • Are incident response procedures easily accessible and up-to-date? Includes faecal and vomiting.

Notes & Signatures

  • General Notes

  • Add media

  • Officer Name

  • Officer's Signature

  • Owner/Manager Name

  • Owner/Manager Signature

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.