Title Page
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Public Pool/Spa Assessment Report
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Business Name
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Conducted on
Business Details
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Proprietor/Company
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ABN/ACN
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Email Address
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Postal Address
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Contact Number
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Person Interviewed
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Inspection Type
- Routine
- Complaint
- Reinspection
General Information
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Number of Outdoor Pools
- 1
- 2
- 3
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Number of Indoor Pools
- 1
- 2
- 3
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Number of Spas
- 1
- 2
- 3
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Is Heterotrophic Plate Testing occuring?
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Please note that heterotrophic plate testing is not a requirement
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UV Treatment?
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Please note that UV Treatment is not a requirement
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Are procedures up-to-date and readily available?
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Procedures include: Feacal and vomiting incidence response procedures.
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Amenities in a clean and sanitary condition?
Testing Criteria
POOL 1
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Name
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Time of Testing
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Estimated Bather Load
- 0 - 10
- 10 - 20
- 20 - 30
- 30 - 40
- 40 +
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Observations: Notes - Odour, Clarity, Colour, Cleaning of Surrounds/Wastewater Drainage.
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Add media
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Water Temperature
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Free Chlorine: Indoor MIN 2.0mg/L, Outdoor MIN 1mg/L, Cyanuric MIN 3mg/L. +1 where pH >7.6.
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Re-Test Required?
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Free Chlorine Re-Test
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Total Chlorine: MAX 10mg/L
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Re-Test Required?
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Total Chlorine Re-Test
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Combined Chlorine - MAX 1mg/L
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pH: MIN 7.0, MAX 7.8.
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Re-Test Required?
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pH Re-Test
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Total Alkalinity: MIN 80mg/L, MAX 200mg/L
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Calcium Hardness
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Bromine (Spas if applicable): MIN 4.5mg/L, MAX 9mg/L
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Re-Test Required?
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Bromine Re-Test
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Cyanuric Acid: MAX 50mg/L
POOL 2
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Name
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Time of Testing
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Estimated Bather Load
- 0 - 10
- 10 - 20
- 20 - 30
- 30 - 40
- 40 +
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Observations - Odour, Clarity, Colour, Cleaning of Surrounds/Wastewater Drainage.
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Add media
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Water Temperature
-
Free Chlorine: Indoor MIN 2.0mg/L, Outdoor MIN 1mg/L, Cyanuric MIN 3mg/L. +1 where pH >7.6.
-
Re-Test Required?
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Free Chlorine Re-Test
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Total Chlorine: MAX 10mg/L
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Re-Test Required?
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Total Chlorine Re-Test
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Combined Chlorine - MAX 1mg/L
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pH: MIN 7.0, MAX 7.8.
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Re-Test Required?
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pH Re-Test
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Total Alkalinity: MIN 80mg/L, MAX 200mg/L
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Calcium Hardness
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Bromine (Spas if applicable): MIN 4.5mg/L, MAX 9mg/L
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Re-Test Required?
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Bromine Re-Test
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Cyanuric Acid: MAX 50mg/L
POOL 3
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Name
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Time of Testing
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Estimated Bather Load
- 0 - 10
- 10 - 20
- 20 - 30
- 30 - 40
- 40 +
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Observations - Odour, Clarity, Colour, Cleaning of Surrounds/Wastewater Drainage.
-
Add media
-
Water Temperature
-
Free Chlorine: Indoor MIN 2.0mg/L, Outdoor MIN 1mg/L, Cyanuric MIN 3mg/L. +1 where pH >7.6.
-
Re-Test Required?
-
Free Chlorine Re-Test
-
Total Chlorine: MAX 10mg/L
-
Re-Test Required?
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Total Chlorine Re-Test
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Combined Chlorine - MAX 1mg/L
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pH: MIN 7.0, MAX 7.8.
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Re-Test Required?
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pH Re-Test
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Total Alkalinity: MIN 80mg/L, MAX 200mg/L
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Calcium Hardness
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Bromine (Spas if applicable): MIN 4.5mg/L, MAX 9mg/L
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Re-Test Required?
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Bromine Re-Test
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Cyanuric Acid: MAX 50mg/L
POOL 4
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Name
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Time of Testing
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Estimated Bather Load
- 0 - 10
- 10 - 20
- 20 - 30
- 30 - 40
- 40 +
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Observations - Odour, Clarity, Colour, Cleaning of Surrounds/Wastewater Drainage.
-
Add media
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Water Temperature
-
Free Chlorine: Indoor MIN 2.0mg/L, Outdoor MIN 1mg/L, Cyanuric MIN 3mg/L. +1 where pH >7.6.
-
Re-Test Required?
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Free Chlorine Re-Test
-
Total Chlorine: MAX 10mg/L
-
Re-Test Required?
-
Total Chlorine Re-Test
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Combined Chlorine - MAX 1mg/L
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pH: MIN 7.0, MAX 7.8.
-
Re-Test Required?
-
pH Re-Test
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Total Alkalinity: MIN 80mg/L, MAX 200mg/L
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Calcium Hardness
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Bromine (Spas if applicable): MIN 4.5mg/L, MAX 9mg/L
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Re-Test Required?
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Bromine Re-Test
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Cyanuric Acid: MAX 50mg/L
Notes & Signatures
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General Notes
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Add media
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Officer Name
- Lindsay Hall
- Alicia Peters
- Greg Perry
- Donna Sims
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Officer's Signature
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Owner/Manager Name
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Owner/Manager Signature
