Orange City Council - Public Swimming Pool Inspection

• Audit Title

• Business Name

• Business Address
  Address

• Conducted on

  Date

• Inspection Type

  Primary

  Follow-Up

  Complaint

Business Details

• Person Interviewed

• Proprietor's Name

• Email Address

• Business ABN

• Business Contact Number

• Number of Indoor Pools

  Select 0 1 2 3

  • 0
  • 1
  • 2
  • 3

• Number of Outdoor Pools

  Select 0 1 2 3

  • 0
  • 1
  • 2
  • 3

• Number of Spas

  Select 0 1 2 3

  • 0
  • 1
  • 2
  • 3

Available and Up-to-date Procedures

• Vomit Incident

  Yes

  No

  N/A

• Solid Stool Incident

  Yes

  No

  N/A

• Loose Stool Incident

  Yes

  No

  N/A

• Chlorine (Free, Total, Combined) too high or too low

  Yes

  No

  N/A

• Superchlorination

  Yes

  No

  N/A

Pool Treatment Records

• Are any pools or spas being treated with bromine?

  Yes

  No

  N/A

• How many?

  Select 0 1 2 3

  • 0
  • 1
  • 2
  • 3

• Are pools being backwashed?

  Yes

  No

  N/A

• Details - Backwash Frequency

• Is UV treatment in use?

  Yes

  No

  N/A

• Is the premises performing plate testing? (Heterotrophic Plate Count)

  Yes

  No

  N/A

• Details - Plate Test frequency:

• Available Log Book of Testing activities?

  Yes

  No

  N/A

• Log Book contains the following details:

  Select Time/Date of testing, test results for required criteria & notes on remedial action (if required) Time/Date of testing & results for required criteria Results for required criteria only Gaps in testing results, minimal or no notes on remedial action

  • Time/Date of testing, test results for required criteria & notes on remedial action (if required)
  • Time/Date of testing & results for required criteria
  • Results for required criteria only
  • Gaps in testing results, minimal or no notes on remedial action

Water quality testing

• In the following section Green indicates criteria is within acceptable range, Orange indicates a need for close monitoring and adjustment, Red indicates non-compliance with the NSW Health Swimming Pool and Spa Advisory Document.

• Pool Premise Observations: Cleanliness, Water Clarity, Odour etc.

• Waste water from the cleaning of pool surroundings drains away from pool (not entering pool water)

  Yes

  No

  N/A

• POOL/SPA 1 TYPE

  Select Outdoor Pool Outdoor Pool with Cyanuric Acid Indoor Pool

  • Outdoor Pool
  • Outdoor Pool with Cyanuric Acid
  • Indoor Pool

• Estimated Bather Load

• Free Chlorine

  Select >3.0 - mg/L 1.0 - 3.0 mg/L <1.0 mg/L Not Applicable

  • >3.0 - mg/L
  • 1.0 - 3.0 mg/L
  • <1.0 mg/L
  • Not Applicable

• Total Chlorine

  Select 3.0 - 5.0 mg/L 5.1 - 9.9 mg/L 10.0 mg/L or greater Not Applicable

  • 3.0 - 5.0 mg/L
  • 5.1 - 9.9 mg/L
  • 10.0 mg/L or greater
  • Not Applicable

• Combined Chlorine

  Select Less than 1.0 mg/L 1.0 mg/L or greater Not Applicable

  • Less than 1.0 mg/L
  • 1.0 mg/L or greater
  • Not Applicable

• pH

  Select Less than 7.0 7.0 - 7.2 7.3 - 7.6 7.7 - 7.9 8.0 or greater

  • Less than 7.0
  • 7.0 - 7.2
  • 7.3 - 7.6
  • 7.7 - 7.9
  • 8.0 or greater

• Total Alkalinity

  Select Less than 80 mg/L 80 - 200 mg/L Greater than 200 mg/L

  • Less than 80 mg/L
  • 80 - 200 mg/L
  • Greater than 200 mg/L

• Calcium Hardness

• Bromine

  Select Less than 2.25 mg/L 2.25 - 4.5 mg/L 4.6 - 8.9 mg/L 9.0 mg/L or greater Not Applicable

  • Less than 2.25 mg/L
  • 2.25 - 4.5 mg/L
  • 4.6 - 8.9 mg/L
  • 9.0 mg/L or greater
  • Not Applicable

• Estimated Bather Load

• Free Chlorine

  Select 5.0 mg/L or greater 3.0 - 5.0 mg/L Less than 3.0 mg/L Not Applicable

  • 5.0 mg/L or greater
  • 3.0 - 5.0 mg/L
  • Less than 3.0 mg/L
  • Not Applicable

• Total Chlorine

  Select 4.0 - 6.0 mg/L 6.1 - 9.9 mg/L 10.0 mg/L or greater Not Applicable

  • 4.0 - 6.0 mg/L
  • 6.1 - 9.9 mg/L
  • 10.0 mg/L or greater
  • Not Applicable

• Combined Chlorine

  Select Less than 1.0 mg/L 1.0 mg/L or greater Not Applicable

  • Less than 1.0 mg/L
  • 1.0 mg/L or greater
  • Not Applicable

• pH

  Select Less than 7.0 7.0 - 7.2 7.3 - 7.6 7.7 - 7.9 8.0 or greater

  • Less than 7.0
  • 7.0 - 7.2
  • 7.3 - 7.6
  • 7.7 - 7.9
  • 8.0 or greater

• Total Alkakinity

  Select Less than 80 mg/L 80 - 200 mg/L Greater than 200 mg/L

  • Less than 80 mg/L
  • 80 - 200 mg/L
  • Greater than 200 mg/L

• Calcium Hardness

• Bromine

  Select Less than 2.25 mg/L 2.25 - 4.5 mg/L 4.6 - 8.9 mg/L 9.0 mg/L or greater Not Applicable

  • Less than 2.25 mg/L
  • 2.25 - 4.5 mg/L
  • 4.6 - 8.9 mg/L
  • 9.0 mg/L or greater
  • Not Applicable

• Cyanuric Acid

  Select Less than 9.0 mg/L 10.0 - 20.0 mg/L 20.0 - 30.0 mg/L 50.0 mg/L or greater

  • Less than 9.0 mg/L
  • 10.0 - 20.0 mg/L
  • 20.0 - 30.0 mg/L
  • 50.0 mg/L or greater

• Estimated Bather Load

• Free Chlorine

  Select Greater than 4.0 mg/L 2.0 - 4.0 mg/L Less than 2.0 mg/L Not Applicable

  • Greater than 4.0 mg/L
  • 2.0 - 4.0 mg/L
  • Less than 2.0 mg/L
  • Not Applicable

• Total Chlorine

  Select 3.0 - 5.0 mg/L 5.1 - 9.9 mg/L 10.0 mg/L or greater Not Applicable

  • 3.0 - 5.0 mg/L
  • 5.1 - 9.9 mg/L
  • 10.0 mg/L or greater
  • Not Applicable

• Combined Chlorine

  Select Less than 1.0 mg/L 1.0 mg/L or greater Not Applicable

  • Less than 1.0 mg/L
  • 1.0 mg/L or greater
  • Not Applicable

• pH

  Select Less than 7.0 7.0 - 7.2 7.3 - 7.6 7.7 - 7.9 8.0 or greater

  • Less than 7.0
  • 7.0 - 7.2
  • 7.3 - 7.6
  • 7.7 - 7.9
  • 8.0 or greater

• Total Alkalinity

  Select Less than 80 mg/L 80 - 200 mg/L Greater than 200 mg/L

  • Less than 80 mg/L
  • 80 - 200 mg/L
  • Greater than 200 mg/L

• Calcium Hardness

• Bromine

  Select Less than 4.5 mg/L 4.5 - 6.5 mg/L 6.6 - 8.9 mg/L 9.0 mg/L or greater Not Applicable

  • Less than 4.5 mg/L
  • 4.5 - 6.5 mg/L
  • 6.6 - 8.9 mg/L
  • 9.0 mg/L or greater
  • Not Applicable

• POOL/SPA 2 TYPE

  Select Outdoor Pool Outdoor Pool with Cyanuric Acid Indoor Pool

  • Outdoor Pool
  • Outdoor Pool with Cyanuric Acid
  • Indoor Pool

• Estimated Bather Load

• Free Chlorine

  Select >3.0 - mg/L 1.0 - 3.0 mg/L <1.0 mg/L Not Applicable

  • >3.0 - mg/L
  • 1.0 - 3.0 mg/L
  • <1.0 mg/L
  • Not Applicable

• Total Chlorine

  Select 3.0 - 5.0 mg/L 5.1 - 9.9 mg/L 10.0 mg/L or greater Not Applicable

  • 3.0 - 5.0 mg/L
  • 5.1 - 9.9 mg/L
  • 10.0 mg/L or greater
  • Not Applicable

• Combined Chlorine

  Select Less than 1.0 mg/L 1.0 mg/L or greater Not Applicable

  • Less than 1.0 mg/L
  • 1.0 mg/L or greater
  • Not Applicable

• pH

  Select Less than 7.0 7.0 - 7.2 7.3 - 7.6 7.7 - 7.9 8.0 or greater

  • Less than 7.0
  • 7.0 - 7.2
  • 7.3 - 7.6
  • 7.7 - 7.9
  • 8.0 or greater

• Total Alkalinity

  Select Less than 80 mg/L 80 - 200 mg/L Greater than 200 mg/L

  • Less than 80 mg/L
  • 80 - 200 mg/L
  • Greater than 200 mg/L

• Calcium Hardness

• Bromine

  Select Less than 2.25 mg/L 2.25 - 4.5 mg/L 4.6 - 8.9 mg/L 9.0 mg/L or greater Not Applicable

  • Less than 2.25 mg/L
  • 2.25 - 4.5 mg/L
  • 4.6 - 8.9 mg/L
  • 9.0 mg/L or greater
  • Not Applicable

• Estimated Bather Load

• Free Chlorine

  Select 5.0 mg/L or greater 3.0 - 5.0 mg/L Less than 3.0 mg/L Not Applicable

  • 5.0 mg/L or greater
  • 3.0 - 5.0 mg/L
  • Less than 3.0 mg/L
  • Not Applicable

• Total Chlorine

  Select 4.0 - 6.0 mg/L 6.1 - 9.9 mg/L 10.0 mg/L or greater Not Applicable

  • 4.0 - 6.0 mg/L
  • 6.1 - 9.9 mg/L
  • 10.0 mg/L or greater
  • Not Applicable

• Combined Chlorine

  Select Less than 1.0 mg/L 1.0 mg/L or greater Not Applicable

  • Less than 1.0 mg/L
  • 1.0 mg/L or greater
  • Not Applicable

• pH

  Select Less than 7.0 7.0 - 7.2 7.3 - 7.6 7.7 - 7.9 8.0 or greater

  • Less than 7.0
  • 7.0 - 7.2
  • 7.3 - 7.6
  • 7.7 - 7.9
  • 8.0 or greater

• Total Alkakinity

  Select Less than 80 mg/L 80 - 200 mg/L Greater than 200 mg/L

  • Less than 80 mg/L
  • 80 - 200 mg/L
  • Greater than 200 mg/L

• Calcium Hardness

• Bromine

  Select Less than 2.25 mg/L 2.25 - 4.5 mg/L 4.6 - 8.9 mg/L 9.0 mg/L or greater Not Applicable

  • Less than 2.25 mg/L
  • 2.25 - 4.5 mg/L
  • 4.6 - 8.9 mg/L
  • 9.0 mg/L or greater
  • Not Applicable

• Cyanuric Acid

  Select Less than 9.0 mg/L 10.0 - 20.0 mg/L 20.0 - 30.0 mg/L 50.0 mg/L or greater

  • Less than 9.0 mg/L
  • 10.0 - 20.0 mg/L
  • 20.0 - 30.0 mg/L
  • 50.0 mg/L or greater

• Estimated Bather Load

• Free Chlorine

  Select Greater than 4.0 mg/L 2.0 - 4.0 mg/L Less than 2.0 mg/L Not Applicable

  • Greater than 4.0 mg/L
  • 2.0 - 4.0 mg/L
  • Less than 2.0 mg/L
  • Not Applicable

• Total Chlorine

  Select 3.0 - 5.0 mg/L 5.1 - 9.9 mg/L 10.0 mg/L or greater Not Applicable

  • 3.0 - 5.0 mg/L
  • 5.1 - 9.9 mg/L
  • 10.0 mg/L or greater
  • Not Applicable

• Combined Chlorine

  Select Less than 1.0 mg/L 1.0 mg/L or greater Not Applicable

  • Less than 1.0 mg/L
  • 1.0 mg/L or greater
  • Not Applicable

• pH

  Select Less than 7.0 7.0 - 7.2 7.3 - 7.6 7.7 - 7.9 8.0 or greater

  • Less than 7.0
  • 7.0 - 7.2
  • 7.3 - 7.6
  • 7.7 - 7.9
  • 8.0 or greater

• Total Alkalinity

  Select Less than 80 mg/L 80 - 200 mg/L Greater than 200 mg/L

  • Less than 80 mg/L
  • 80 - 200 mg/L
  • Greater than 200 mg/L

• Calcium Hardness

• Bromine

  Select Less than 4.5 mg/L 4.5 - 6.5 mg/L 6.6 - 8.9 mg/L 9.0 mg/L or greater Not Applicable

  • Less than 4.5 mg/L
  • 4.5 - 6.5 mg/L
  • 6.6 - 8.9 mg/L
  • 9.0 mg/L or greater
  • Not Applicable

• POOL/SPA 3 TYPE

  Select Outdoor Pool Outdoor Pool with Cyanuric Acid Indoor Pool

  • Outdoor Pool
  • Outdoor Pool with Cyanuric Acid
  • Indoor Pool

• Estimated Bather Load

• Free Chlorine

  Select >3.0 - mg/L 1.0 - 3.0 mg/L <1.0 mg/L Not Applicable

  • >3.0 - mg/L
  • 1.0 - 3.0 mg/L
  • <1.0 mg/L
  • Not Applicable

• Total Chlorine

  Select 3.0 - 5.0 mg/L 5.1 - 9.9 mg/L 10.0 mg/L or greater Not Applicable

  • 3.0 - 5.0 mg/L
  • 5.1 - 9.9 mg/L
  • 10.0 mg/L or greater
  • Not Applicable

• Combined Chlorine

  Select Less than 1.0 mg/L 1.0 mg/L or greater Not Applicable

  • Less than 1.0 mg/L
  • 1.0 mg/L or greater
  • Not Applicable

• pH

  Select Less than 7.0 7.0 - 7.2 7.3 - 7.6 7.7 - 7.9 8.0 or greater

  • Less than 7.0
  • 7.0 - 7.2
  • 7.3 - 7.6
  • 7.7 - 7.9
  • 8.0 or greater

• Total Alkalinity

  Select Less than 80 mg/L 80 - 200 mg/L Greater than 200 mg/L

  • Less than 80 mg/L
  • 80 - 200 mg/L
  • Greater than 200 mg/L

• Calcium Hardness

• Bromine

  Select Less than 2.25 mg/L 2.25 - 4.5 mg/L 4.6 - 8.9 mg/L 9.0 mg/L or greater Not Applicable

  • Less than 2.25 mg/L
  • 2.25 - 4.5 mg/L
  • 4.6 - 8.9 mg/L
  • 9.0 mg/L or greater
  • Not Applicable

• Estimated Bather Load

• Free Chlorine

  Select 5.0 mg/L or greater 3.0 - 5.0 mg/L Less than 3.0 mg/L Not Applicable

  • 5.0 mg/L or greater
  • 3.0 - 5.0 mg/L
  • Less than 3.0 mg/L
  • Not Applicable

• Total Chlorine

  Select 4.0 - 6.0 mg/L 6.1 - 9.9 mg/L 10.0 mg/L or greater Not Applicable

  • 4.0 - 6.0 mg/L
  • 6.1 - 9.9 mg/L
  • 10.0 mg/L or greater
  • Not Applicable

• Combined Chlorine

  Select Less than 1.0 mg/L 1.0 mg/L or greater Not Applicable

  • Less than 1.0 mg/L
  • 1.0 mg/L or greater
  • Not Applicable

• pH

  Select Less than 7.0 7.0 - 7.2 7.3 - 7.6 7.7 - 7.9 8.0 or greater

  • Less than 7.0
  • 7.0 - 7.2
  • 7.3 - 7.6
  • 7.7 - 7.9
  • 8.0 or greater

• Total Alkakinity

  Select Less than 80 mg/L 80 - 200 mg/L Greater than 200 mg/L

  • Less than 80 mg/L
  • 80 - 200 mg/L
  • Greater than 200 mg/L

• Calcium Hardness

• Bromine

  Select Less than 2.25 mg/L 2.25 - 4.5 mg/L 4.6 - 8.9 mg/L 9.0 mg/L or greater Not Applicable

  • Less than 2.25 mg/L
  • 2.25 - 4.5 mg/L
  • 4.6 - 8.9 mg/L
  • 9.0 mg/L or greater
  • Not Applicable

• Cyanuric Acid

  Select Less than 9.0 mg/L 10.0 - 20.0 mg/L 20.0 - 30.0 mg/L 50.0 mg/L or greater

  • Less than 9.0 mg/L
  • 10.0 - 20.0 mg/L
  • 20.0 - 30.0 mg/L
  • 50.0 mg/L or greater

• Estimated Bather Load

• Free Chlorine

  Select Greater than 4.0 mg/L 2.0 - 4.0 mg/L Less than 2.0 mg/L Not Applicable

  • Greater than 4.0 mg/L
  • 2.0 - 4.0 mg/L
  • Less than 2.0 mg/L
  • Not Applicable

• Total Chlorine

  Select 3.0 - 5.0 mg/L 5.1 - 9.9 mg/L 10.0 mg/L or greater Not Applicable

  • 3.0 - 5.0 mg/L
  • 5.1 - 9.9 mg/L
  • 10.0 mg/L or greater
  • Not Applicable

• Combined Chlorine

  Select Less than 1.0 mg/L 1.0 mg/L or greater Not Applicable

  • Less than 1.0 mg/L
  • 1.0 mg/L or greater
  • Not Applicable

• pH

  Select Less than 7.0 7.0 - 7.2 7.3 - 7.6 7.7 - 7.9 8.0 or greater

  • Less than 7.0
  • 7.0 - 7.2
  • 7.3 - 7.6
  • 7.7 - 7.9
  • 8.0 or greater

• Total Alkalinity

  Select Less than 80 mg/L 80 - 200 mg/L Greater than 200 mg/L

  • Less than 80 mg/L
  • 80 - 200 mg/L
  • Greater than 200 mg/L

• Calcium Hardness

• Bromine

  Select Less than 4.5 mg/L 4.5 - 6.5 mg/L 6.6 - 8.9 mg/L 9.0 mg/L or greater Not Applicable

  • Less than 4.5 mg/L
  • 4.5 - 6.5 mg/L
  • 6.6 - 8.9 mg/L
  • 9.0 mg/L or greater
  • Not Applicable

• POOL/SPA 4 TYPE

  Select Outdoor Pool Outdoor Pool with Cyanuric Acid Indoor Pool

  • Outdoor Pool
  • Outdoor Pool with Cyanuric Acid
  • Indoor Pool

• Estimated Bather Load

• Free Chlorine

  Select >3.0 - mg/L 1.0 - 3.0 mg/L <1.0 mg/L Not Applicable

  • >3.0 - mg/L
  • 1.0 - 3.0 mg/L
  • <1.0 mg/L
  • Not Applicable

• Total Chlorine

  Select 3.0 - 5.0 mg/L 5.1 - 9.9 mg/L 10.0 mg/L or greater Not Applicable

  • 3.0 - 5.0 mg/L
  • 5.1 - 9.9 mg/L
  • 10.0 mg/L or greater
  • Not Applicable

• Combined Chlorine

  Select Less than 1.0 mg/L 1.0 mg/L or greater Not Applicable

  • Less than 1.0 mg/L
  • 1.0 mg/L or greater
  • Not Applicable

• pH

  Select Less than 7.0 7.0 - 7.2 7.3 - 7.6 7.7 - 7.9 8.0 or greater

  • Less than 7.0
  • 7.0 - 7.2
  • 7.3 - 7.6
  • 7.7 - 7.9
  • 8.0 or greater

• Total Alkalinity

  Select Less than 80 mg/L 80 - 200 mg/L Greater than 200 mg/L

  • Less than 80 mg/L
  • 80 - 200 mg/L
  • Greater than 200 mg/L

• Calcium Hardness

• Bromine

  Select Less than 2.25 mg/L 2.25 - 4.5 mg/L 4.6 - 8.9 mg/L 9.0 mg/L or greater Not Applicable

  • Less than 2.25 mg/L
  • 2.25 - 4.5 mg/L
  • 4.6 - 8.9 mg/L
  • 9.0 mg/L or greater
  • Not Applicable

• Estimated Bather Load

• Free Chlorine

  Select 5.0 mg/L or greater 3.0 - 5.0 mg/L Less than 3.0 mg/L Not Applicable

  • 5.0 mg/L or greater
  • 3.0 - 5.0 mg/L
  • Less than 3.0 mg/L
  • Not Applicable

• Total Chlorine

  Select 4.0 - 6.0 mg/L 6.1 - 9.9 mg/L 10.0 mg/L or greater Not Applicable

  • 4.0 - 6.0 mg/L
  • 6.1 - 9.9 mg/L
  • 10.0 mg/L or greater
  • Not Applicable

• Combined Chlorine

  Select Less than 1.0 mg/L 1.0 mg/L or greater Not Applicable

  • Less than 1.0 mg/L
  • 1.0 mg/L or greater
  • Not Applicable

• pH

  Select Less than 7.0 7.0 - 7.2 7.3 - 7.6 7.7 - 7.9 8.0 or greater

  • Less than 7.0
  • 7.0 - 7.2
  • 7.3 - 7.6
  • 7.7 - 7.9
  • 8.0 or greater

• Total Alkakinity

  Select Less than 80 mg/L 80 - 200 mg/L Greater than 200 mg/L

  • Less than 80 mg/L
  • 80 - 200 mg/L
  • Greater than 200 mg/L

• Calcium Hardness

• Bromine

  Select Less than 2.25 mg/L 2.25 - 4.5 mg/L 4.6 - 8.9 mg/L 9.0 mg/L or greater Not Applicable

  • Less than 2.25 mg/L
  • 2.25 - 4.5 mg/L
  • 4.6 - 8.9 mg/L
  • 9.0 mg/L or greater
  • Not Applicable

• Cyanuric Acid

  Select Less than 9.0 mg/L 10.0 - 20.0 mg/L 20.0 - 30.0 mg/L 50.0 mg/L or greater

  • Less than 9.0 mg/L
  • 10.0 - 20.0 mg/L
  • 20.0 - 30.0 mg/L
  • 50.0 mg/L or greater

• Estimated Bather Load

• Free Chlorine

  Select Greater than 4.0 mg/L 2.0 - 4.0 mg/L Less than 2.0 mg/L Not Applicable

  • Greater than 4.0 mg/L
  • 2.0 - 4.0 mg/L
  • Less than 2.0 mg/L
  • Not Applicable

• Total Chlorine

  Select 3.0 - 5.0 mg/L 5.1 - 9.9 mg/L 10.0 mg/L or greater Not Applicable

  • 3.0 - 5.0 mg/L
  • 5.1 - 9.9 mg/L
  • 10.0 mg/L or greater
  • Not Applicable

• Combined Chlorine

  Select Less than 1.0 mg/L 1.0 mg/L or greater Not Applicable

  • Less than 1.0 mg/L
  • 1.0 mg/L or greater
  • Not Applicable

• pH

  Select Less than 7.0 7.0 - 7.2 7.3 - 7.6 7.7 - 7.9 8.0 or greater

  • Less than 7.0
  • 7.0 - 7.2
  • 7.3 - 7.6
  • 7.7 - 7.9
  • 8.0 or greater

• Total Alkalinity

  Select Less than 80 mg/L 80 - 200 mg/L Greater than 200 mg/L

  • Less than 80 mg/L
  • 80 - 200 mg/L
  • Greater than 200 mg/L

• Calcium Hardness

• Bromine

  Select Less than 4.5 mg/L 4.5 - 6.5 mg/L 6.6 - 8.9 mg/L 9.0 mg/L or greater Not Applicable

  • Less than 4.5 mg/L
  • 4.5 - 6.5 mg/L
  • 6.6 - 8.9 mg/L
  • 9.0 mg/L or greater
  • Not Applicable

General Notes and Signatures

• Notes

• Officer

  Select Lindsay Hall Alicia Peters Greg Perry Donna Sims

  • Lindsay Hall
  • Alicia Peters
  • Greg Perry
  • Donna Sims

• Officer Signature

  Sign

• Owner/Employee Signature

  Sign