Pool Water Test Record

• Location
  Address

• Conducted on

  Date

• Test Completed By

• Signed (Tester)

  Sign

• Supervisor

• Signed (Supervisor)

  Sign

Pool

• Pool

  50m Pool

  25m Pool

  Program Pool

  Leisure Pool

  Spa Pool

• Insert image of sample locations

• From which location was the sample taken?

  Select 1 2 3 4 5 6

  • 1
  • 2
  • 3
  • 4
  • 5
  • 6

• Insert image of sample locations

• From which location was the sample taken?

  Select 1 2 3 4 5 6

  • 1
  • 2
  • 3
  • 4
  • 5
  • 6

• Insert image of sample locations

• From which location was the sample taken?

  Select 1 2 3 4 5 6

  • 1
  • 2
  • 3
  • 4
  • 5
  • 6

• Insert diagram showing sample locations

• From which location was the sample taken?

  Select 1 2 3 4 5 6

  • 1
  • 2
  • 3
  • 4
  • 5
  • 6

• Insert diagram showing sample locations

  Yes

  No

  N/A

• From which location was the sample taken?

  Select 1 2 3 4 5 6

  • 1
  • 2
  • 3
  • 4
  • 5
  • 6

• Bather Load

  Low (< 20)

  Medium (21 - 50)

  High (> 50)

• Water Clarity

  Good

  Fair

  Poor

Photometer Results

• Free Chlorine (ppm)

• Total Chlorine (ppm)

• Combined Chlorine (ppm)

• pH

• Alkalinity

• Calcium Hardness

• TDS

Temperature

• Insert table of prescribed operating parameters for facility

• Are all test results within acceptable operating parameters?

  Yes

  No

Plant Inspection

• Remember to STOP - LOOK, LISTEN & FEEL. Follow the flow of water and look for leaks, valves in the incorrect position or obvious signs of damage. Listen for squealing, grating, changes in pitch or an absence of noise. Feel for airflow and unusual vibrations.

• Chlorine (ppm)

• pH

Temperature

• Pump #1 Discharge Pressure (kpa)

• Filter #1 Inlet Pressure (kpa)

• Filter #1 Outlet Pressure (kpa)

• Pump #2 Discharge Pressure (kpa)

• Filter #2 Inlet Pressure (kpa)

• Were there any issues requiring attention?

  Yes

  No

• If yes, detail

• Filter #2 Outlet Pressure (kpa)

Water Balance Adjustment

• Langelier Saturation Index

  

• Saturation Index

• Were chemicals required to be manually added (either directly to the pool or via an inline dosing method) to adjust water chemistry?

  Yes

  No

• Insert dosage table for your facility

• Chemical Type

  Sodium Hypochlorite

  Hydrochloric Acid

  Sodium Bicarbonate

  Sodium Thiosulphate

  Cyanuric Acid

• Quantity