Public swimming pool and spa inspection form

• Proprietor

• Document No.

• Trading Name

• Conducted on

  Date

• Prepared by

  Select Josh Smith Dan Bugitti Daryl Pasfield Philip Martin

  • Josh Smith
  • Dan Bugitti
  • Daryl Pasfield
  • Philip Martin
• Location
  Address

• Person interviewed

• Phone number

• Email address

• Test kit satisfactory

  Yes

  No

  N/A

Log Book Maintenance

• Have records of the following parameters been maintained at the frequency specified?

• Free Chlorine recorded daily

  Yes

  No

  N/A

• Total Chlorine recorded daily

  Yes

  No

  N/A

• Total Bromine recorded daily

  Yes

  No

  N/A

• Combined Chlorine recorded daily

  Yes

  No

  N/A

• pH recorded daily

  Yes

  No

  N/A

• Alkalinity recorded daily

  Yes

  No

  N/A

• Cyanuric acid recorded weekly

  Yes

  No

  N/A

• Have records been kept for the previous 6 months?

  Yes

  No

  N/A

• Comments

CHLORINE POOLS & SPAS

• Chlorine Pool

Pool

• Description

• Pool photo

  Media

• Pool type

  Select Outdoor Indoor

  • Outdoor
  • Indoor

• Disinfectant System

  Select Metered Automatic

  • Metered
  • Automatic

• Bathing load

  Select Light Medium Heavy

  • Light
  • Medium
  • Heavy

• Is the pool clean and free of debris

  Yes

  No

  N/A

• Free Chlorine (mg/L)

• Total Chlorine (mg/L)

• Combined Chlorine (mg/L)

• pH range

• Total Alkalinity (mg/L)

• Cyanurate (mg/L)

• Comments

• Chlorine Spa

Spa

• Description

• Spa photo

  Media

• Spa type

  Select Outdoor Indoor

  • Outdoor
  • Indoor

• Disinfectant System

  Select Metered Automatic

  • Metered
  • Automatic

• Bathing load

  Select Light Medium Heavy

  • Light
  • Medium
  • Heavy

• Is the spa clean and free of debris

  Yes

  No

  N/A

• Free Chlorine (mg/L)

• Total Chlorine (mg/L)

• Combined Chlorine (mg/L)

• pH range

• Total Alkalinity (mg/L)

• Cyanurate (mg/L)

• Comments

BROMINE POOLS & SPAS

• Bromine Pool

Pool

• Description

• Pool photo

  Media

• Pool type

  Select Outdoor Indoor

  • Outdoor
  • Indoor

• Disinfectant System

  Select Metered Automatic

  • Metered
  • Automatic

• Bathing load

  Select Light Medium Heavy

  • Light
  • Medium
  • Heavy

• Is the pool clean and free of debris

  Yes

  No

  N/A

• Total Bromine (mg/L)

• pH range

• Total Alkalinity (mg/L)

• Comments

• Bromine Spa

Spa

• Description

• Pool photo

  Media

• Spa type

  Select Outdoor Indoor

  • Outdoor
  • Indoor

• Disinfectant System

  Select Metered Automatic

  • Metered
  • Automatic

• Bathing load

  Select Light Medium Heavy

  • Light
  • Medium
  • Heavy

• Is the spa clean and free of debris

  Yes

  No

  N/A

• Total Bromine (mg/L)

• pH range

• Total Alkalinity (mg/L)

• Comments

Recommendations

• Comments

• Environmental Health Officer

  Sign

Contact

• Greater Taree City Council
  2 Pulteney Street
  PO Box 482
  TAREE NSW 2430
  P: 02 6592 5399 F: 02 6592 5311 E: gtaree@gtcc.nsw.gov.au