Public swimming pool and spa inspection form

• Reference No

• Trading Name

• Company Name

• Conducted on

  Date

• Prepared by

• Location
  Address

• Contact Number

• Prop/Director

• Email Address
  Address

• ABN/ACN

• Type of Premise

  Hotel

  Motel

  Swim School

  Recreation Facility

  Schools

• Date of inspection

  Date

• Log book maintained

  Yes

  No

  N/A

• Email address

CHLORINE POOLS

Pool 1

• Pool size

  Select Diving Olympic Training Toddler Zero Slide Spa

  • Diving
  • Olympic
  • Training
  • Toddler
  • Zero
  • Slide
  • Spa

• Location

  Indoor

  Outdoor

• Circulation System

  Separate

  Combined

• Dosing

  Metered

  Automatic

  None

• Auxiliary system

  Select UV light Ozone Ionic Cyanurate Other None

  • UV light
  • Ozone
  • Ionic
  • Cyanurate
  • Other
  • None

• Test kit method

  Colorimetric

  Photometric

• Testing frequency

• Bathing load (prev. hour)

  Light

  Medium

  Heavy

• Clarity

  Sparkling

  Clear

  Cloudy

  Debris

• Pool wall

  Clean

  Dirty

  Greasy

• Concourse drainage

  Separate to pool

• Incident response plans / kits

• Water temperature (°C)

• Free Chlorine (mg/L)

• Total Chlorine (mg/L)

• Combined Chlorine (mg/L)

• pH range

• Total alkalinity (mg/L)

• Cyanurate (mg/L)

• Ozone (mg/L)

• Maintenance

  Good

  Poor

• Breakpoint practiced

  Yes

  No

  shock dosed

• Comments

Pool 2

• Pool size

  Toddler

  25 metre

  50 metre

• Location

  Indoor

  Outdoor

• Circulation System

  Separate

  Combined

• Dosing

  Metered

  Automatic

  None

• Auxiliary

  Select UV light Ozone Ionic Cyanurate Other None

  • UV light
  • Ozone
  • Ionic
  • Cyanurate
  • Other
  • None

• Test kit method

  Colorimetric

  Photometric

• Testing frequency

• Bathing load (prev. hour)

  Light

  Medium

  Heavy

• Clarity

  Sparkling

  Clear

  Cloudy

  Debris

• Pool wall

  Clean

  Dirty

  Greasy

• Concourse drainage

  Separate to pool

• Incident response plans / kits

• Water temperature (°C)

• Free Chlorine (mg/L)

• Total Chlorine (mg/L)

• Combined Chlorine (mg/L)

• pH range

• Total alkalinity (mg/L)

• Cyanurate (mg/L)

• Ozone (mg/L)

• Maintenance

  Good

  Poor

• Breakpoint practiced

  Yes

  No

  shock dosed

• Comments

Pool 3

• Pool size

  Toddler

  25 metre

  50 metre

• Location

  Indoor

  Outdoor

• Circulation System

  Separate

  Combined

• Dosing

  Metered

  Automatic

  None

• Auxiliary

  Select UV light Ozone Ionic Cyanurate Other None

  • UV light
  • Ozone
  • Ionic
  • Cyanurate
  • Other
  • None

• Test kit method

  Colorimetric

  Photometric

• Testing frequency

• Bathing load (prev. hour)

  Light

  Medium

  Heavy

• Clarity

  Sparkling

  Clear

  Cloudy

  Debris

• Pool wall

  Clean

  Dirty

  Greasy

• Concourse drainage

  Separate to pool

• Incident response plans / kits

• Water temperature (°C)

• Free Chlorine (mg/L)

• Total Chlorine (mg/L)

• Combined Chlorine (mg/L)

• pH range

• Total alkalinity (mg/L)

• Cyanurate (mg/L)

• Ozone (mg/L)

• Maintenance

  Good

  Poor

• Breakpoint practiced

  Yes

  No

  shock dosed

• Comments

BROMINE POOLS & SPA

Pool 1

• Pool size

  Toddler

  25 metre

  50 metre

• Location

  Indoor

  Outdoor

• Circulation System

  Separate

  Combined

• Dosing

  Metered

  Automatic

  None

• Auxiliary

  Select UV light Ozone Ionic Cyanurate Other None

  • UV light
  • Ozone
  • Ionic
  • Cyanurate
  • Other
  • None

• Test kit method

  Colorimetric

  Photometric

• Testing frequency

• Bathing load (prev. hour)

  Light

  Medium

  Heavy

• Clarity

  Sparkling

  Clear

  Cloudy

  Debris

• Pool wall

  Clean

  Dirty

  Greasy

• Concourse drainage

  Separate to pool

• Incident response plans / kits

• Water temperature (°C)

• Free Bromine (mg/L)

• Total Bromine (mg/L)

• Combined Chlorine (mg/L)

• pH range

• Total alkalinity (mg/L)

• Cyanurate (mg/L)

• Ozone (mg/L)

• Maintenance

  Good

  Poor

• Breakpoint practiced

  Yes

  No

  shock dosed

• Comments

Spa

• Location

  Indoor

  Outdoor

• Water temperature (°C)

• Free Bromine (mg/L)

• Total Bromine (mg/L)

• pH range

• Total alkalinity (mg/L)

• Comments

Premises Inspection Report

1. Pool Surrounds

• Floor or ground (graded, drained, non-slip, cleaned and in good repair) - Satisfactory

  Yes

  No

  N/A

• Walls and ceiling (for indoor pools); (tiled, clean and in good repair)

  Yes

  No

  N/A

• Lighting and ventilation (adequate and operating)

  Yes

  No

  N/A

• Fittings and fixtures (clean, in good repair and adequate)

  Yes

  No

  N/A

• Garbage disposal (clean, in good repair and adequate)

  Yes

  No

  N/A

2. Toilets / change rooms / showers

• Floor (graded, drained, tiled and clean)

  Yes

  No

  N/A

• Walls and ceiling (tiled - clean and in good repair)

  Yes

  No

  N/A

• Lighting and ventilation (adequate and operating)

  Yes

  No

  N/A

• Fittings and fixtures (clean, in good repair and adequate)

  Yes

  No

  N/A

• Toilet paper, soap and hand drying facilities provided?

  Yes

  No

  N/A

• Nappy change facilities (clean, in good repair)

  Yes

  No

  N/A

• Sanitary disposal

  Yes

  No

  N/A

• Garbage disposal (cleanliness, adequate)

  Yes

  No

  N/A

3. Chemical storage

• Chemicals (stored in labelled containers)

  Yes

  No

  N/A

• Location (secured and away from other chemicals)

  Yes

  No

  N/A

• Pool manger to seek advice from WorkCover about the safe storage of pool chemicals

  Yes

  No

  N/A

4. Fencing

• Refer to local government to follow-up any problems

  Yes

  No

  N/A

• Chemistry

  Pass

  Fail

• Risk to public health

  Yes

  No

• Last inspection

  Date

• Pool operator formal training?

• Bacteriological sample taken?

• Result?

  Warning

  Improvement notice

  Prohibition order

  None

  Other

• EHO name

• Overall comments

• Owner/Prop Signature

  Sign

• EHO/Officer

  Sign