Title Page

  • Application Number

  • Name of premises

  • Address of premises

  • Name of manager/ owner

  • Contact phone number

  • Email of manager/owner

  • Trim File No.

  • Inspection Started

  • Authorised Officer/s

Business Details

  • Entity Name (Individual/ Partnership/Company/Body Corporate/Trust/Other)

  • ABN Number

  • Postal Address

  • Person/s Interviewed

Unit

  • Pool Type

  • Photo of Pool

  • Disinfectant Dosing System Make/Model

  • Photo of Dosing System

  • Dosing System Controller

  • Dosing System

  • Disinfection Type

  • Are dosing chemicals APVMA approved?

  • Records Sighted?

  • Are All Parameters Tested?

  • Is Cyanuric Acid Used?

  • Bathing Load

  • Free Chlorine

  • pH

  • Total Chlorine

  • Total Bromine

  • Cyanuric Acid

  • Total Alkalinity

  • ORP

  • Water Temperature

  • Weather Conditions On Inspection

Additional Unit

    Additional Unit
  • Pool Type

  • Photo of Pool

  • Disinfectant Dosing System Make/Model

  • Photo of Dosing System

  • Dosing System Controller

  • Dosing System

  • Disinfection Type

  • Records Sighted?

  • Are All Parameters Tested?

  • Is Cyanuric Acid Used?

  • Bathing Load

  • Free Chlorine

  • pH

  • Total Chlorine

  • Total Bromine

  • Cyanuric Acid

  • Total Alkalinity

  • ORP

  • Water Temperature

Inspection Outcome

  • Comments

  • Inspection Outcome

  • Person Interviewed Signature

  • Authorised Officers Signature

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.