Title Page
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Location
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Conducted on
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Prepared by
Bathhouse/ Pool Supplies Order/ Pool
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Toilets Clean
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Sinks Clean
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Showers Clean
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Floors Clean
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Mirrors Clean
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Trash Emptied
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Toilet Paper Stocked
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Paper Towels Stocked
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Soap Dispensers Filled
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Trash Bags replaced and empty
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Pool Vacuumed
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Tiles Clean
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Skimmers Clean
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No Floating Debris
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Good Clarity
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Deck Clean
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Furniture straight
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Pump Room Clean
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Guard Room Clean
Pool Operation/ Pool Safety/ Filtration/ Staff
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Maintaining Gate Control
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Guard Attentive
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Guards in Lifeguard Stand
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Pool Operator on Duty
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All Hazardous Chemicals Stored Properly
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Emergency Action Plan Posted
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Emergency Phone Numbers Posted
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No Deck Hazard Present
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MSDS Up to Date & Available
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Pump Room Door(s) Closed & Secure
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Ladder & Hand rails Secure
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Diving Board Secure & Safe
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Safety Rope in Place
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Rescue Tube Easily Accessible
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Original Certifications Present & Current
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Flow Rate:
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Hair/Lint Basket Clean
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Last Backwash/Filters Changed
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Pressure on Tanks
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Log book Up to Date
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Daily Checklist Current
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Schedules Filled out
Supervisor & Community Representative Acknowledgements
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Supervisor's Printed Name
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Supervisor's Signature
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Date Signed
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Since your last inspection how would you rate your pool's operation?
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Remarks:
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Community Representative's Printed Name
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Community Representative's Signature
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Date Signed
