Swimming Pool and Spa Pool Inspection Report

• Premises Name

• Type of Premise

  Premise1
• Location
  Address

• Occupier

• Conducted on

  Date

POOL 1

Details

• Pool Type

  Select Diving Olympic Training Toddler Zero Slide Spa

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

• Indoor/Outdoor

  Indoor

  Outdoor

• Circulation System

  Separate

  Combined

• Disinfectant Type

  Chlorine

  Bromine

• Dosing

  Metered

  Automatic

• Auxillary System

  Select UV Light Ozone Ionic Cyanurate Other None

  • UV Light
  • Ozone
  • Ionic
  • Cyanurate
  • Other
  • None

• Test Kit Method

  Colorimetric

  Photometric

• Testing Frequency

• Log Book

  Complete

  Current

  Poor

• Bathing Load (Prev Hour)

  Light

  Medium

  Heavy

• Clarity

  Sparkling

  Clear

  Cloudy

  Debris

• Pool Wall

  Clean

  Dirty

  Greasy

• Concourse Drainage

  Separate to Pool

• Incident Response Plan Kits

  Yes

  No

Chemistry

• Free Chlorine (Br) mg/L

• Total Chlorine (Br) mg/L

• Comb. Chlorine mg/L

• pH

• Total Alkalinity mg/L CaCo3

• Temperature (Celcius)

• Cyanurate mg/L

• Ozone mg/L

• ORP mv

• Last Bacto Sample

  Pass

  Fail

  Result

• Maintenance

  Good

  Poor

• Breakpoint Practiced

  Yes

  No

  Shock Dosed

POOL 2

Details

• Pool Type

  Select Diving Olympic Training Toddler Zero Slide Spa

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

• Indoor/Outdoor

  Indoor

  Outdoor

• Circulation System

  Separate

  Combined

• Disinfectant Type

  Chlorine

  Bromine

• Dosing

  Metered

  Automatic

• Auxillary System

  Select UV Light Ozone Ionic Cyanurate Other None

  • UV Light
  • Ozone
  • Ionic
  • Cyanurate
  • Other
  • None

• Test Kit Method

  Colorimetric

  Photometric

• Testing Frequency

• Log Book

  Complete

  Current

  Poor

• Bathing Load (Prev Hour)

  Light

  Medium

  Heavy

• Clarity

  Sparkling

  Clear

  Cloudy

  Debris

• Pool Wall

  Clean

  Dirty

  Greasy

• Concourse Drainage

  Separate to Pool

• Incident Response Plan Kits

  Yes

  No

Chemistry

• Free Chlorine (Br) mg/L

• Total Chlorine (Br) mg/L

• Comb. Chlorine mg/L

• pH

• Total Alkalinity mg/L CaCo3

• Temperature (Celcius)

• Cyanurate mg/L

• Ozone mg/L

• ORP mv

• Last Bacto Sample

  Pass

  Fail

  Result

• Maintenance

  Good

  Poor

• Breakpoint Practiced

  Yes

  No

  Shock Dosed

POOL 3

Details

• Pool Type

  Select Diving Olympic Training Toddler Zero Slide Spa

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

• Indoor/Outdoor

  Indoor

  Outdoor

• Circulation System

  Separate

  Combined

• Disinfectant Type

  Chlorine

  Bromine

• Dosing

  Metered

  Automatic

• Auxillary System

  Select UV Light Ozone Ionic Cyanurate Other None

  • UV Light
  • Ozone
  • Ionic
  • Cyanurate
  • Other
  • None

• Test Kit Method

  Colorimetric

  Photometric

• Testing Frequency

• Log Book

  Complete

  Current

  Poor

• Bathing Load (Prev Hour)

  Light

  Medium

  Heavy

• Clarity

  Sparkling

  Clear

  Cloudy

  Debris

• Pool Wall

  Clean

  Dirty

  Greasy

• Concourse Drainage

  Separate to Pool

• Incident Response Plan Kits

  Yes

  No

Chemistry

• Free Chlorine (Br) mg/L

• Total Chlorine (Br) mg/L

• Comb. Chlorine mg/L

• pH

• Total Alkalinity mg/L CaCo3

• Temperature (Celcius)

• Cyanurate mg/L

• Ozone mg/L

• ORP mv

• Last Bacto Sample

  Pass

  Fail

  Result

• Maintenance

  Good

  Poor

• Breakpoint Practiced

  Yes

  No

  Shock Dosed

RESULTS

• Chemistry Pass/Fail

  Pass

  Fail

• Risk to Public Health

  Yes

  No

• Comments

• Last Inspection by Council

  Date

• Pool Operator Formal Training

  Yes

  No

• Bacteriological Sample Taken

  Yes

  No

• Bacteriological Results Attached

  Yes

  No

• Closing Order Issued

  Yes

  No

• Copy Attached

  Yes

  No

• Revocation Order Issued

  Yes

  No

• Copy Attached

  Yes

  No

• Inspection Officer

  Dayanand, Sharomi

  Kieltyka, Douglas

  Lamb, Susan

• Signature

  Sign

• Sketch of Pool Complex (if Required)

  Drawing