Information

  • Premises Name

  • Type of Premise

  • Location
  • Occupier

  • Conducted on

POOL 1

Details

  • Pool Type

  • Indoor/Outdoor

  • Circulation System

  • Disinfectant Type

  • Dosing

  • Auxillary System

  • Test Kit Method

  • Testing Frequency

  • Log Book

  • Bathing Load (Prev Hour)

  • Clarity

  • Pool Wall

  • Concourse Drainage

  • Incident Response Plan Kits

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

  • Maintenance

  • Breakpoint Practiced

POOL 2

Details

  • Pool Type

  • Indoor/Outdoor

  • Circulation System

  • Disinfectant Type

  • Dosing

  • Auxillary System

  • Test Kit Method

  • Testing Frequency

  • Log Book

  • Bathing Load (Prev Hour)

  • Clarity

  • Pool Wall

  • Concourse Drainage

  • Incident Response Plan Kits

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

  • Maintenance

  • Breakpoint Practiced

POOL 3

Details

  • Pool Type

  • Indoor/Outdoor

  • Circulation System

  • Disinfectant Type

  • Dosing

  • Auxillary System

  • Test Kit Method

  • Testing Frequency

  • Log Book

  • Bathing Load (Prev Hour)

  • Clarity

  • Pool Wall

  • Concourse Drainage

  • Incident Response Plan Kits

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

  • Maintenance

  • Breakpoint Practiced

RESULTS

  • Chemistry Pass/Fail

  • Risk to Public Health

  • Comments

  • Last Inspection by Council

  • Pool Operator Formal Training

  • Bacteriological Sample Taken

  • Bacteriological Results Attached

  • Closing Order Issued

  • Copy Attached

  • Revocation Order Issued

  • Copy Attached

  • Inspection Officer

  • Signature

  • Sketch of Pool Complex (if Required)

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