Swimming Pool Inspection Form
Facility Name
Inspection Date
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Facility Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Inspection purpose
Construction
Permit / Opening
Routine
Follow-up
Complaint
Pool class
Competition
General recreational
Lodging related
Special Purpose
Therapy
Pool type
Swimming pool
Spa
Special purpose
Location
Indoor
Outdoor
Both
Critical violations
Rows
Yes
No
Pool is enclosed / fencing in compliance
1
2
Drain covers are compliant, secure, and present
3
4
Main drains are clearly visible
5
6
Emergency phone is in good condition and easily accessible
7
8
Disinfectant level is proper
9
10
pH level is between 7.2 and 7.8
11
12
Chemical feeder is operational and approved
13
14
Filter is operational, maintained, and approved
15
16
Pump is operational, maintained, and approved
17
18
Lifesaving equipment is appropriate
19
20
Critical completion score
Area & water safety
Rows
Yes
No
Hand ladders are installed and secure
21
22
Float line is in position
23
24
Vacuum line is protected
25
26
Step marking is installed and contrasting
27
28
Pool deck is clean and maintained
29
30
Skimmers are in operation and maintained
31
32
Chlorine level is not more than 0.4 ppm
33
34
Turnover rate is adequate
35
36
Return inlets are maintained
37
38
Cyanuric acid level is adequate
39
40
Area & water safety score
Equipment/pump room
Rows
Yes
No
Automated controller is operational
41
42
Pumps are interlocked
43
44
Piping is identified and marked
45
46
Pump stainer basket is cleanable
47
48
Flow meter is in appropriate range and location
49
50
Equipment/pump room score
Hygiene facilities
Rows
Yes
No
Toilets and lavatories are clean, maintained, and stocked
51
52
Rinse shower is maintained
53
54
Dressing showers are clean, maintained
55
56
Hot and cold water is available at dressing showers
57
58
Hygiene facilities score
Records
Rows
Yes
No
Operator training certificate is available onsite and approved
59
60
Lifeguard training certification is available onsite
61
62
Inspection report is available in public view
63
64
Daily records of water testing is available in public view
65
66
Records score
Overall score
Inspector name
First Name
Last Name
Signature
Submit
Should be Empty: