Water Safety Checklist
Complete this form to assess and document compliance with water safety standards at your site.
Site/Facility Name
*
Assessment Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Assessor's Full Name
*
First Name
Last Name
Contact Email
*
example@example.com
Contact Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Water Safety Items Checklist
*
Rows
Yes
No
N/A
Appropriate signage is visible and legible
1
2
3
Barriers/fencing are secure and in good condition
4
5
6
Lifebuoys or rescue equipment are accessible and in good condition
7
8
9
Emergency contact information is posted
10
11
12
Water clarity allows visibility to the bottom
13
14
15
No slip/trip hazards around water area
16
17
18
First aid kit is available and stocked
19
20
21
Supervision is present (if required)
22
23
24
Drain covers are secure and intact
25
26
27
Chemicals (if any) are safely stored
28
29
30
Are there any risks or hazards identified during this assessment?
*
Yes
No
If risks or hazards were identified, please describe them and any actions taken or recommended.
Additional Comments or Observations
Signature of Assessor
*
Submit Checklist
Submit Checklist
Should be Empty: