Water Temperature Inspection Form
Please complete all fields to document your water temperature inspection accurately.
Inspector Full Name
*
First Name
Last Name
Inspection Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Inspection Location
*
Water Source Type
*
Please Select
Tap
Well
Tank
Reservoir
Other
Temperature Reading
*
Measurement Unit
*
Celsius (°C)
Fahrenheit (°F)
Measurement Method
*
Please Select
Digital Thermometer
Glass Thermometer
Infrared Thermometer
Other
Is the water temperature within the acceptable range?
*
Yes
No
Not Applicable
Corrective Action Taken (if any)
Additional Comments / Observations
Submit
Should be Empty: