Pool Inspection Report Form PDF Details

Ensuring public swimming pools meet specific health and safety standards is critical for the well-being of their users. The Pool Inspection Report form, utilized under Chapter V of the State Sanitary Code, 105 CMR 435.000, serves as a comprehensive tool for evaluating various aspects of pool maintenance and operation. This form addresses pools categorized as public, semi-public, and special purpose, ensuring a wide scope of water recreational areas are inspected thoroughly. Inspectors record details about the pool’s location, capacity, water source, and treatment methods. Furthermore, the form meticulously lists regulations related to structural conditions, water quality, safety equipment, and personnel requirements. Violations are marked alongside satisfactory items, offering a clear overview of areas needing attention. Special regulations include but are not limited to, the adequacy of bathhouse facilities, pool enclosure, water filtration systems, emergency procedures, and the presence of necessary safety and first aid equipment. Importantly, the form mandates immediate corrective actions for certain violations, emphasizing the importance of maintaining high standards for pool safety and sanitation. Signed off by both the operator and a representative of the Board of Health or Health Department, the document underscores the collaborative effort in upholding public health standards in aquatic environments.

QuestionAnswer
Form NamePool Inspection Report Form
Form Length3 pages
Fillable?No
Fillable fields0
Avg. time to fill out45 sec
Other namesswimming pool inspection report, swimming pool inspection sheet, residential swimming pool inspection form, swimming pool inspection report inspections

Form Preview Example

NAME OF CITY OR TOWN

STATE SANITARY CODE: CHAPTER V, MINIMUM STANDARDS FOR SWIMMING POOLS,

105 CMR 435.000

SWIMMING POOL INSPECTION REPORT

TYPE OF POOL: PUBLIC

SEMI-PUBLIC

SPECIAL PURPOSE POOL

NAME OF POOL

 

 

 

ADDRESS

 

 

 

 

 

 

 

OWNER

 

 

 

ADDRESS

 

DATE OF

 

POOL CAPACITY

 

INSPECTED BY

 

INSPECTION

 

# OF GALS

 

 

 

 

 

 

 

 

 

METHOD OF WATER

 

BATHER

 

# OF LIFEGUARDS

WATER SOURCE:

TREATMENT

 

LOAD

 

____

 

 

 

 

 

 

 

Regulation 105 CMR 435.000 The items marked below with an “X” indicate the violated provisions of 105 CMR 435.000. Items marked with a “” are satisfactory.

REGULATION

X/

VIOLATIONS/COMMENTS

.03 Bathhouse and sanitary facilities adequate lighting; ventilation; sanitary condition.

.03 Adequate enclosure around pool. Gate self-latching w/ latch 4 ft above ground.

.04 Sewage Disposal

.05 Location, structural stability, finish.

.06 Water circulation & filtration systems. Filter Effluent flow meter reading: ______gpm. # of turnovers _______

.06 Suitable automatic equipment for disinfection of pool water.

.06 Carbon dioxide (CO2) equipment for pH control adequate. CO2 cylinders anchored. Inaccessible to public, adequate ventilation provided.

.08 Inlets and outlets - Inlets located to produce uniform circulation. Over rim fill spout 6” above maximum water level. Properly shielded and located.

.08 Main drain suction outlets covered with suitable protective covers or grates. Cannot be removed without the use of tools. Open area does not provide entrapment of fingers, toes, etc. At least one antivortex drain provided.

.08 Each system outlet protected against user entrapment by antivortex cover or other means. Minimum of 2 suction outlets provided for each pump, properly located and plumbed.

.08 Suction outlet covers in place, unbroken and secure and cannot be removed except with the use of tools.

Close pool immediately if outlet covers missing, broken, loose or can be removed without tools until repairs can be made.

.08

Special purpose pool and wading pools equipped with

 

 

 

 

 

emergency shut off pump switch. Accessible and

 

 

 

 

 

prominently marked.

 

 

 

 

 

 

 

 

.09

Cross connections. Portable water supplied through air

 

 

 

 

 

gap.

 

 

 

 

 

 

 

 

.10

Skimming facilities.

50% of recirculation drawn from

 

 

 

 

 

surface of pool.

 

 

 

 

 

 

 

 

.12

Line with floats separates non-swimmer area from

 

 

 

 

 

deeper water.

 

 

 

 

 

 

 

 

.12

Water depth markings on deck and walls. Properly

 

 

 

 

 

spaced. Boundary line on pool floor and walls. Step

 

 

 

 

 

edges marked with contrasting color.

 

 

 

 

.13

Walkway and decks 4 feet wide, safe condition.

 

 

 

 

.14

Ladders, steps - one per 75 feet. Not less than 2

 

 

 

 

 

ladders.

 

 

 

 

 

 

 

 

.15

Diving equipment in safe condition.

 

 

 

 

 

 

 

.17

Pool supervision - Pool supervision provided.

 

 

 

 

 

Effective Jan. 1, 1999, pool supervisor certified as pool

 

 

 

 

 

operator from YMCA or NSPF.

 

 

 

 

 

 

 

.21

Permit requirements - Permit issued. Adequate

 

 

 

 

 

maintenance and testing records maintained. Records

 

 

 

 

 

initialed by person making tests.

 

 

 

 

 

 

 

.22

Health regulations: Signs posted. Health warning

 

 

 

 

 

signs posted for special purpose pools.

 

 

 

 

.23

Lifeguards required:

Yes

No

 

 

 

 

 

If lifeguards required. Proper credentials, proper suits

 

 

 

 

 

and garments worn. Whistle and bullhorn provided

 

 

 

 

.24

Safety equipment. Ring buoys and rescue hook

 

 

 

 

 

provided. Rescue tube and backboard with straps at

 

 

 

 

 

pools attended by a lifeguard.

 

 

 

 

 

 

 

.25

First Aid equipment provided.

 

 

 

 

 

 

 

.25

Emergency Communication System at the pool and in

 

 

 

 

 

working order. Emergency communication device in

 

 

 

 

 

unlocked area and available at all times to staff and the

 

 

 

 

 

public. Operating instructions and emergency

 

 

 

 

 

numbers posted.

 

 

 

 

 

 

 

 

.26

Waste and backwash water disposal properly

 

 

 

 

 

discharged. No direct connection to sewer system.

 

 

 

 

 

Separation tank provided for diatomaceous earth filter

 

 

 

 

 

backwash water.

 

 

 

 

 

 

 

 

.29

Chemical standards

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

POOLSIDE READINGS

 

 

 

 

 

 

Bromine

 

(2.0-6.0 ppm*)

 

Total Chlorine

 

 

 

 

 

Alkalinity

 

(50-150 ppm)

 

Free Chlorine

(1.0-3.0 ppm)

 

 

 

 

Cyanuric Acid

 

(30-100 ppm)

 

Comb.

(0.0-0.2 ppm)

 

 

 

 

 

 

 

 

 

Chlorine

 

 

 

 

 

Water Temp.

 

104°F.

 

pH level

(7.2-7.8)

 

 

 

 

* parts per million

 

Other

 

 

 

.29

Pool water tested with appropriate frequency.

 

 

 

 

.30

Water testing equipment. DPD kit provided for

 

 

 

 

 

chlorine and bromine. Unbreakable thermometer for

 

 

 

 

 

special purpose pools.

 

 

 

 

 

 

 

.31

Water clarity

 

 

 

 

 

 

 

 

.32 Water clarity maintenance. Filtration system operating continuously.

.32 Special purpose pool drained, cleaned and every 14 days.

Maximum Operating Temperatures for Special Purpose Pools. (SPP).

.33 a. Thermostatic control provided for each SPP.

b.Thermostatic control only accessible to the pool operator

.38 General sanitation

REGULATION

NO.

THE SPACE BELOW DESCRIBES VIOLATIONS MARKED ABOVE

.34

X/

Closure of the pool. POOL MUST BE CLOSED UNTIL IT MEETS THE STANDARDS OF 105 CMR 435.29 THROUGH 435.31.

SIGNED_______________________________________________

Operator

SIGNED_______________________________________________

Board of Health/Health Department

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1. You will need to complete the swimming pool inspection report form correctly, hence be mindful while working with the segments that contain these blanks:

Learn how to complete residential swimming pool inspection form part 1

2. When this section is done, go to enter the relevant information in all these - Sewage Disposal, Location structural stability, Water circulation filtration, Suitable automatic equipment for, Carbon dioxide CO equipment for, Inlets and outlets Inlets, Main drain suction outlets, Each system outlet protected, and Suction outlet covers in place.

The right way to complete residential swimming pool inspection form step 2

3. This next portion is mostly about Special purpose pool and wading, Cross connections Portable water, and Ladders steps one per feet Not - type in each of these fields.

Filling in segment 3 in residential swimming pool inspection form

When it comes to Cross connections Portable water and Special purpose pool and wading, be certain that you do everything properly here. These are surely the most important fields in the form.

4. This next section requires some additional information. Ensure you complete all the necessary fields - Ladders steps one per feet Not, POOLSIDE READINGS Bromine, ppm ppm ppm, Water Temp parts per million, cid F, Total Chlorine Free Chlorine Comb, ppm ppm, and Pool water tested with - to proceed further in your process!

Tips on how to fill out residential swimming pool inspection form part 4

5. This final notch to finalize this form is integral. Make sure to fill out the necessary fields, particularly REGULATION, and THE SPACE BELOW DESCRIBES, prior to finalizing. In any other case, it may end up in an unfinished and potentially unacceptable form!

THE SPACE BELOW DESCRIBES, REGULATION, and REGULATION in residential swimming pool inspection form

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