Form Center

2. Date/Time*
   Date/Time

   Date/Time
4. 1. Perimeter is secure - fences are intact and all gates/doors are locked.

   1. Yes
   2. No
5. 1. If answer is no - describe issue.
7. 2. Building is secure - windows are intact and all doors are closed and locked.*

   1. Yes
   2. No
8. 2. If answer is no - describe issue.
10. 3. Pool bottom scan performed - drains are visible, water is clear, no abnormalities found.*

    1. Yes
    2. No
11. 3. If answer is no - describe issue.
13. 4. Decks are clean and clear - no slip and fall hazards, deck drains clear.*

    1. Yes
    2. No
14. 4. If answer is no - describe issue.
16. 5. Water is circulating - pumps are running*

    1. Yes
    2. No
17. 5. If answer is no - describe issue.
19. 6. Pool water chemistry has been tested and is within acceptable range.*

    1. Yes
    2. No
20. 6. If answer is no - describe issue.
22. 7. AED has been tested and is functioning properly.*

    1. Yes
    2. No
23. 7. If answer is no - describe issue.
25. 8. Backboard and rescue equipment in working order and is in position.*

    1. Yes
    2. No
26. 8. If answer is no - describe issue.
28. 9. Ring buoy and reaching pole are present and in proper location.*

    1. Yes
    2. No
29. 9. If answer is no - describe issue.
31. 10. Lifeline rope is secure and in place.*

    1. Yes
    2. No
32. 10. If answer is no - describe issue.
34. 11. Lift battery is installed in lift and lift is functioning properly.*

    1. Yes
    2. No
35. 11. If answer is no - describe issue.
37. 12. Bathrooms checked - clean and stocked.*

    1. Yes
    2. No
38. 12. If answer is no - describe issue.
40. 13. Emergency call box and pool phone tested and working properly.*

    1. Yes
    2. No
41. 13. If answer is no - describe issue
43. 14. Daily Pollution Prevention Inspection Checklist completed.*

    1. Yes
    2. No
44. 14. If answer is no - describe issue.
46. 15. List any additional information regarding this inspection below (if needed).
48. 16. Upload any photos related to this inspection below (if needed).
50. 17. I verify that the above items have been inspected and conditions have been accurately documented. Any issues have been reported and further explained above (Insert name).*
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54. Submit

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