Date:

[Date]

Pool Name:

[Your Company Name]

Location:

[Your Company Address]

Responsible Person:

[Your Name]

Contact Information:

[Your Company Email]

Weather Conditions:

Temperature:

Weather:

Wind Speed:

Precipitation:

• Yes / No

Maintenance Tasks:

Cleaning:

Skim Surface:

• Yes / No

Vacuum Pool Floor:

• Yes / No

Brush Walls:

• Yes / No

Clean Skimmer Basket:

• Yes / No

Clean Pump Basket:

• Yes / No

Empty Automatic Cleaner Bag:

• Yes / No

Backwash Filter:

• Yes / No

Rinse Filter:

• Yes / No

Chemical Checks:

Chlorine Level:

___ ppm

pH Level:

Total Alkalinity:

___ ppm

Calcium Hardness:

___ ppm

Cyanuric Acid (CYA):

___ ppm

Salt Level (if applicable):

___ ppm

Other Chemicals:

Equipment Checks:

Pump:

Operational / Requires Maintenance

Filter:

Operational / Requires Maintenance

Heater:

Operational / Requires Maintenance

Automatic Pool Cleaner:

Operational / Requires Maintenance

Lights:

Operational / Requires Maintenance

Timer/Clock:

Operational / Requires Maintenance

Safety Checks:

Depth Markers Visible:

• Yes / No

Safety Equipment Available:

• Yes / No

No Diving Signs Visible:

• Yes / No

No Running Signs Visible:

• Yes / No

No Glass Signs Visible:

• Yes / No

Emergency Phone Operational:

• Yes / No

First Aid Kit Stocked:

• Yes / No

Pool Area Clean and Tidy:

• Yes / No