Aquatic Facility Water Quality & Drain Cover Safety Inspection Checklist
Facility Name
· · ·
Facility Address
· · ·
Facility Permit/License Number
· · ·
Submit
The Aquatic Facility Water Quality & Drain Cover Safety Inspection Checklist is a professional-grade form designed to help certified pool inspectors, facility managers, and health department officials conduct thorough, compliant inspections of pools, spas, and other aquatic environments. It captures essential facility and inspector details alongside critical water chemistry readings.
This template is ideal for public pools, recreational centers, hotels, water parks, and any licensed aquatic facility required to demonstrate regulatory compliance. Inspectors can record free chlorine, combined chlorine, pH, water temperature, and total alkalinity readings from multiple bodies of water in a single, organized submission.
By digitizing your inspection process, you eliminate paperwork errors, improve data accuracy, and maintain a clear audit trail of every inspection conducted. Start using this free template today to ensure your aquatic facility meets safety standards and protects the health of every swimmer.
4Pages
35Questions
~12minTo complete
FreeNo credit card needed
Field types
number ×7
Single Choice ×6
Short Text ×4
Long Text ×3
Dropdown ×2
Date ×2
Yes / No ×2
Address
Full Name
Email
Phone
Time Picker
File Upload
Priority Selection
termsandconditions
Signature
Questions in this template
Free template
The exact questions included — customize any of them to fit your needs.
Inspect all drain covers, grates, and anti-entrapment devices in accordance with the Virginia Graeme Baker Pool and Spa Safety Act (VGB Act) and local codes.
1
Total Number of Drain Covers/Grates Inspected
*number
2
Are all drain covers compliant with ASME/ANSI A112.19.8 or successor standard?
*Single Choice
3
Are all drain covers securely fastened and free of cracks, damage, or missing screws?
*Single Choice
4
Are drain covers within their rated service life (check manufacture date)?
*Single Choice
5
Does the facility use an approved anti-entrapment system (e.g., SVRS, dual drains, gravity drainage, or automatic pump shut-off)?
*Single Choice
6
Is the suction outlet/drain configuration compliant (unblockable or dual/multiple drains)?
*Single Choice
7
Drain Cover / Anti-Entrapment Deficiencies or Notes
Long Text
8
Upload Photos of Drain Covers and Anti-Entrapment Devices
File Upload
Page 4Overall Assessment & Sign-Off6 questions
Inspection Summary & Corrective Actions
1
Overall Facility Risk Level
*Priority Selection
2
Inspection Result
*Single Choice
3
Summary of Violations and Required Corrective Actions
Long Text
4
Corrective Action Deadline
Date
5
I certify that this inspection was conducted thoroughly and all findings documented herein are accurate to the best of my knowledge.
*termsandconditions
6
Inspector Signature
*Signature
How to use this template
Click "Use This Template Free" to open it in the FormBuilder editor. From there you can add, remove, or reorder fields with drag-and-drop, switch themes for instant restyling, add your logo, configure email notifications, and set your success message. When ready, publish with a unique link and start collecting responses immediately.
Ready-to-use structure — pre-configured fields out of the box
Applied "Umber" theme — fonts, colors, and layout already set
Mobile-responsive — works on every device without extra configuration
Fully editable with drag-and-drop — change anything in seconds
Free to use on any plan, no credit card required
Use this template
Free to use. Open in the editor, customize, and publish in minutes.
English
Español
Português
Русский
العربية
