Public Swimming Pool Health & Safety Inspection Checklist
Facility / Pool Name
· · ·
Facility Address
· · ·
Inspector Name
· · ·
Submit
The Public Swimming Pool Health & Safety Inspection Checklist is a professional-grade digital form designed to help health inspectors, facility managers, and compliance officers conduct thorough and consistent pool inspections. It captures essential facility and inspector details, water quality readings, and chemical parameter data all in one place.
This template is ideal for municipal health departments, public aquatic centers, hotel pools, and recreational facilities that must meet local and state health code requirements. It records critical measurements such as free chlorine levels, pH, water temperature, total alkalinity, and cyanuric acid concentration, helping inspectors identify and document potential health hazards quickly.
By digitizing your pool inspection process, you eliminate paperwork errors, ensure nothing is overlooked, and create a reliable audit trail. Customize the form to match your jurisdiction's standards and instantly share completed reports with facility operators or regulatory agencies.
4Pages
37Questions
~12minTo complete
FreeNo credit card needed
Field types
Single Choice ×12
number ×6
Long Text ×3
Short Text ×2
Full Name ×2
Date ×2
Address
Email
Phone
Time Picker
Dropdown
Yes / No
Priority Selection
Multiple Choice
File Upload
Signature
Questions in this template
Free template
The exact questions included — customize any of them to fit your needs.
Page 1Facility & Inspector Information9 questions
Facility & Inspector Details
1
Facility / Pool Name
*Short Text
2
Facility Address
*Address
3
Inspector Name
*Full Name
4
Inspector Email
*Email
5
Inspector Phone Number
Phone
6
Inspector License / Certification Number
*Short Text
7
Inspection Date
*Date
8
Inspection Start Time
*Time Picker
9
Inspection Type
*Dropdown
Page 2Water Quality & Chemical Compliance10 questions
Water Quality & Chemical Parameters
Record all chemical readings taken at the time of inspection. Ensure testing equipment is properly calibrated.
1
Free Chlorine Level (ppm)
*number
2
Combined Chlorine Level (ppm)
*number
3
pH Level
*number
4
Water Temperature (°F)
*number
5
Total Alkalinity (ppm)
*number
6
Cyanuric Acid Level (ppm)
number
7
Water Clarity — Can the main drain be clearly visible from the deck?
*Yes / No
8
Are chemical storage areas properly secured and labeled?
*Single Choice
9
Are chemical logs and records up to date?
*Single Choice
10
Water Quality Notes / Violations Observed
Long Text
1
Life ring(s) and/or reaching poles present and accessible?
*Single Choice
2
First aid kit stocked and accessible?
*Single Choice
3
Emergency phone or communication device available?
*Single Choice
4
Pool depth markings clearly visible and accurate?
*Single Choice
5
No Diving signage posted where required?
*Single Choice
6
Pool rules and capacity limits posted?
*Single Choice
7
Anti-entrapment drain covers in place and compliant (VGBA)?
*Single Choice
8
Fencing/barriers and self-latching gates intact and functional?
*Single Choice
9
Deck surfaces in good condition (no tripping hazards, non-slip)?
*Single Choice
10
Restrooms and shower facilities clean and operational?
*Single Choice
11
Safety Equipment & Physical Condition Notes / Deficiencies
Long Text
Page 4Overall Assessment & Sign-Off7 questions
Inspection Summary & Sign-Off
1
Overall Inspection Result
*Priority Selection
2
Corrective Actions Required
*Multiple Choice
3
Corrective Action Deadline
Date
4
Inspector Comments / Summary of Findings
*Long Text
5
Upload Photos of Violations or Conditions
File Upload
By signing below, I certify that this inspection was conducted thoroughly and all findings are accurately reported.
6
Inspector Printed Name
*Full Name
7
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 "Teal" 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
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