Form Center

1. Pool Office

Disinfect iPad
Disinfect City Cell Phone
Disinfect Computer and Mouse
Disinfect High Touch Surface Areas

Notes / Actions Taken

Clarity of Water (Bottom of Deep End)

Clear
Partially Cloudy

Fully Cloudy and Unsafe for Use

Notes / Actions Taken

Are the pool drain covers in place and secure?

Yes
No

Notes / Actions Taken

Are the grab rails, ADA chair lift, ladders and diving board working properly?

Yes
No

Notes / Actions Taken

3. Are the exterior lights working properly?

Yes
No
N/A - Daylight Hours

Notes / Actions Taken

Are the underwater lights working properly?

Yes
No
N/A - Daylight Hours

Notes / Actions Taken

4. Lifeguard Towers

Disinfect Railings and High Touch Areas
Tower is in Proper Working Order
Tower Needs Maintenance

5. Flags

Disinfect Pole and High Touch Areas
Flags in Proper Working Order
Flags Need Maintenance

6. Check-In Table

Disinfect Table and Set-Up

Disinfect Chair and Set-Up

Notes/Actions Taken

Notes / Actions Taken

7. Condition of Women's Restroom and Locker Room

8. Condition of Men's Restroom and Locker Room

9. Was the facility unlocked before the inspection was conducted?

Yes
No

If yes, what program was using the facility? (High School Waterpolo, Swim Team etc.)

10. Is the SMMUSD Pump Room Locked and Secured?

Yes
No

11. Emergency Supplies

First Aid Kit Needs to be Restocked
Ice Packs Need to be Restocked
AED Battery Needs Replacement

Backboard Needs Maintenance
Fire Extinguisher Needs Maintenance
All Equipment in Working Condition

Notes / Maintenance Concerns

12. Were there any safety issues or vandalism observed during your inspection that needs immediate attention?

Yes
No

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