000 SWIMMING POOL INSPECTION REPORT TYPE OF POOL PUBLIC SEMI-PUBLIC NAME OF POOL OWNER DATE OF INSPECTION METHOD OF WATER TREATMENT SPECIAL PURPOSE POOL ADDRESS INSPECTED BY POOL CAPACITY OF GALS BATHER LOAD OF LIFEGUARDS WATER SOURCE Regulation 105 CMR 435. NAME OF CITY OR TOWN STATE SANITARY CODE CHAPTER V MINIMUM STANDARDS FOR SWIMMING POOLS 105 CMR 435. 000 The items marked below with an X indicate the violated provisions of 105 CMR 435. 000. Items marked with a are satisfactory. REGULATION. 03 Bathhouse and sanitary facilities adequate lighting ventilation sanitary condition*. 03 Adequate enclosure around pool* Gate self-latching w/ latch 4 ft above ground. 04 Sewage Disposal. 05 Location structural stability finish. 06 Water circulation filtration systems. Filter Effluent flow meter reading gpm* of turnovers. 06 Suitable automatic equipment for disinfection of pool water. 06 Carbon dioxide CO2 equipment for pH control adequate. CO2 cylinders anchored* Inaccessible to public adequate ventilation provided*. 08 Inlets and outlets - Inlets located to produce uniform circulation* Over rim fill spout 6 above maximum water level* Properly shielded and located*. 08 Main drain suction outlets covered with suitable protective covers or grates. Cannot be removed without the use of tools. Open area does not provide entrapment of fingers toes etc* At least one antivortex drain provided*. 08 Each system outlet protected against user entrapment by antivortex cover or other means. Minimum of 2 suction outlets provided for each pump properly located and plumbed*. 08 Suction outlet covers in place unbroken and secure and cannot be removed except with the use of tools. Close pool immediately if outlet covers missing broken loose or can be removed without tools until repairs can be made. X/ VIOLATIONS/COMMENTS. 08 Special purpose pool and wading pools equipped with emergency shut off pump switch. Accessible and prominently marked*. 09 Cross connections. Portable water supplied through air gap*. 10 Skimming facilities. 50 of recirculation drawn from surface of pool*. 12 Line with floats separates non-swimmer area from deeper water. 12 Water depth markings on deck and walls. Properly spaced* Boundary line on pool floor and walls. Step edges marked with contrasting color. 13 Walkway and decks 4 feet wide safe condition*. 14 Ladders steps - one per 75 feet. Not less than 2 ladders. 15 Diving equipment in safe condition*. 17 Pool supervision - Pool supervision provided* Effective Jan* 1 1999 pool supervisor certified as pool operator from YMCA or NSPF*. 21 Permit requirements - Permit issued* Adequate maintenance and testing records maintained* Records initialed by person making tests. 22 Health regulations Signs posted* Health warning signs posted for special purpose pools. 23 Lifeguards required Yes No If lifeguards required* Proper credentials proper suits and garments worn* Whistle and bullhorn provided. 24 Safety equipment. Ring buoys and rescue hook provided* Rescue tube and backboard with straps at pools attended by a lifeguard.
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