Send
reports to: Environmental
Health Consortium, South Milwaukee, Cudahy & St. Francis 2424
15th Avenue, South Milwaukee, WI 53172 Fax:
414-768-5720
MONTH/YEAR_____________________________________
MONTHLY REPORT ON PUBLIC
POOL OPERATION POOL
NAME: ______________________________________ ADDRESS: ______________________________________ OPERATOR: ______________________________________ COMMENTS:
Please note any
1) Unusual occurrences and actions to correct conditions, 2)
Chemical levels that do not comply with code requirements, 3)
Equipment replacement, 4) Change in person responsible for pool
maintenance, 4) Fecal accidents, etc.
TYPE
OF POOL (use a
separate form for each pool)
Swim
Whirlpool
Wading
Exercise
Therapeutic
Water Attraction
Other__________
SAFETY EQUIPMENT ON SITE
First Aid Kit
Blankets (2)
DPD Test Kit
Spine Board
Safety Line
Shepherd’s Crook
Depth Markings
Lifeguard Chair Signature
_____________________________________ Title
___________________________ Date _____________________
SWIMMING POOL WHIRLPOOL OTHER __________________ TYPE OF DISINFECTANT ______________________________
(USE A SEPARATE FORM FOR EACH POOL)
M
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Water
Temp
Day
Water
Appearance
Clear Turbid
Patron
Loading
24 Hr
Max Total INSTRUCTIONS:
All information must be filled in daily and signed by the person in
charge. PATRON
LOADING: Columns
must show the maximum number of patrons using the pool at any one
time and the total number of patrons for the entire day. WATER
APPEARANCE: Place
an X in the Clear or Turbid column. FILTER
BACKWASH: Place a
“B” in the column for any day the filter is backwashed. CARTRIDGE
FILTER CLEANED/CHANGED:
Place a “C” in the column for any day the cartridge
filter is cleaned or changed. WHIRLPOOL
DRAINED: Place a
“D” in the column for any day the whirlpool is drained.
CHEMICAL
CONTROL: Enter pH
and chlorine/ bromine test readings. Test swimming pools at least
twice daily and whirlpools at least four times daily. Enter the
amount of each chemical used as lbs. or gallons.
SIGNATURE:
Must be initialed daily by the person responsible for the operation
of the pool.
3 ANNEX A COUNTRY REPORTS MYANMAR 2ND AHP CONFERENCE
456001 §45600—SEMIANNUAL COMPILATION 456001 SUBPART F — AGENCY REPORTS
5 SUMMARY OF REPORTS GIVEN AT THE 162ND MEETING
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