SP/Spa Inspection Form

Download PDF
3 downloads 151 Views 12KB Size Report
Comment
Apr 15, 2016 - Fountain. [ ] Other. Insp Date (mm/dd/yy) 04/13/2016. 2. 8772. 2016081. Travel Time. License no. ID no. S
Health District:

Public Swimming Pool Inspection Report Name of Facility:

Public Health Datyon-Montgomery County

Type visit

Type pool

Setting

[ X ] Standard

[ X ] Pool

[

] Wading pool

[

] Zero Entry

[

] Spray ground

Special feature (SF)

[

] Re-inspection

[

] SPA

[

] School

[

] Govt

[

] MHP

900 S ALEX ROAD

[

] Complaint

[

] SUP

[ X ] Indoor

[

] Outdoor

[

] Camp

City:

[

] Epi Investigation

[

] Apartment/Condo

[

] Hotel/Motel

WEST CARROLLTON OH 45449

[

] Consulation

[

] Other

WEST CARROLLTON YMCA Address:

Insp Date (mm/dd/yy) 04/13/2016 Surface Area (sf)

[X]

3375

Flow measure reading (gpm)

Insp Time

Travel Time

20

Required turnover rate (min) [ie 30]

ID no.

2

Volume (gallons)

480

135406

300

[X]

[

]

Max allow. flow: SF pump capacity (gpm)

[

] Other

2016081

Required flow min:(gpm) [Volume/TRate]

Check if in violation of the Ohio Administrative Code 3701-31-04 (A-E); NA= Not Applicable

20

] Kiddie Slide ] Playground slide ] Rec Slide ] Water Slide ] Fountain

License no.

8772

[X]

Max allow. filter flow: (gpm) [filter label]

[ [ [ [ [

[

]

282

Max allow. flow: Jet pump capacity (gpm)

Critical violations (3701-31-04(B)(1)(a-l)

[

]

(a) Outlet covers installed/secured/ in compliance

[

]

(d) Circulation/Disinfection system operating properly

[

]

(g) Water clarity; (can see pool bottom)

[

]

(j) Pool treated after RWI

[

]

(b) SVRS devices functioning

[

]

(e) Automatic chemical controller functioning properly

[

]

(h) Natural or artificial light sufficient

[

]

(k) Proper use/storage of chemicals

(c) Disinfection residual as required

[

]

(f) Lifeguards on duty

[

]

(j) Fecal accident treated properly

[

]

(l) No Electrical hazards present

[X]

Water Quality 3701-31-04 C, D (check all that apply)

[

] Calcium Hypochlorite

[ X ] Sodium Hypochlorite

[

] Bromine

[

(D)(6)Total Chlorine-Cl2 (ppm)

1.0

[

] (C)(2) pH (7.2 - 7.8)

[

] Di-Chloro

[

[

] Salt

[X]

(D)(6)Free Chlorine-Cl2 (ppm) [>= 1; 2]

0.5

[

] (C)(3)Alkalinity (ppm) [min 60]

80

[

]

(D)(6)Combined - Cl2/ (ppm) [