Pool Safety Check Form

Pool Owner *

Address: *

Date: * 12345678910111213141516171819202122232425262728293031 JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember 20092010

Contact Person (if different):

Email Address: *

Telephone Number: *

Checkbox if Statement is True: *

The pool deck is uncluttered.
The pool area is in good repair.
There is a telephone available with emergency numbers posted.
Rescue equipment is by the pool?
The pool water chemistry is monitored regularly.
A basic first aid kit is available.
The deep and shallow ends are clearly marked

Other Comments/Descriptions:

Directions to Pool: *

By typing my name below, I am stating that I understand that At Home Aquatics shall not be held liable for any accident, injury or damage that may result due to the pool itself, its’ equipment, maintenance of chemicals, and or any other items at the homeowners residence.

Pool Check Completed By: *

Pool Owner:

Date 12345678910111213141516171819202122232425262728293031 JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember 1950195119521953195419551956195719581959196019611962196319641965196619671968196919701971197219731974197519761977197819791980198119821983198419851986198719881989199019911992199319941995199619971998199920002001200220032004200520062007200820092010