Application Form For The Registration Of Swimming Pool
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1The completed form should be sent to:
F
O
U
O
OR
FFICE
SE
NLY
Environmental Health Directorate
Swimming Pool Reg. No.
Health Inspectorate Services
37 – 39 Rue D’Argens
Premises Reg. No.
Msida MSD 1368
Date Processed
/
/
Tel : 21320413/21324093
MALTA
Fax : 21344767
E-mail : mhi@gov.mt
A
F
R
O
S
P
PPLICATION
ORM FOR THE
EGISTRATION
F
WIMMING
OOL
T
L.N. 129
2005 (P
H
A
2003)
IN
ERMS OF
OF
UBLIC
EALTH
CT
T
. P
BLOCK LETTERS.
O BE FILLED FOR EACH SWIMMING POOL ON PREMISES
LEASE USE
PART 1 – G
I
ENERAL
NFORMATION
1. Premises Name: ______________________________________________________ 2. Type of Premises: _______________________
3. Premises Address: ______________________________________________________________________________________________
Town or Village: _______________________________________________________________ Post Code: _____________________
Tel. No. : _____________________ Fax. No. : _______________________ E-mail address : __________________________________
4. Company Name & Address (if applicable) : __________________________________________________________________________
______________________________________________________________________________________________________________
5. Name & Surname of responsible person : ____________________________________________ Position held : ___________________
Home Address : ___________________________________________________ Tel. No. : _______________ I.D. No.: ___________
6. Name & Surname of Pool Supervisor : ______________________________________________ Position held : __________________
PART 2 – P
T
OOL
YPE BEING REGISTERED
7. Type of Pool (P
ONE
)
LEASE TICK
BOX ONLY
S
P
W
P
S
D
P
S
P
P
*
WIMMING
OOL
ADING
OOL
PA
IVING
OOL
PECIAL
URPOSE
OOL
8. *In the case of a Special Purpose Pool (P
ONE
)
LEASE TICK
BOX ONLY
W
F
P
S
D
P
T
P
H
P
F
V
ATER
LUMES
OOL
CUBA
IVING
OOL
HERAPEUTIC
OOL
YDROTHERAPY
OOL
LOATATION
ESSEL
P
A
H
O
*
*S
_________________________
OOL USED IN
QUATIC PROGRAMMES FOR
ANDICAPPED PERSONS
THERS
PECIFY
PART 3 – S
P
D
WIMMING
OOL
ETAILS
9. Pool Name : _____________________________________
10. Pool Location :
O
I
R
N
.
O
*
*S
_______________
UTDOOR
NDOOR
OOM
O
THER
PECIFY
(P
ONE
)
LEASE TICK
BOX ONLY
PART 4 – P
I
OOL
NFORMATION
11. Swimming Pool Information (Excluding SPAS)
2
3
Length :
_______ m
Width :
_______ m
Surface Area :
_______ m
Volume :
_______ m
3
Maximum Bathing Load : ________
Turnover Rate : ________ Hrs
Circulation Rate : ________ m
/Hr
Source of pool water : ________________________________
Type of Biocide/s used : __________________________________________________________________________________________
12. Decleration:
I, the undersigned, hereby declare that the information given above is accurate, complete and not misleading.
Signature: __________________________
Date: ……./……./…….
Name (Capitals): ____________________________________
Position held: ___________________________________________
I.D. Card No.: _________________________
Date Protection Statement: All data collected is processed in accordance with L.N. 129 of 2005 (Public Health Act, 2003) and the Data Protection Act 2001.
Data is required for administration purposes in the interest of Public Health.
DEH 5-00
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