Pool And Spa Log Sheet
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1Pool and Spa Log Sheet
Month of: _____________________________,20_______
Type of disinfectant:
Facility Name:
Chlorine Tablets (circle one)
stabilized
non-stabilized
Permit #
Pool/Spa Location:
Bromine
Chlorine Liquid
Pool/Spa Operator:
Other
DISINFECTANT RESIDUAL
MINIMUM AND MAXIMUM* LEVELS OF DISINFECTANT
TEST DAILY
TEST WEEKLY
RECORD WHEN APPLIED
Swimming Pool
Spa/Wading Pool
pH
Temp
Flow
Alkalinity
Miscellaneous
Combined Chlorine
Minimum (ppm)
Minimum (ppm)
Cyanuric
Chemicals
(ppm)
Chlorine
Acid
Added
1.5
3.0
(list correct
problems, closures,
Chlorine with
2.0
3.5
total – free =
Bromine
cyanurate
2.5
4.0
(suggest
(if used,
measurement
remarks, backwash
*Maximum disinfectant allowed 10 ppm
max
combined chlorine
rate
range of 80
max. 90
eg: lbs, gal,
of filter, clarity,
– 200 ppm)
Date
Time/Level
Time/Level
Time/Level
(<50% of free)
(7.2-8.0)
104F
(gpm)
ppm)
oz, tbl)
injury, etc.
1.
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PoolSpaLogSheet_EH-2014_kkc
on:
EMERGENCY PHONE tested
SHUT OFF SWITCHES / ALARMS tested on:
Environmental Health Division
3020 Rucker Ave, Suite 104 Everett, WA 98201-3900 fax: 425.339.5254 tel: 425.339.5250
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Parent category: Life