Southern Nevada Health District Monthly Pool/spa Report Form
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1Southern Nevada Health District Monthly Pool/Spa Report Form
Month:
Year:
Pool/Spa Water Volume:
Gallons
Minimum Required Flow:
GPM
Filter Type:
Facility Name:
Facility Address:
Total Filter Area:
Sq. Ft.
Water Tests
Amount of Chemicals Added (units)
Gauge/Meter Readings
Recirculation/Filtration
Date
# of
Disinfectant
pH
Total
Cyanuric
Water
Disinfectant
Soda
D.E.
Other
Pressure
Vacuum
Flow
Filter
Back
Water
Pool
Water Amount
Comments/Notes
Bathers
Residual
Alkalinity
Acid
Temp
Ash
PSI
In of Hg
Meter
Pressure
Wash
Clarity
Cleaned
Drained/Added
SVRS Check
1
2
3
4
5
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7
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9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Operator/Service Company__________________________
Phone #:__________________ Disinfectant used ______________________
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Parent category: Business