Daily Log Sheet
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1HEALTH PROTECTION DEPARTMENT
458 Laurier Blvd., Brockville, ON K6V 7A3
25 Johnston Street, Smiths Falls, ON K7A 0A4
DAILY LOG SHEET
DATE:
TIME
FAC/
pH
TESTED
Total Number of Bathers: __________________
FAB
BY
Make-up Water Meter Reading: _____________
(Initials)
Emergencies, breakdowns,
Rescues: _______________________________
_______________________________________
_______________________________________
Telephone Check: _____ a.m. _____ p.m.
Ground Fault Detector: ____ a.m. ____p.m.
*Total Alkalinity weekly: _________________
*CA reading weekly: ____________________
(Cyanuric Acid)
*Combined Chlorine (Total) daily: __________
* Comments: ___________________________
_______________________________________
_______________________________________
*Outlet cover inspected monthly □
_______________________________________
Signature: _________________________________
* Frequency is set as a minimum in the Ontario Pool Regulation 565. Increasing frequencies of
inspections and chemical testing are encouraged.
R: April 2011
s:\hprot\hprot storage (final)\safe water\forms\daily log sheet form.doc
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