Fillable SWIMMING POOL SURVEY (complete for each pool managed) (Colonial General Insurance Agency, Inc)

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SWIMMING POOL SURVEY (complete for each pool managed) (Colonial General Insurance Agency, Inc)

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GLS-STMT-3 (1-10) Page 1 of 2
SWIMMING POOL SURVEY
(complete for each pool managed)
Pool Name: Number of Members:
Address: Pool Capacity:
POOL
Dimensions Depth: Min Max Hours of operation: from to
Operating months: from to Lifeguard-to-swimmer ratio: to
Are depth markers clearly visible above the water line? .................................................................................... Yes No
Are diving boards or diving platforms present? .................................................................................................. Yes No
If yes, how many? Height of each diving board or diving platform:
Are there pool slides? ......................................................................................................................................... Yes No
If yes, how many? Height of each slide:
Is the shallow end of the pool roped off? ............................................................................................................ Yes No
Are “No Running” signs posted? ........................................................................................................................ Yes No
Are the rules of the pool posted? (please attach a copy) ................................................................................... Yes No
Is the pool fenced? ............................................................................................................................................. Yes No
If so, height of the fence?
Does pool have self-latching gates? .................................................................................................................. Yes No
Is the fence locked when the pool is not in use? ................................................................................................ Yes No
Is the fence locked when the lifeguard is not present? ...................................................................................... Yes No
Is life-safety equipment available at poolside? ................................................................................................... Yes No
Are alcoholic beverages permitted in the pool area? ......................................................................................... Yes No
Are glass containers permitted in the pool area? ............................................................................................... Yes No
Are pool passes required? ................................................................................................................................. Yes No
If yes, who checks the passes?
Are under-age children allowed pool access without a parent? ......................................................................... Yes No
Minimum age for pool access without a parent?
Are waivers of liability, signed by swimmers or parents, obtained? ................................................................... Yes No
(If waivers are used, please attach a copy.)
Is a CPR-trained individual on duty at all times when pool is open? .................................................................. Yes No
Is pool in compliance with federal Virginia Graeme Baker Pool and Spa Safety Act? ....................................... Yes No
GLS-STMT-3 (1-10) Page 2 of 2
LIFEGUARDS
Are lifeguards present during operating hours? ................................................................................................. Yes No
Are all lifeguards American Red Cross (or equivalent) certified? ....................................................................... Yes No
Is certification current? ....................................................................................................................................... Yes No
Are supervised safety exercise drills held periodically? ..................................................................................... Yes No
If so, is a record log maintained? ................................................................................................................. Yes No
Is a certificate of insurance obtained from the pool owners? ............................................................................. Yes No
Are swimmers allowed in the pool while the pool is being serviced? ................................................................. Yes No
JACUZZI OR WHIRLPOOL
Is there a Jacuzzi or Whirlpool? ......................................................................................................................... Yes No
Can temperature be adjusted by anyone? ......................................................................................................... Yes No
Maximum temperature setting:
Are Jacuzzi or Whirlpool in compliance with federal Virginia Graeme Baker Pool and Spa Safety Act? ........... Yes No
OTHER ISSUES
Does the club/pool have a swim team?.............................................................................................................. Yes No
If yes, number of meets held on premises:
Is there diving instruction or diving competition held at the pool? ...................................................................... Yes No
Is competitive diving taught? .............................................................................................................................. Yes No
Is scuba diving taught at the pool? ..................................................................................................................... Yes No
Are trampolines used? ....................................................................................................................................... Yes No
How often is water tested and by whom?
Please submit a photograph of the pool and pool area with this survey.
Pool Manager’s Signature: Date:
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SWIMMING POOL SURVEY (complete for each pool managed) (Colonial General Insurance Agency, Inc)

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Completed 22 August 2020

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