"Monthly Pool Record Chart Template"

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Monthly Pool Record – Month:______________________ Year:_________
Name of Pool: ______________________________________________ Circle Type of Pool: Swimming, Wading, Spa, Other
CPO Name(s): ____________________________________________________________________________________________
Date
Time
Free Cl
pH
Drains
Temp
TA*
CA*
Maintenance (Backwash, Vacuum, Chemicals)
CPO Signature
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
*Check and record total alkalinity (TA) and cyanuric acid (CA) weekly. The Pool Operator shall inspect the pool daily and maintain written records.
Monthly Pool Record – Month:______________________ Year:_________
Name of Pool: ______________________________________________ Circle Type of Pool: Swimming, Wading, Spa, Other
CPO Name(s): ____________________________________________________________________________________________
Date
Time
Free Cl
pH
Drains
Temp
TA*
CA*
Maintenance (Backwash, Vacuum, Chemicals)
CPO Signature
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
*Check and record total alkalinity (TA) and cyanuric acid (CA) weekly. The Pool Operator shall inspect the pool daily and maintain written records.