Greater Houston Pool Management - Contamination Report

Contamination Report

Please fill in all of the information below and provide as much detail as possible. Immediately notify your supervisor of the issue.

Pool Name *

Pool Name

Location *

(main pool, baby pool, deck, slide, etc.)

Location

Contamination Type *

Solid Fecal Diarrhea Vomit Blood x Clear

Other

Duration of Closure *

No Closure 1 hour All Day x Clear

Other

pH level at time of contamination *

pH level at time of contamination

Chlorine level at time of contamination *

Chlorine level at time of contamination

Equipment Used *

Equipment Used

Equipment Disinfected? *

Yes No x Clear

Chemical Adjustments *

Describe any chemicals added to the pool or chemical systems (N/A if none)

Chemical Adjustments

Lifeguard's Name

First name

Last name

Date & Time *

Additional Comments

Name of Supervisor Notified *

Electronic signature*

Please sign your name inside the box or type your name below.

Type your name

Signature style

Electronic signature Signature pad

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