Form Details Your Name * Your Email * Date of Inspection Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year20222023202420252026 Address Phone Type of Pool In Ground Above Ground Approximate Depth of Pool Is the pool surrounded by a fence of substantial construction not less than four (4) feet in height and in reasonably good condition? Yes No Is the fence set back a minimum of three (3) feet from the edge of the pool? Yes No Is the fence equipped with a self closing gate and complete with a self closing latch and lock? Yes No Are all parts of the deck and pool structure in reasonably good condition? Yes No Is there a ladder or steps sufficient to exit the pool to the ground? Yes No Is the water clear and free of debris and the pool bottom clean? Yes No Recommendations/Corrections Required Outcome of Inspection Satisfactory Not Satisfactory Name of Inspector Re-Inspection Date Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year20222023202420252026 Leave this field blank
