Pool Safety Compliance Form

POOL SAFETY COMPLIANCE FORM & INSPECTION AGREEMENT

Parties and Contact Information

Recitals

WHEREAS, Owner / Operator operates or controls the pool and associated pool deck, equipment and safety systems located at the property identified above; and

WHEREAS, Inspector is a qualified provider of pool safety inspection services and has been retained to assess compliance with applicable local safety standards, barrier requirements, equipment operation and emergency preparedness measures; and

WHEREAS, the parties desire to document the inspection, findings, required corrective measures, payment terms and mutual obligations in this Pool Safety Compliance Form and Inspection Agreement.

Scope of Work

Inspector shall perform a visual and operational inspection of the pool, pool barrier, gates and safety equipment, and shall prepare a written report of findings. Services include testing gate self-closing and latching mechanisms, verification of drain cover compliance, assessment of pool alarms where installed, inspection of signage and depth markings, evaluation of water clarity and chemical maintenance records, and documentation of any hazards or deficiencies requiring remedial action.

Inspection Checklist (select all applicable)

Perimeter fencing and barrier integrity
Gate self-closing and self-latching devices
Gate latch height and operation
Safety pool cover condition (if present)
Anti-entrapment drain covers and visible labeling
Pool perimeter/entry alarms and functionality
Required signage and depth markings
Rescue equipment and first aid access
Water clarity and chemical maintenance records
Lighting and electrical safety around pool

Findings and Deficiencies

Describe each deficiency observed, cite location, and note any immediate hazards requiring emergency action. Inspector shall itemize required corrective actions and recommended completion deadlines.

Payment Terms

Owner agrees to pay Inspector for inspection services and any agreed follow-up inspections in accordance with the terms below. Payment is due in U.S. dollars and timely payment is a material obligation under this Agreement.

Term and Termination

This Agreement commences on the start date below and continues until all required corrective actions are completed and final report acceptance by Owner, unless earlier terminated in accordance with this section.

Either party may terminate this Agreement for material breach by the other party if the breach remains uncured for the notice period specified above. Termination does not relieve Owner of payment obligations for services rendered or costs incurred prior to termination.

Confidentiality

Each party shall keep confidential all non-public information obtained from the other party in connection with the inspection and shall not disclose such information except to its professional advisors, contractors performing remediation with a need to know, or as required by law. Confidential information does not include information which becomes publicly available other than through unauthorized disclosure by the receiving party.

Governing Law

This Agreement shall be governed by and construed in accordance with the laws of the jurisdiction identified below, without regard to conflict of law principles.

Certifications and Compliance Determination

Based on the inspection performed and the items selected in the checklist above, Inspector makes the following compliance determination:

Compliant — no immediate corrective actions required
Non-Compliant — corrective actions specified above are required

Entire Agreement

This document, including any attachments and the written inspection report, constitutes the entire agreement between Owner and Inspector with respect to the subject matter hereof and supersedes all prior agreements and understandings, whether written or oral. Any amendment must be in writing and signed by both parties.

Additional Notes

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