Site name
*
Site address
*
Street Address
Street Address Line 2
Suburb
State
Post Code
Site phone number
*
How many pools / bodies of water do you have at this site?
*
Please Select
1
2
3
4
5
PLEASE NOTE: Connected pools/splash pads etc are one body of water.
Pool 1 name
*
Pool 2 name
*
Pool 3 name
*
Pool 4 name
*
Pool 5 name
*
Please note: You must provide a unique mobile number and email address for each user.
How many users do you require at this site?
*
Please Select
1
2
3
4
5
User 1
*
First Name
Last Name
Position
Phone
*
Email
*
example@example.com.au
Do you want to receive water quality email alerts?
*
Please Select
Yes
No
User 2
*
First Name
Last Name
Position
Phone
*
Email
*
example@example.com
Do you want to receive water quality email alerts?
*
Please Select
Yes
No
User 3
*
First Name
Last Name
Position
Phone
*
Email
*
example@example.com.au
Do you want to receive water quality email alerts?
*
Please Select
Yes
No
User 4
*
First Name
Last Name
Position
Phone
*
Email
*
example@example.com.au
Do you want to receive water quality email alerts?
*
Please Select
Yes
No
User 5
*
First Name
Last Name
Position
Phone
*
Email
*
example@example.com.au
Do you want to receive water quality email alerts?
*
Please Select
Yes
No
Microbiological Testing
Is your site performing microbiological testing?
Yes
No
What is the frequency of the testing?
Monthly
Bi-monthly
Quarterly
Other
Who is providing this service?
Microbiological Contact Person
First Name
Last Name
Microbiological Contact Person
example@example.com
Microbiological Contact Person Phone Number
External Service Entity
Does your site engage external pool service providers?
Yes
No
What is the frequency of the service?
E.g. Once per month, week
Who is providing this service?
Service Provider Contact Person
First Name
Last Name
Service Provider Contact Person Email
example@example.com
Service Provider Contact Person Number
Your name
*
First Name
Last Name
Date
-
Day
-
Month
Year
2 digit day, 2 digit month, 4 digit year
Date
Should be Empty: