Fillable Printable Daily Report Form - New York
Fillable Printable Daily Report Form - New York
Daily Report Form - New York
NEW YORK STATE DEPARTMENT OF HEALTH
Bureau of Community Environmental Health and Food Protection
Daily Report on Beach Operation
For: month __________ year _____
NAME OF BEACH
ADDRESS (City, Village, Town) COUNTY
Complete Daily – See reverse side for instruction
Date
1
2
3
4
5
6
7
8
9
10
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12
13
14
15
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1
Number of
Lifeguards
on Duty
2
Daily
Number
of Bathers
3
Weather
Conditions
Sunny = S,
Cloudy = C,
Rainy = R,
Windy = W
4
Water Quality
Monitoring
5
Rescues
6
Injuries
7
Remarks
Operator's Name: __________________________________ Signature: __________________________________ Date: ___________
DOH-2287 (5/04) p 1 of 2
Instructions
Column 1. Enter the total number of lifeguards on duty during the day.
Column 2. Enter the total number of bathers using the beach during the day.
Column 3. Enter code or codes for weather conditions. Air temperature should also be recorded (i.e., 82 degrees, S).
Column 4. Where sampling is required, list results of the sample under the date the sample was collected.
Also indicate results of visual observations: include such items as :oils, greases, sewage discharges
and water clarity (indicate if clarity is not sufficient to see an object to a depth of four feet).
Column 5. Indicate number of rescues. Provide a brief description of each incident (i.e., tired swimmer - assist;
submersion, etc.) on the reverse of the form.
Column 6. Indicate number of injuries. Provide a brief description of each incident on the reverse of the form.
Column 7. Indicate other comments, such as beach closure due to weather or clarity, etc.
Comments: (attach additional sheets as needed)
Operator's Name: __________________________________ Signature: __________________________________ Date: ___________
DOH-2287 (5/04) p 2 of 2
At the end of each month,
mail completed form to:
