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Temporary Residence (Hotel/Motel)

The following is a list of forms that you must complete and submit to the Dutchess County Department of Behavioral & Community Health (DBCH) prior to opening your swimming pool/beach.

Safety Plan Statement Form - once completed, this form will provide written confirmation that your previously approved safety plan accurately represents the staff training and emergency response procedures that will be implemented during the upcoming season. Any changes or additions to your safety plan must be submitted to this office in written form and receive approval. Safety Plan Templates are available on this website for your use.

Swimming Pool and Bathing Beach Safety Plan Checklist - you must use this to review your facility’s safety plan for the required content. Please check off each item on this sheet under the column labeled “facility operator use.” Once you have completed your plan review, you must sign the back of the form and return it to the Dutchess County Department of Behavioral & Community Health.

Written Notification for Supervision - this form must be completed and submitted if your facility is permitted as a “Temporary Residence” and you plan to change the supervision level that you previously selected.

These forms as well as other important information relating to the operation of your swimming pool / bathing beach are all available for download on this website.

This includes Fact Sheets which outline the Department of Behavioral & Community Health’s approved lifeguard certifications. Certification courses can be found at and

DBCH offers an awareness-heightening presentation on drowning victim recognition. This seminar will be given by the Department of Behavioral & Community Health staff upon receipt of your request. To arrange for a training session, please call the district office that covers your facility. Additionally, you may send staff to any of the workshops listed on the DBCH Drowning Prevention Seminar Schedule.

Beacon District Office

Brandy Vadala


Millbrook District Office

Kathleen Lizewski


Poughkeepsie District Office

Gena Mitchell



All the Documents referenced in this letter may be found on this website. If you are unable to access these forms, please contact the Department of Behavioral & Community Health at 845-486-3404.