At Lifetime Fitness it looks "ok" in the cleanliness department but it is what you do not see that should worry you. I went in a hot tub for the first time in my life and developed a rash almost immediately.
I did not put it with the hot tub until it got out of control and I went to the doctor and within 10 seconds he asked if I had been in a hot tub lately. I said "Yes". He said it was hot tub folliculitis. According to the CDC it comes from severely neglected hot tubs.
It is a bacterial infection.