1984E (2012/0) Queen's Printer for Ontario, 2012 Disponible en franais Page 1 of 7

Ministry of
the Environment

Instructions for Drinking Water
Operator and Water Quality
Analyst Renewal Application Form
PLEASE READ BEFORE COMPLETING AND SUBMITTING AN APPLICATION FORM
In order for an application to be processed the form MUST be filled out completely. Incomplete forms WILL NOT BE
PROCESSED. Please type or print CLEARLY.

Please submit the completed application form(s) in ONE of the following ways to the Program Administrator Ontario
Water Wastewater Certification Office (OWWCO) by:

1. Mail: 302 The East Mall, Suite 410
Etobicoke ON M9B 6C7

2. Fax: 416 231-2107

For questions on how to complete an application form, please call an OWWCO Customer Service Representative at:
416 231-2100 or 1 877 231-2122

NOTE: Where an asterisk (*) is present please refer to A Guide to Completing MOE Operator Certification and
Classification Forms for further explanation.
Part A Personal Information / Part B Employer Information
Please ensure that all personal and employer information requested is complete and accurate.

Part C Certificate to Renew
Please fill out the appropriate boxes to indicate the certificate to renew.

Part D Operating Experience Verification
Please only complete this section if the applicant has performed at least three (3) months of operational duties or related
duties in the previous 36 months of working as an operator and water quality analyst in a subsystem. Be sure to indicate
the date ranges for operational duties performed or related duties in the previous 3 years.
Related experience includes experience gained in a drinking water subsystem or wastewater facility in a technical or
managerial capacity (For example, supervision, management, consulting, technical, inspection or training experience in a
subsystem or facility.) For more specific details, please consult Guidelines 3.4 and/or 3.4b.

Please ensure that this section is filled out completely and accurately and that the Overall Responsible Operator or
designate of the Overall Responsible Operator for the system that the experience is for has signed, dated and included
contact information prior to the submission of the form.

JOB DESCRIPTIONS ARE NOT REQUIRED WITH RENEWAL APPLICATION FORMS.

Part E Training Requirements
Please indicate the types of training requirements that the applicant has met. For the Mandatory Renewal Course,
indicate the date that it was taken. Indicate the number of hours of Director Approved training completed by the
applicant as well as the number of hours of On-the-Job training that the applicant has completed.

Please ensure that the applicant has met the necessary training requirements for the level of certification being applied
for.

It is the responsibility of the operator to know what training they have completed.

For more information about the Mandatory Renewal Course, please contact the Walkerton Clean Water Centre at
www.wcwc.ca or 1-866-515-0550.

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1984E (2012/0) Page 2 of 7
Part F Applicant Verification and Consent
Please ensure that this section is filled out completely and that you have signed where indicated.

It is an offense under the Safe Drinking Water Act, 2002 to provide false information. You should understand that should
the review of this application disclose such misrepresentation, that this application may be rejected.
Part G Check List
Please ensure that all of the items listed in the check list are included with the application.

Part H On-the-Job Practical Training
This is on the final page of the application and is the section for on-the-job practical training. In the spaces provided,
indicate the applicants on-the-job practical training.

Please ensure that this section is signed and dated by an authorized representative. An authorized representative can be
an Overall Responsible Operator (ORO), the Manager/Supervisor of an ORO or a person designated by an ORO for the
system that the experience is for.

Submission of Training

When submitting on-the-job practical training, the information can be presented using various formats however please
ensure that all requested training information is included.
Part I Payment Information
Please ensure that all cheques and money orders are made payable to the MINISTER OF FINANCE. Cheques made out
to MOE or OWWCO will be returned. For credit card payments ensure that all information is accurate and a signature is
present.

If your ministry certificate has expired, a $25 late fee must also be submitted. Certificates which have expired for more
than one year may require completion of the applicable exam or other requirements.


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1984E (2012/0) Page 3 of 7

Ministry of
the Environment

Drinking Water Operator and Water
Quality Analyst Certificate Renewal
Application Form
Complete this form to request the renewal of a drinking water operator and water quality analyst certificate. Please fill out a
separate renewal form for each type of certificate for which you are applying (i.e. water treatment, water distribution and
supply, water quality analyst, etc.). Each form is to be submitted with payment separately to the Program Administrator, as per
the last page of this application.
Part A - Personal Information
First Name

Last Name

Middle Initial

Operator ID Your operator ID can be found on past correspondence (letters) mailed out
by the Program Administrator.
Home Address
Unit No.

Street No.

Street Name

PO Box

City/Town

Province

Postal Code

Home Phone No. (including area code)

Cell Phone No. (including area code)

E-mail address

Please indicate how you would prefer the Program Administrator and/or the Ministry to contact you, if required:
Home Phone Cell Phone Business Phone E-mail Regular Mail (Canada Post)
Part B - Employer Information
Name of Employer

Employer Address
Unit No.

Street No.

Street Name

PO Box

City/Town

Province

Postal Code

Business Phone No. (including area code) Business Cell Phone No. (including area code) Business Fax No. (including area code)

Part C - Certificate to Renew
Certificate Type
Certificate Class
(1,2,3, or 4)
Certificate Number Expiry Date Fee
Water Treatment
$115
Water Distribution
$115
Water Distribution & Supply
$115
Limited Surface
$115
Limited Groundwater $115
Water Quality Analyst $75
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1984E (2012/0) Page 4 of 7
Part D - Operating Experience Verification

Highest Class Drinking Water Subsystem Operated
Name of Subsystem Classification (e.g. WT or WDS) Class (Limited, 1, 2, 3, or 4)
Complete this section only if the applicant has performed at least three (3) months of operational duties or related duties (see
subsection 4.3 of the Certification Guide for Operators and Water Quality Analysts for Drinking Water Systems) in the previous
36 months of working as an operator and water quality analyst in a subsystem.
Operating / Related Experience
From Date (mm/dd//yyyy) To Date* (mm/dd//yyyy)
If the operator has Related Experience, please provide their job title and duties which are considered related:
I hereby certify that the above experience is true and I understand that it is an offense under the Safe Drinking Water Act to provide false
information. I understand that should the review of this application disclose such misrepresentation, that this application will be rejected. I
am an authorized representative of the operators present employer as indicated below and I understand that I cannot sign off on my own
operating experience.
Name of Authorized Representative (please print) Title
Signature of Authorized Representative Telephone No. (including area code) Date (mm/dd//yyyy)

I am one of the following Authorized Representatives for the system that the above experience is for (please choose at least one of the
following)
Overall Responsible Operator (ORO) Authorized designate of the ORO
Manager/Supervisor of the ORO
Part E - Training Requirements
Mandatory Renewal Course**
Date taken (mm/dd//yyyy)
Total Director Approved training hours
Hours completed
Total On-the-job training hours
Hours completed
** Hours obtained completing Mandatory Renewal Course can be counted towards Director Approved CEUs requirement.
Part F - Applicant Verification and Consent
By signing this Drinking Water Operator and Water Quality Analyst Renewal form, I hereby consent to the collection, use, and disclosure of
my personal information contained in this Renewal form by the Ministry of the Environment and its Certification Program Administrator for the
purposes of examination registration, renewals/upgrades and enforcement as set out in Part G of this form. I further declare that all
information in this application is true and correct and that I understand it is an offence under the Safe Drinking Water Act, 2002 to provide
false information.
Signature of Applicant Date (mm/dd/yyyy)
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1984E (2012/0) Page 5 of 7
Part G - Check List
Prior to submitting this application you must enclose and check off the requirements of this application to verify that your application is
complete.
JOB DESCRIPTIONS ARE NOT REQUIRED WITH RENEWAL APPLICATION FORMS.
Operating/related experience has been verified and signed by my Overall Responsible Operator (ORO)/Authorized designate of the ORO
Payment enclosed (cheques and money orders need to be made payable the MINISTER OF FINANCE)
Copies of Director Approved Certificates enclosed
Part I (Summary of On-the-Job practical training) is completed and signed (on reverse)
Your signature to verify the information provided.
Personal information provided on this form is collected by the Ontario Water Wastewater Certification Office (OWWCO) on behalf of the Ministry of the
Environment in accordance with the Safe Drinking Water Act, 2002 S.O. 2002, c. 32, as amended (SDWA) and Ontario Regulation 128/04 and the
Ontario Water Resources Act, R.S.O. 1990, c. O.40, as amended (OWRA) and Ontario Regulation 129/04. The collection, use and dissemination of
this information are governed by the Freedom of Information and Protection of Privacy Act, R.S.O. 1990, c. F.31, as amended (FOIPPA).
The information gathered herein will be used for the principle purpose of assessment and verification of eligibility for, and issuing of, a drinking water
operator certificate, a wastewater licence or a water quality analyst certificate; as well as for secondary purposes including reporting, investigating and
law enforcement under the aforementioned Acts and regulations (including the Health Protection and Promotion Act, O. Reg. 318/08, O. Reg. 319/08,
and the use by the Ministry of the Environments Investigations and Enforcement Branch). Information contained on this Renewal Application form,
with the exception of payment information may be disclosed to other government agencies (including municipalities, public health unit employees, the
Walkerton Clean Water Centre, Ministry of Health and Long Term Care and Ministry of Natural Resources) pursuant to section 42 of FOIPPA for the
consistent purpose of administering the OWRA and the SDWA that pertains to drinking water and safety.
Any questions can be directed to an OWWCO Customer Service Representative by calling 416 231-2100 or 1 877 231-2122 or by sending your
inquiry to the address below or to info@owwco.ca.

Please submit the completed application form to:
The Ontario Water Wastewater Certification Office (OWWCO)
302 The East Mall, Suite 410
Etobicoke ON M9B 6C7
Or fax to: 416 231-2107

* Please refer to A Guide to Completing MOE Operator Certification and Classification Forms for further explanation.
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1984E (2012/09) Page 6 of 7

Ministry of
the Environment
Drinking Water Operator and Water Quality
Analyst Certificate Renewal Application Form
Part H On-the-Job-Training
Name of Operator


Operator ID Signature of Operator Date (mm/dd/yyyy)
I declare that all information in this application is true and I understand it is an offence under the Safe Drinking Water Act, 2002 to provide false information.
Date of Training
Session (mm/dd/yyyy)
Topic(s) of Training
(Include course name if applicable; list of major topics)
Training Provider/Instructors Name Telephone Number of
Training Provider*
(Including area code)
Duration
(Hours)
























Signature of authorized representative (Overall Responsible Operator (ORO) / Authorized designate of ORO / Manager or Supervisor of ORO) Date (mm/dd/yyyy)
Please refer to A Guide to Completing MOE Operator Certification and Facility Classification Forms for further explanation.
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1984E (2012/09)

Part I - Payment Information
Please make cheques or money orders payable to the MINISTER OF FINANCE.
If a refund is requested, payment will be returned to the original payment source (i.e. individual, employer, etc.) by method in which the
payment was received by the Program Administrator.
Total Fee(s) Due
Water Certificate $115
Water Certificate with Late Fee $140
Water Quality Analyst $75
Water Quality Analyst with Late Fee $100
Late Fee (if applicable) $25
Method of Payment
Money Order(s) Cheque(s) Visa MasterCard
VISA / MasterCard Number

Card Holders Name Expiry Date (mm/yy)
Card Holders Signature Telephone No. (including area code) Date (mm/dd/yyyy)
Mail Receipt To: check if same as Part A Personal Information
First Name

Last Name

Middle Initial

Unit No.

Street No.

Street Name

PO Box

City/Town

Province

Postal Code


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