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Forms for Operators of Small Drinking Water Systems
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4578-64E Laboratory Services Notification form (doc)
The Laboratory Services Notification (LSN) form is to be used by small drinking water system owners/operators to notify the local public health unit in writing as to which licensed laboratories will test drinking water samples for their small drinking water systems.

4579-64E SDWS Identification form (doc)
The Small Drinking Water System Identification form is to be used by owners of small drinking water systems to notify in writing the medical officer of health in the health unit where their system is located before supplying drinking water to users of the system following construction or alteration of the small drinking water system or following a shut-down of the system that lasts longer than seven days.

4580-64E Notice of Adverse test result and Issue Resolution form (doc)
The Notice of Adverse Test Results and Issue Resolution form is to be used by licensed laboratories and owners/operators of small drinking water systems to support required written notifications pertaining to small drinking water system adverse water quality incidents (AWQI)

For further information please call our Small Drinking Water Systems inspectors:

  • Brockville office:
    Gary Mackenzie
    613-345-5685

  • Smiths Falls office:
    Jennifer Bricker
    613-283-2740

  • or email Gary or Jennifer


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In case of public emergency please call 613-345-5685 • An accredited Health Unit since 1990