Required fields are marked with asterisks (*)

Risk management plan inquiry

As your property is near a municipal drinking water well that has increasing chloride levels, the Region of Waterloo may require your organization to complete a winter maintenance risk management plan. By completing this form, you are requesting Region of Waterloo staff to contact you to determine if your property will require a risk management plan.

First Name

Last Name

Preferred Phone Number (mobile or landline)

Email Address

Property address

Please contact me to book my free property review consultation

Yes

Notice of Collection of Personal Information

To the extent that the foregoing information constitutes personal information as defined in the Municipal Freedom of Information and Protection of Privacy Act, R.S.O. 1990, chapter M.56 as amended, the information is subject to provisions of that Act and will be used to collect information for the purpose of communicating requirements of the Risk Management Plan negotiating process. Any questions regarding the collection of this personal information should be directed to the Risk Management Official at rmo@regionofwaterloo.ca or 519-575-4400.

I have read and understood the above notice of collection of my personal information.,

Yes

City of Cambridge

City of Kitchener

City of Waterloo

Township of North Dumfries

Township of Wellesley

Township of Wilmot

Township of Woolwich