Waterworks Operator Change of lnformation Form

Certified waterworks operators must submit this form to notify Department of Health and Washington Certification Services of changes to their contact information. Only a home address will be accepted as the mailing address of record. The Waterworks Operator Certification Program will not consider an appeal from an operator that is assessed a renewal late fee, does not renew a certificate, or does not meet the professional growth requirement due to failure to provide a valid home and email address.

Required Verification Information

I certify that I am the operator identified above and I authorize Department of Health and Washington Certification Services to make these changes to my contact information. I understand that third parties, such as employers, are prohibited from submitting changes.

Change Operator Information

Enter only the information that has changed.


Name Change

Change Employer Information