Renewal of high risk manufactured water systems form

Required fields are marked with an asterisk (*).

If any details around business ownership or significant modifications have been made to any of the systems in the last 12 months, you will be required to fill out a new registration form.

Significant modifications include, a new tower added, tower removed, or significant changes to the location of a current tower.

Contact Details

Registered Business Name *

Registered Business ABN *

Business site address *

Business postal address If different from site address

Business reference number * As per email (i.e. CT0001/01)

Responsible person's name * The person employed by the business and responsible for ensuring compliant operation and maintenance of the system

Responsible person's phone number *

Responsible person's email address * Please note this e-mail address will be the primary means of all communication related to the HRMWS

Responsible person's residential address *

Is the responsible person located at the same site as where the system exists? *

If 'no' where do they primarily work?

Service Technician details

Service technician's company name *

Service technician's full name *

Service technician's phone number *

Service technician's email address *

System Maintenace Operation Standard

Which standard do you operate under? *

Australian Standard 3666.2
Australian Standard 3666.3
Warm Water System/s

Declaration

I confirm that *

all the details of onsite systems are the same as the previously submitted HRMWS registration details with no additional systems or towers, or changes to the physical location of any onsite systems or towers, or to business ownership
all details contained within this submission are true and accurate
in submitting this form, I acknowledge the legal responsibilities to manage onsite HRMWS’s under the South Australian Public Health (Legionella) Regulations 2013