Forms

Required fields are marked with asterisks (*)

Pre-screening form for in-home lead testing

We are signing up single family homes built before 1989 to add to our lead sampling program. This pre-screening form will help us determine if your home qualifies for the program.

Each year the city tests at 50 residential sites and 5 non-residential sites twice per year. Lead levels are regulated by the province of Ontario, and lead exposure can adversely impact health, especially the vulnerable population.

What to expect:

  • sampling requires a one hour appointment for staff to come to the house
  • testing is available in the summer and winter during the day on weekdays
  • a sample is taken at a cold, hard-water tap
  • the sample is sent for analysis
  • residents are notified directly of the results
  • testing is available again after 6 months

Lead plumbing and solders were banned in Canada by 1986 and are generally not suspected to be used in Waterloo after the mid 1970s, however we have to target homes where lead services or internal plumbing is suspected. Our targeted areas are the Mary Allen, Uptown surrounding area, Westmount, Lincoln Heights, Sugarbush and Northdale neighbourhoods.

For more general information on ‘Lead in Drinking Water’, refer to the Public Health pages at www.region.waterloo.on.ca , or call Waterloo Region Public Health at 519-883-2008.

Collection and use of personal information

Personal information on this form is collected under the authority of the Municipal Act, 2001, S.O. 2001, c.25 and will be used to determine eligibility and provide services under the in-home lead testing program. If you have questions regarding this collection, please contact the Legislative services team at (clerks@waterloo.ca) City of Waterloo 100 Regina Street South, Waterloo, ON, N2J 4A8, (519-747-8777).

When was your home built?
 


Are you the property owner?
 


Do you have a kitchen tap or other tap with cold, hard water available that is regularly used for drinking or cooking?
 
If you have a water softener, can it be placed on bypass?
 
If you have a water treatment system, can it be placed on bypass?
 
Do you have leaks in your plumbing?