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Certified Operator Forms

For Massachusetts' public drinking water systems.
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Staffing and Comprehensive Operations Plan Forms

Open DOCX file, 48.85 KB,  Staffing and Comprehensive Operations Plan (Form ID: STAFF-PLAN) (English, DOCX 48.85 KB)

Form to be filled out by Public Water Systems with Primary and, if applicable, Secondary Distribution Operator data and zero or more treatment plants. This form is applicable to all PWS. Version: 2024-05-28

Open DOCX file, 38.44 KB,  Staffing and Comprehensive Operations Plan: Staffing - Secondary Distribution Operators (Form ID: STAFF-PLAN-DIST-ATTACH) (English, DOCX 38.44 KB)

Form to be filled out by Public Water Systems if more space is needed to list Secondary Distribution Operator data. Version: 2024-05-28

Open DOCX file, 53.18 KB,  Staffing and Comprehensive Operations Plan: Treatment Plant Staffing (Form ID: STAFF-PLAN-TP) (English, DOCX 53.18 KB)

Form to be filled out by Public Water Systems with at least one treatment facility. A form should be completed for each treatment facility with Primary and, if applicable, Secondary Treatment Operator data and treatment facility staffing coverage for each treatment facility. Version: 2024-05-28.

Open DOCX file, 38.47 KB,  Staffing and Comprehensive Operations Plan: Treatment Plant Staffing - Secondary Treatment Operators (Form ID: STAFF-PLAN-TP-ATTACH-1) (English, DOCX 38.47 KB)

Form to be filled out by Public Water Systems if more space is needed to list Secondary Treatment Operator data. Version: 2024-05-28

Open DOCX file, 37.17 KB,  Staffing and Comprehensive Operations Plan: Treatment Plant Coverage - Additional (Form ID: STAFF-PLAN-TP-ATTACH-2) (English, DOCX 37.17 KB)

Form to be filled out by Public Water Systems if more space is needed to list treatment facility staffing coverage. Version: 2024-05-28

Compliance Notice and Typical Duties & Responsibilities (COD) Forms

The Typical Duties and Responsibilities (COD) forms are for public water systems to identify the responsibilities of the certified operator and the owner, including any responsibilities that are shared by both parties. Public water systems can use the following matrix to determine which COD form is most appropriate for their system. 

Type of PWSMinimum Distribution and Treatment Classifications
VSS 
(no treatment)		VSS & 1T
(with disinfection only)		VSS & 1T
(with chemical treatment)
Community
(year-round and seasonal)		COD-7COD-8COD-9
Non-Community
(year-round)		COD-1COD-4COD-5
Non-Community
(seasonal)		COD-2COD-3COD-6

Open DOCX file, 88.62 KB,  Public Water System Certified Operator Compliance Notice (English, DOCX 88.62 KB)

Open DOC file, 181.5 KB,  Typical Duties & Responsibilities - NC, VSS (COD-1) (English, DOC 181.5 KB)

Open DOC file, 184.5 KB,  Typical Duties & Responsibilities - Seasonal, VSS (COD-2) (English, DOC 184.5 KB)

Open DOC file, 172 KB,  Typical Duties & Responsibilities - Seasonal NC, VSS (COD-3) (English, DOC 172 KB)

Open DOC file, 170 KB,  Typical Duties & Responsibilities - Year-Round NC, VSS (COD-4) (English, DOC 170 KB)

Open DOC file, 185 KB,  Typical Duties & Responsibilities - Year-Round NC, Chem, VSS, 1T (COD-5) (English, DOC 185 KB)

Open DOC file, 187 KB,  Typical Duties & Responsibilities - SNC, VSS 1T (COD-6) (English, DOC 187 KB)

Open DOC file, 185 KB,  Typical Duties & Responsibilities - SC, VSS (COD-7) (English, DOC 185 KB)

Open DOC file, 187 KB,  Typical Duties & Responsibilities - SC, disinfection, VSS (COD-8) (English, DOC 187 KB)

Open DOC file, 187 KB,  Typical Duties & Responsibilities of a Certified Operator - SC, chemical treatment, VSS, 1T (COD-9) (English, DOC 187 KB)

Termination Notice Forms

Open DOC file, 33 KB,  Certified Operator Termination Notice (English, DOC 33 KB)

Open DOC file, 32.5 KB,  Certified Operator Termination Rescission Notice (English, DOC 32.5 KB)

Other Forms

Application Form for TCH Approval from Board of Certification 
Contract Certified Operator Directories Form 

Form to be filled out by certified drinking water operators and contract operator companies that want to be listed in the individual or company directory.

Open DOC file, 42 KB,  Certified Operator Inspection Form and Check List - Contract Operation (English, DOC 42 KB)

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