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Critical Water User Registration
(for Home Haemodialysis Users)

The Region of Peel makes every effort to provide a continuous supply of high quality drinking water to its customers. From time to time, the water supply may need to be temporarily interrupted to allow for emergency repair or maintenance activities.
The Region of Peel recognizes that there may be vulnerable water consumers (Critical Water Users) who require an uninterrupted water supply for home haemodialysis. The Region of Peel maintains a Critical Water Users list where these customers can voluntarily register for notification prior to required water interruptions. By completing this registration, you are identifying yourself as a Critical Water User. By providing your contact information below, you are also consenting to the collection and use of the personal information you are voluntarily providing in this form by the Region of Peel in accordance with the relevant privacy legislation.
Registration in this program is not a guarantee that water supply interruptions will not occur; however, notice will be made on a priority basis as a result of registration in this program. The Region of Peel will make every reasonable effort to contact residents registered for this program by using the contact information provided when water supply interruptions are necessary for routine maintenance or emergency repairs. It is the registered customer's responsibility to ensure that the contact information is effective for you to be reached on short notice.
It is the customer's responsibility to organize appropriate individual health management plans and to make alternative arrangements to accommodate haemodialysis sessions as a planning and risk management exercise for himself/herself. The Region of Peel encourages vulnerable customers to discuss same with their health care providers.
The Region of Peel is not liable for any damages resulting from the interruption or reduction of the amount of a public utility supplied to the land of any person as a result of an emergency or a breakdown, repair or extension of its public utility if, in the circumstances, reasonable notice of its intention to interrupt or reduce the supply is given (per s. 82 of the Municipal Act, 2001, as amended).
* - Required fields
Critical Water User
First Name *
Last Name *
Address *
Phone Number *
Secondary Phone Number [optional]
Alternate Contact
Should we be unable to contact you, please provide contact information for a person who would know how to contact you.
First Name [optional]
Last Name [optional]
Phone Number [optional]
Secondary Phone Number [optional]
What is your assigned haemodialysis clinic/hospital? [optional]
Trillium Health Partners, Credit Valley Hospital, 2200 Eglinton Ave W, Mississauga
Trillium Health Partners, Renal Care Centre, 75 Watline Ave, Mississauga
William Osler Health System, Brampton Civic Hospital, 2100 Bovaird Dr E, Brampton
University Health Network, Toronto General Hospital, 200 Elizabeth St, Toronto
St. Michael's Hospital, 30 Bond St, Toronto
St. Joseph's Health Care, Community Renal Centre, 1020 Islington Ave, Toronto
Halton Healthcare, Burlington Dialysis Centre, Joseph Brant Wellness House, 2160 Itabashi Way, Burlington
Other:
How did you learn about this program? [optional]
Dialysis clinic/hospital
Nurse
Region of Peel website
Other:
It may take up to three (3) business days for your information to be added to the Region of Peel's Critical Water Users list and the resulting notification service to commence. Within three (3) business days of completing this registration, you should receive a call from the Region of Peel to acknowledge your registration, confirm the information herein and obtain additional (voluntary) information about your specific needs.
If your situation changes, or your address changes, please contact the Region of Peel at 905-781-7900 ext. 4685. For information on the Region of Peel's privacy practices please visit Region of Peel Privacy Policy.
Notice of Collection
The Region of Peel's authority to collect water customer information comes from its Municipal Act, 2001 responsibilities to provide water and notices of supply interruption. Privacy questions related to the information collected for the Critical Water Users Database can be directed to Water Quality and Compliance Specialist, 10 Peel Centre Drive, Suite A, 4th Floor, Brampton ON L6T 4B9, or by telephone at 905-791-7800 ext. 4685.

Revised: Monday December 02 2013

www.peelregion.ca

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