DDW-2025-002259

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Water Operator Information
*Name *Cert#
Employer Email
Course Information
*Title
*Duration (in hours)*Location (City & State or Online)
*Start Date *End Date *Organization
Date
By signing, I certify the above information is correct & complete.
Utah Operator Certification Program
Continuing Education Unit (CEU)
Individual Accreditation Application
Complete ALL the Steps and fill out this application for each training. Please submit CEU’s on a regular basis with
the completed CEU application & course documentation. Incomplete CEU submissions will be rejected .
Checklist Instructions:
Operator's Signature
Complete ALL the Steps and fill out this application for the course to be approved by the Secretary of the
Operator Certification Commission.
Attach course documentation for proof of attendance and course objectives for CEU credit approval.
Examples: course outlines, agendas, screenshot of webinar, & certificate of completion.
Submit application and course related documents to the Division of Drinking Water.
*Detailed Course Description & Objectives
Include an agenda, a discussion outline, or some language describing the course content and the subjects covered. All CEU's for renewal are subject
to approval to ensure that the training is applicable to waterworks operation.
Division of Drinking Water
Operator Certification Program
P.O. Box 144830 • Salt Lake City, UT 84114
Phone:[phone]
E-mail:[e-mail]
DDWOpCert.Utah.gov
Notes