Schools & Childcares Interest Form – Philadelphia Water Department

Name *

Email Address *

Phone Number *

Are you the best person at your facility to be our primary contact? *

The primary contact should be someone who we can ask about the building’s plumbing, will be present for our walk-through, and will follow our instructions to collect water samples from the outlets we identify. This may be the owner/operator of a small childcare, a janitor or facilities manager at a school, or someone else who is familiar with the plumbing and available to assist. We can provide the sampling results and guidance to other people, if needed.

Primary Contact Name *

Primary Contact Email Address *

Primary Contact Phone Number *

Name of School or Childcare Facility *

Is your facility interested in participating in PWD’s Schools & Childcares Lead Sampling Program? *

Yes, we’re ready to participate
Yes, but not right now
Maybe
No

No problem, we can reach out again later. When do you think you might be ready? *

In 3 months
In 6 months
In a year

Schedule

Schedule a call with PWD to plan your next steps

The next section will open a pop-up for you to schedule a 20 minute call with PWD for you to get any questions answered and provide us with more information about your facility.

In the pop-up, scroll down to select a date and time you are available, (re)enter your name, email, a phone number where you can be reached at that time, and your facility’s name, and click the “Book” button.

Once you have done that, you can close the popup using the X in the top right corner.