This form is to be completed by the contractor. It is designed to be an electronic form which can be completed and emailed back to the project manager. 

UQ Project Manager	insert name here	

Project Name	insert project name here

The University of Queensland aims to maintain water consumption at all UQ sites at or below1.1kL/m2 in accordance with its legislative obligations and its Water Efficiency Management Plan (WEMP).  All contractors should use water responsibly and in compliance with UQ’s current WEMP and the Queensland Water Commission Water Restriction Guidelines.

Important Information regarding the use of this Water Efficiency Management Plan template:

This template has been developed for contractors who plan to use the University of Queensland’s water for work on any University campuses or sites, regardless of water type.

Please complete and forward a copy to the Property and Facilities Project Manager responsible for the work or project that the plan relates to. 

If completing more than one job/project that will require the use of the University’s water, please submit a plan for each job/project.

The author of the plan is responsible for all actions within the plan. 

The information within the plan is intended for internal use within the Property and Facilities Division of the University to ensure that water is used safely and efficiently.

Permanent water conservation measures apply throughout South East Queensland and contractors should be aware of their responsibilities under the current restrictions. 

For further information on current water restrictions please refer to the Queensland Water Commission website:  www.qwc.gov.au 

All breaches of the Environmental Protection Act or other relevant environmental legislation are required to be reported to the Manager Sustainability on 3365 1587.

Report leaks or other infrastructure problems to PF Assist at pfassist@pf.uq.edu.au or telephone:

St Lucia                               3365 2222           internal  52222
Gatton and Ipswich          546 01226           internal  50226	
	
This form is to be completed and signed by the contractor 
1.0 Declaration 
I declare that the information given in this Water Efficiency Management Plan is true and correct.
Name	     	
Position:	     	
Signature:	     	
Date:	     	
2.0 Business Information
Name of Business	     	
Contact Person	     	
Position	     	
Mobile	     	
Fax	     	
Email	     	
No. of Employees	     	
3.0 Baseline Information
Project Description	      
Project Start Date	       				Project Completion Date      

Indicate the source/s of water you will be using 
 Mains			Treated wastewater		 Bore water
 Stormwater			Rainwater tank		River/stream
 Dam			Other      

Indicate the type of equipment or specific areas where water will be used, how it will be used, and known or estimated consumption per unit of production or per day. 

Water Source (e.g. mains, rainwater)	How will the water be used? (e.g. high pressure unit with trigger hose)	L/unit of production or L/day	
     	     	     	
     	     	     	
     	     	     	

If known, indicate total expected water consumption for the project	      Litres

Will you be recycling water used in the project?	Yes  No
If yes what %      
Can the project be completed without the use of water? 	Yes  No 

Comments     

Please indicate if you require water to be tested for appropriate reuse (this may be the case if you are using water from rainwater tanks or from the lakes).   	Yes  No