Annual Summary Reports

The Cross Connection Annual Summary Report is a requirement for all community water systems in Oregon. Community water systems must report the requested information on their cross connection control programs each year to Oregon Department of Human Services, Public Health Division on the forms provided below.

Annual Report Forms and Instructions: The Annual Summary Report is due each year before the last business day of March for the previous years' reporting period of January 1st to December 31st.

REPORT FORMS AND INSTRUCTIONS WERE MAILED TO ALL PUBLIC WATER SUPPLIERS IN OREGON DURING THE WEEK OF JANUARY 14, 2008. THESE ARE FOR THE ANNUAL SUMMARY REPORT FOR 2008.

These files are available in (pdf) format. See "File Download Tips" below for help with obtaining these files. Please make your selection from the lists below based on the number of water service connections within your water system. 

Forms for 2008:

For systems with 300 or more connections

For systems with less than 300 connections

1. You need the Acrobat Reader to OPEN/VIEW/PRINT (pdf) files.
2. The (pdf) files cannot be edited electronically. They must be downloaded and printed, and either hand-written or typed in a typewriter. To do this:
   1. Right-click the (pdf) link.
   2. Save the file to your computer.
   3. Open the file.
   4. Print the file.
   5. Complete the form.