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 DHS, Health Services, on the forms provided.

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.

Annual Report Forms & Instructions

REPORT FORMS AND INSTRUCTIONS WERE MAILED TO ALL PUBLIC WATER SUPPLIERS IN OREGON THE WEEK OF JANUARY 14, 2008 .  TO REDUCE UNNEEDED MAILINGS, THE DEPARTMENT WILL PROVIDE FUTURE FORMS ON THIS WEBSITE.  IF YOU ARE UNABLE TO USE THIS SITE, PLEASE CONTACT THE PROGRAM COORDINATOR OR INDICATE IN THE REPORT "PART F" COMMENTS SECTION A REQUEST FOR THE FORM TO BE MAILED.

These files are available in two formats: (Word) and (pdf) 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. 

• Water systems serving 300 or more connections.
     (Word)   |   (pdf)
  
• Water systems serving fewer than 300 connections.
     (Word)   |   (pdf)

• Water systems serving 300 or more connections.
     (Word)   |   (pdf)
  
• Water systems serving fewer than 300 connections.
     (Word)   |   (pdf)

1. You need Microsoft Word® to OPEN/EDIT/PRINT the (Word) file.
2. You need the Acrobat Reader to OPEN/VIEW/PRINT (pdf) files.
3. 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.