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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 the Oregon Health Authority on the forms provided below.
The Annual Summary Report is due each year by March 31
2017 Annual Summary Report - Fillable
Note: The survey monkey version is not available this year. We apologize for the inconvenience.
2016 Annual Summary Report - Fillable
2015 Annual Summary Report - Fillable
Annual summary report form for systems with 300 or more connections
Annual summary report form for systems with fewer than 300 connections
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