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Annual Summary Reports

The Cross Connection Annual Summary Report is a requirement for all community water systems in Oregon with 15 or more connections. 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


2018 Annual Summary Report

There are two Options for completing the 2018 Cross Connection Annual Summary Report. Please only select 1 of the options below. 

Option 1

Fill out the report online with SmartSheet by clicking one of the buttons below.
NOTE: You will have the option to receive a completed report by email. Follow the instructions in the form. 

Not sure how many connections you have, check Data Online
Phone: 971-673-0405

Option 2

Fill out the PDF electronically or by hand and submit it by email, fax, or mail.  
Fax: 971-673-0694 
Mail: DWS - Cross Connection 
800 NE Oregon St, Ste 640
Portland, OR 97232

You can check the status of your report by looking at Data Online

  • Find your water system by name or by PWS ID
  • Scroll towards the bottom. Under the heading Cross Connection in the middle column, if it says 2018, then your report has been entered.
  • If it does not say 2018, please make sure a sufficent enough time has passed (at least 2 weeks) to allow time for data entry before contacting the program 

2017 Annual Summary Report

2017 Annual Summary Report - Fillable

Note: The survey monkey version is not available this year. We apologize for the inconvenience.

2016 Annual Summary Report

PDF icon2016 Annual Summary Report - Fillable

2015 Annual Summary Report

PDF icon2015 Annual Summary Report - Fillable

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