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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 the Oregon Health Authority on the forms provided below.

The Annual Summary Report is due each year by March 31

2023 Annual Summary Report
There are two Options for completing the 2023 Cross Connection Annual Summary Report. Please only select 1 of the options below. 

Option 1

Fill out the report online with SmartSheet by clicking the blue button 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: 971-673-0321

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

Phone: 971-673-0321
You can check the status of your ASR 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 2020, then your report has been entered.
  • If it does not say 2020, please make sure a sufficent enough time has passed (at least 8 weeks) to allow time for data entry before contacting the program 

2022 Annual Summary Report

2022 Annual Summary Report - (SmartSheet)

2021 Annual Summary Report
2021 Annual Summary Report - (SmartSheet)

2020 Annual Summary Report

2019 Annual Summary Report