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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.

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

REPORT FORMS AND INSTRUCTIONS WERE MAILED TO ALL PUBLIC WATER SUPPLIERS IN OREGON JANUARY 2, 2014. THESE ARE FOR THE ANNUAL SUMMARY REPORT FOR 2013.

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

Forms for 2013:


Forms for 2012:




File Download Tips

  1. You need Adobe Reader to open, view, and print PDF files.  Download Adobe Reader free-of-charge if you do not already have it installed on your computer.
  2. The PDF reports cannot be filled in electronically - they must be printed and either hand-written or typed in a typewriter.  You can click on the form's link to open a copy of the form in your web browser and print it directly from there.  Alternatively, you can save a copy to your computer by right-clicking the form's link and selecting the Save As option; then you can open and print the document from your computer.