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PUBLIC HEALTH DIVISION Center for Health Protection, Drinking Water Services Kate Brown, Governor2021 ANNUAL SUMMARY REPORT CROSS CONNECTION & BACKFLOW PREVENTIONReceived Oct 6 2022 Cross Connectionless
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Begin by gathering all necessary information and paperwork related to the cross connection annual form.
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Read through the form instructions thoroughly to understand the requirements and guidelines.
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Fill out the basic information section of the form, including your name, contact information, and the year (2020).
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Provide details about the cross connection you are reporting, such as its location, type, and any associated hazards.
05
Answer any additional questions or sections on the form as required, such as providing a description of the prevention program in place.
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Keep a copy of the filled-out form and any supporting documentation for your records.

Who needs 2020 cross connection annual?

01
Any individual, business, or organization that is responsible for a cross connection and meets the criteria set by the relevant regulatory authority needs to fill out the 2020 cross connection annual form.
02
This can include utility companies, property owners, facility managers, or anyone else who has a cross connection that is subject to annual reporting requirements.
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The cross connection annual summary is a report that outlines the details of cross connection control programs, documenting any instances of cross connections within a water system to ensure public health safety.
Entities that operate a public water system or any facility with potential cross connections are required to file a cross connection annual summary.
To fill out the cross connection annual summary, provide details such as the location, type of cross connection, inspections conducted, and any corrective actions taken throughout the year.
The purpose of the cross connection annual summary is to help monitor and control cross connections, thereby protecting drinkable water supplies from contamination and ensuring compliance with regulatory requirements.
The report must include the number of cross connections identified, inspection dates, corrective actions taken, and any occurrences of contamination due to cross connections.
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