Reporting Forms

Operator Designation Form for Community Water Supplies in Word or PDF

Administrative Rule R 325.11905(1) requires water supplies to be under the supervision of an operator in charge (OIC), certified in the system classification. Please use this form to designate an OIC, back-up operator, or if appropriate, a backup operations plan.

Annual Pumpage/Usage Report in Word or PDF

Community water supplies that do not submit a monthly operation report must submit a report of annual water pumpage and use to your EGLE District Office by March 31 of each year.

Cross Connection Report 

Community water supplies must report annually on the status of their cross connection program to your EGLE District Office by March 31 of each year.  Download the appropriate version of the form:

  • Cross Connection Report for municipal supplies:  Word or PDF
  • Cross Connection Report for Systems Serving Only Residential Accounts:  Word or PDF
    • Better for Mobile Home Parks, Condos, and Apartments

Revised Total Coliform Rule - Sample Siting Plan in Word or PDF (updated for RTCR)

Water supplies must have a current sample siting plan detailing sampling locations for routine and follow-up bacteriological monitoring.  If you have more than five (5) distribution sample sites, you may incorporate this sheet (PDF) as part of the SSP.

Revised Total Coliform Rule - Level 1 Assessment Form in Word or PDF
This form must be completed and submitted to your EGLE District Office as soon as possible, but no later than 30 days after the Level 1 Assessment is triggered.

Disinfectants and Disinfection Byproducts Monitoring Plan

Community water supplies that serve disinfected water must have a monitoring plan detailing sampling locations, sampling dates, and compliance calculation procedures for disinfectants and disinfection byproducts monitoring.

Lead and Copper Report and Consumer Notice of Lead Result Certificate

Lead and Copper reporting forms are available on the Lead and Copper Rule webpage

2020 CCR Template

Every community water supply must deliver a Consumer Confidence Report to consumers by July 1st annually. The report should include the most recent water quality data for the system within the last five (5) years.

CCR Certificate of Distribution in Word or PDF 

Community water supplies must submit a certificate to your EGLE District Office immediately following delivery of the annual Consumer Confidence Report confirming that the CCR is correct and has been distributed as required.

Emergency Response Plan in Word or PDF 

This form replaces the Contingency Plan. Community water supplies must prepare plans and procedures and identify personnel and equipment that can be used in the event of an emergency.  The Emergency Response Plan outlines a program for rapid correction or mitigation of emergencies to significantly lessen the impact of the emergency on the public health and the safety and supply of drinking water provided to the public.  Water supplies with a Contingency Plan will transition to the Emergency Response Plan according to the update schedule contained in the Contingency Plan.

Drinking Water Emergency Report in Word or PDF

Public water supplies must file a written report with EGLE within 90 days of an emergency. An "emergency" includes situations that result in contamination, loss of pressure, lack of adequate water supply, or other condition that poses an imminent hazard or danger to the public health.

Boil Drinking Water Public Notice Templates

Water supplies that need to issue a public notice should contact EGLE drinking water staff to ensure content and delivery requirements are met.

Stipulate to Conditions for Private Ownership of Public Water Supply

The owner of a privately owned Community Water Supply (CWS) must stipulate to conditions required by the department to ensure the CWS will meet the requirements of the act and rules.  The stipulation is required of owners of proposed water supplies, new owners of existing water supplies, and owners of water supplies whose classification is changed to CWS.  This stipulation is only one of many requirements on privately owned CWS.  Contact the appropriate Environment, Great Lakes, and Energy (EGLE) district office to discuss requirements.

EGLE districts serving Community Water Supplies 

Addresses of the 8 EGLE district offices overseeing community water supplies including an EGLE district map with telephone numbers of EGLE staff that oversee the community water supply program and the counties they serve.