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Healthy Communities

Water System Forms

Reporting and forms of interest to operators of community and non-community water systems, and other individuals.

Please note: Electronic Reporting of required SDWA information has not yet been approved by EPA. Reporting forms are provided to you to help you in preparing printed reports only.


Bacteriological Sampling Site Plan
Bacteriological Monitoring Report Form | EXCEL
Bin 2 Demonstration for LT2ESWTR | EXCEL
Water System Operating Report Form (Long Form) 
Water System Operating Report Form (Short Form) 
SWTR Operation Report Form 
Individual Filter Monitoring for 10,000 population or more 
Individual Filter Monitoring under 10,000 population 
Revised Total Coliform Rule Summary
RTCR Level 1 Assessment Form
Supplemental Surface source systems with Cartridge-Bag Filters Form 
Operator in Responsible Charge Verification Form
Frequently Asked Questions about  the Operational Evaluation Level
Operational Evaluation Questionnaire- Consecutive Systems
Operational Evaluation Questionnaire- Groundwater Systems
Operational Evaluation Questionnaire- Surface Water Systems
CT Calculation Spreadsheet (Excel)

Policies and Guidance

ADH Boil Order Policy
ADH Drip Dispersal System Policy
ADH Wastewater Bufferzone Policy
ADH Plastic Pipe Policy (Water)
ADH Plastic Pipe Policy (Wastewater)
ADH Fluoride Policy
ADH Policy for Underwater Tank Inspections
Policy on Submetered Property
Guidance for Water Storage Tank Inspections
Water Storage Tank Inspection Checklist


Public Health Accrediation Board
Arkansas Department of Health
© 2017 Arkansas Department of Health. All Rights Reserved.
4815 W. Markham, Little Rock, AR 72205-3867