Community Public Water Supply
Forms

These forms are used for Community Public Water Supply system activities, such as cities and manufactured housing developments, which typically serve people in their home.

• Bacteriological/Disinfectant Residual Monthly Report (PDF)
• Community Public Water System Interconnection Plan (PDF)
• Cybersecurity Assessment Certification Form (PDF)
• Fluoridation & Nitrate or Nitrite Removal Monthly Report (PDF)
• Fluoridation Phosphate & Nitrate or Nitrite Removal Monthly Report (PDF)
• Fluoride Monthly Report: Fewer Than 3300 (PDF)
• Fluoride Monthly Report: Multi Well (PDF)
• Fluoride Monthly Report: Phosphate (PDF)
• Fluoride Monthly Report: Single Treatment Point (PDF)
• How to Interpret Drinking Water Lab Results (PDF)
• Plan Review Fee Worksheet (PDF)
• Turbidity Monthly Report: Small Surface Water Systems (PDF)
• Turbidity Monthly Report: Large Surface Water Systems (PDF)
• Turbidity Monthly Report: Membrane Filtration Systems (PDF)
• Water Operator Exam Application (PDF)
• Water Tank Record for an Event (PDF)

Excel versions of some forms listed above

• Minnesota Rural Water Association (MRWA) MDH Report Forms
  • Fluoride Monthly Report: Single Treatment Point
  • Fluoride Monthly Report: Single Treatment Point with Corrosion Control
  • Community Public Water System Interconnection Plan

Additional forms

• Drinking Water Protection Forms