+-----------------+----------------------------------------------------+
| Number range    | Security Vulnerability                             |
| CHAPTER         |                                                    |
|                 | Self-Assessment Guide for Tribal Drinking Water    |
| ![](m           | Systems                                            |
| edia/image1.png |                                                    |
| ){width="0.9895 | **Environmental Protection Agency, Office of Water |
| 833333333334in" | Region X**                                         |
| height="0.97916 |                                                    |
| 66666666666in"} | **Evergreen Rural Water of Washington**            |
+-----------------+----------------------------------------------------+

\+

  ------------------------------------- -----------------------------------
  A Note about Security for this        
  Document                              

  ![](media/image3.wmf){width="1.5in"   This document contains sensitive
  height="2.033333333333333in"}         information about the security of
                                        your water system. Therefore, it
                                        should be treated as **Confidential
                                        Information** and should be stored
                                        in a secure place at your water
                                        system. A duplicate copy should
                                        also be stored in a secure off-site
                                        location.
  ------------------------------------- -----------------------------------

Contents

[**Security Vulnerability Self-Assessment Guide for Small Water
Systems**
4](#security-vulnerability-self-assessment-guide-for-small-water-systems)

[Introduction 4](#introduction)

[How to Use this Self-Assessment Guide
4](#how-to-use-this-self-assessment-guide)

[Keep this Document 4](#keep-this-document)

[**Security Vulnerability Self-Assessment**
5](#number-range-chaptersecurity-vulnerability-self-assessment)

[Record of Security Vulnerability Self-Assessment Completion
5](#record-of-security-vulnerability-self-assessment-completion)

[Inventory of Small Water System Critical Components
6](#inventory-of-small-water-system-critical-components)

[**Security Vulnerability Self-Assessment for Small Water Systems**
7](#security-vulnerability-self-assessment-for-small-water-systems)

[General Questions for the Entire Water System
7](#general-questions-for-the-entire-water-system)

[Water Sources 10](#water-sources)

[Treatment Plant and Suppliers 10](#treatment-plant-and-suppliers)

[Distribution 12](#distribution)

[Personnel 12](#personnel)

[Information storage/computers/controls/maps
13](#__RefHeading___Toc10537804)

[Public Relations 14](#public-relations)

[**Attachment 1. Prioritization of Needed Actions**
16](#attachment-1.-prioritization-of-needed-actions)

[**Attachment 2. Emergency Contact List**
17](#attachment-2.-emergency-contact-list)

[Section 1. System Identification 17](#section-1.-system-identification)

[Section 2. Notification/Contact Information
18](#section-2.-notificationcontact-information)

[Section 3. Communication and Outreach
21](#section-3.-communication-and-outreach)

[**Attachment 3: Threat Identification Checklists**
22](#attachment-3-threat-identification-checklists)

[Water System Telephone Threat Identification Checklist
22](#water-system-telephone-threat-identification-checklist)

[Water System Report of Suspicious Activity
24](#water-system-report-of-suspicious-activity)

[Certification of Completion 27](#certification-of-completion)

#   {#section .unnumbered}

# Security Vulnerability Self-Assessment Guide for Small Water Systems

## Introduction

Water systems are critical to every community. Protection of public
drinking water systems must be a high priority for local officials and
water system owners and operators to ensure an uninterrupted water
supply, which is essential for the protection of public health (safe
drinking water and sanitation) and safety (fire fighting).

Adequate security measures will help prevent loss of service through
terrorist acts, vandalism, or pranks. If your system is prepared, such
actions may even be prevented. The appropriate level of security is best
determined by the water system at the local level.

This Security Vulnerability Self-Assessment Guide is designed to help
small water systems determine possible vulnerable components and
identify security measures that should be considered. A "vulnerability
assessment" is the identification of weaknesses in water system
security, focusing on defined threats that could compromise its ability
to provide adequate potable water, and/or water for firefighting. This
document is designed particularly for systems that serve populations of
3,300 or less. This document is meant to encourage smaller systems to
review their system vulnerabilities, but it may not take the place of a
comprehensive review by security experts.

The Self-Assessment Guide has a simple design. Answers to assessment
questions are "yes" or "no," and there is space to identify needed
actions and actions you have taken to improve security. For any "no"
answer, refer to the "comment" column and/or contact your state Rural
Water Association.

## How to Use this Self-Assessment Guide

This document is designed for use by water system personnel. Physical
facilities pose a high degree of exposure to any security threat. This
self-assessment should be conducted on all components of your system
(wellhead or surface water intake, treatment plant, storage tank(s),
pumps, distribution system, and other important components of your
system).

The Assessment includes an emergency contact list for your use. This
list will help you identify who you need to contact in the event of an
emergency or threat and will help you develop communication and outreach
procedures. Filling out the Emergency Contact List is an important step
toward developing an Emergency Response Plan, which provides detailed
procedures on how to respond to an emergency.

Security is everyone's responsibility. We hope this document helps you
to increase the awareness of all your employees, governing officials,
and customers about security issues.

Once you have completed this document, review the actions you need to
take to improve your system's security. Make sure to prioritize your
actions based on the most likely threats. Please complete the
Certificate of Completion on page 27.

## Keep this Document

This is a working document. Its purpose is to start your process of
security vulnerability assessment and security enhancements. Security is
not an end point, but a goal that can be achieved only through continued
efforts to assess and upgrade your system.

Don't forget that this is a sensitive document. It should be stored
separately in a secure place at your water system. A duplicate copy
should also be retained at a secure off-site location.

Access to this document should be limited to key water system personnel
and local officials.

+----------------+---------------------------+---------+--------------+
| # Num          |                           |         |              |
| ber range CHAP |                           |         |              |
| TERSecurity Vu |                           |         |              |
| lnerability Se |                           |         |              |
| lf-Assessment  |                           |         |              |
|                |                           |         |              |
| ## Rec         |                           |         |              |
| ord of Securit |                           |         |              |
| y Vulnerabilit |                           |         |              |
| y Self-Assessm |                           |         |              |
| ent Completion |                           |         |              |
|                |                           |         |              |
| *The following |                           |         |              |
| information    |                           |         |              |
| should be      |                           |         |              |
| completed by   |                           |         |              |
| the individual |                           |         |              |
| conducting the |                           |         |              |
| s              |                           |         |              |
| elf-assessment |                           |         |              |
| and/or any     |                           |         |              |
| additional     |                           |         |              |
| revisions.*    |                           |         |              |
+----------------+---------------------------+---------+--------------+
| Name:          |                           |         |              |
+----------------+---------------------------+---------+--------------+
| Title:         |                           |         |              |
+----------------+---------------------------+---------+--------------+
| Area of        |                           |         |              |
| R              |                           |         |              |
| esponsibility: |                           |         |              |
+----------------+---------------------------+---------+--------------+
| Water System   |                           |         |              |
| Name:          |                           |         |              |
+----------------+---------------------------+---------+--------------+
| Water System   |                           |         |              |
| Number:        |                           |         |              |
+----------------+---------------------------+---------+--------------+
| Address:       |                           |         |              |
+----------------+---------------------------+---------+--------------+
| City:          |                           |         |              |
+----------------+---------------------------+---------+--------------+
| County:        |                           |         |              |
+----------------+---------------------------+---------+--------------+
| State:         |                           |         |              |
+----------------+---------------------------+---------+--------------+
| Zip Code:      |                           |         |              |
+----------------+---------------------------+---------+--------------+
| Telephone:     |                           |         |              |
+----------------+---------------------------+---------+--------------+
| Fax:           |                           |         |              |
+----------------+---------------------------+---------+--------------+
| E-mail:        |                           |         |              |
+----------------+---------------------------+---------+--------------+
| Date           |                           |         |              |
| Completed:     |                           |         |              |
+----------------+---------------------------+---------+--------------+
| Date Revised:  |                           | Sig     |              |
|                |                           | nature: |              |
+----------------+---------------------------+---------+--------------+
| Date Revised:  |                           | Sig     |              |
|                |                           | nature: |              |
+----------------+---------------------------+---------+--------------+
| Date Revised:  |                           | Sig     |              |
|                |                           | nature: |              |
+----------------+---------------------------+---------+--------------+
| Date Revised:  |                           | Sig     |              |
|                |                           | nature: |              |
+----------------+---------------------------+---------+--------------+
| Date Revised:  |                           | Sig     |              |
|                |                           | nature: |              |
+----------------+---------------------------+---------+--------------+

## Inventory of Small Water System Critical Components

+---------------------+-------------------------+---------------------+
| ###### Component    | **Number & Location (if | **Description**     |
|                     | applicable)**           |                     |
+---------------------+-------------------------+---------------------+
| **Source Water      |                         |                     |
| Type**              |                         |                     |
+---------------------+-------------------------+---------------------+
| Ground Water        |                         |                     |
+---------------------+-------------------------+---------------------+
| Surface Water       |                         |                     |
+---------------------+-------------------------+---------------------+
| > Purchased         |                         |                     |
+---------------------+-------------------------+---------------------+
| Treatment Plant     |                         |                     |
+---------------------+-------------------------+---------------------+
| > Buildings         |                         |                     |
+---------------------+-------------------------+---------------------+
| > Pumps             |                         |                     |
+---------------------+-------------------------+---------------------+
| > Treatment         |                         |                     |
| > Equipment (e.g.,  |                         |                     |
| > basin, clearwell, |                         |                     |
| > filter)           |                         |                     |
+---------------------+-------------------------+---------------------+
|                     |                         |                     |
+---------------------+-------------------------+---------------------+
|                     |                         |                     |
+---------------------+-------------------------+---------------------+
|                     |                         |                     |
+---------------------+-------------------------+---------------------+
| > Process Controls  |                         |                     |
+---------------------+-------------------------+---------------------+
| > Treatment         |                         |                     |
| > Chemicals and     |                         |                     |
| > Storage           |                         |                     |
+---------------------+-------------------------+---------------------+
| > Laboratory        |                         |                     |
| > Chemicals and     |                         |                     |
| > Storage           |                         |                     |
+---------------------+-------------------------+---------------------+
| Storage             |                         |                     |
+---------------------+-------------------------+---------------------+
| Storage Tanks       |                         |                     |
+---------------------+-------------------------+---------------------+
| Pressure Tanks      |                         |                     |
+---------------------+-------------------------+---------------------+
| Power               |                         |                     |
+---------------------+-------------------------+---------------------+
| > Primary Power     |                         |                     |
+---------------------+-------------------------+---------------------+
| > Auxiliary Power   |                         |                     |
+---------------------+-------------------------+---------------------+
| **Distribution      |                         |                     |
| System**            |                         |                     |
+---------------------+-------------------------+---------------------+
| > Pumps             |                         |                     |
+---------------------+-------------------------+---------------------+
| > Pipes             |                         |                     |
+---------------------+-------------------------+---------------------+
| > Valves            |                         |                     |
+---------------------+-------------------------+---------------------+
| > Appurtenances     |                         |                     |
| > (e.g., flush      |                         |                     |
| > hydrants,         |                         |                     |
| > backflow          |                         |                     |
| > preventers,       |                         |                     |
| > meters)           |                         |                     |
+---------------------+-------------------------+---------------------+
| > Other Vulnerable  |                         |                     |
| > Points            |                         |                     |
+---------------------+-------------------------+---------------------+
| **Offices**         |                         |                     |
+---------------------+-------------------------+---------------------+
| > Buildings         |                         |                     |
+---------------------+-------------------------+---------------------+
| > Computers         |                         |                     |
+---------------------+-------------------------+---------------------+
| > Files             |                         |                     |
+---------------------+-------------------------+---------------------+
| > Transportation/   |                         |                     |
| >                   |                         |                     |
| > Work Vehicles     |                         |                     |
+---------------------+-------------------------+---------------------+
| **Communications**  |                         |                     |
+---------------------+-------------------------+---------------------+
| > Telephone         |                         |                     |
+---------------------+-------------------------+---------------------+
| > Cell Phone        |                         |                     |
+---------------------+-------------------------+---------------------+
| > Radio             |                         |                     |
+---------------------+-------------------------+---------------------+
| > Computer Control  |                         |                     |
| > Systems (SCADA)   |                         |                     |
+---------------------+-------------------------+---------------------+

+-------------+-------+----------------------------+------------------+
| # Securit   |       |                            |                  |
| y Vulnerabi |       |                            |                  |
| lity Self-A |       |                            |                  |
| ssessment f |       |                            |                  |
| or Small Wa |       |                            |                  |
| ter Systems |       |                            |                  |
+-------------+-------+----------------------------+------------------+
| ## G        |       |                            |                  |
| eneral Ques |       |                            |                  |
| tions for t |       |                            |                  |
| he Entire W |       |                            |                  |
| ater System |       |                            |                  |
+-------------+-------+----------------------------+------------------+
| *The first  |       |                            |                  |
| 13          |       |                            |                  |
| questions   |       |                            |                  |
| in this     |       |                            |                  |
| vu          |       |                            |                  |
| lnerability |       |                            |                  |
| self        |       |                            |                  |
| -assessment |       |                            |                  |
| are general |       |                            |                  |
| questions   |       |                            |                  |
| designed to |       |                            |                  |
| apply to    |       |                            |                  |
| all         |       |                            |                  |
| components  |       |                            |                  |
| of your     |       |                            |                  |
| system      |       |                            |                  |
| (wellhead   |       |                            |                  |
| or surface  |       |                            |                  |
| water       |       |                            |                  |
| intake,     |       |                            |                  |
| treatment   |       |                            |                  |
| plant,      |       |                            |                  |
| storage     |       |                            |                  |
| tank(s),    |       |                            |                  |
| pumps,      |       |                            |                  |
| d           |       |                            |                  |
| istribution |       |                            |                  |
| system, and |       |                            |                  |
| offices).   |       |                            |                  |
| These are   |       |                            |                  |
| followed by |       |                            |                  |
| more        |       |                            |                  |
| specific    |       |                            |                  |
| questions   |       |                            |                  |
| that look   |       |                            |                  |
| at          |       |                            |                  |
| individual  |       |                            |                  |
| system      |       |                            |                  |
| components  |       |                            |                  |
| in greater  |       |                            |                  |
| detail.*    |       |                            |                  |
+-------------+-------+----------------------------+------------------+
| QUESTION    | A     | COMMENT                    | ACTION           |
|             | NSWER |                            | NEEDED/TAKEN     |
+-------------+-------+----------------------------+------------------+
| 1\. Do you  | Yes  | It is essential that you   |                  |
| have a      | No   | have an ERP. As a first    |                  |
| written     |       | step in developing your    |                  |
| emergency   |       | ERP, you should develop    |                  |
| response    |       | your Emergency Contact     |                  |
| plan (ERP)? |       | List (see Attachment 2).   |                  |
|             |       |                            |                  |
|             |       | A plan is vital in case    |                  |
|             |       | there is an incident that  |                  |
|             |       | requires immediate         |                  |
|             |       | response. Your plan should |                  |
|             |       | be reviewed at least       |                  |
|             |       | annually (or more          |                  |
|             |       | frequently if necessary)   |                  |
|             |       | to ensure it is up-to-date |                  |
|             |       | and addresses security     |                  |
|             |       | emergencies.               |                  |
|             |       |                            |                  |
|             |       | You should designate       |                  |
|             |       | someone to be contacted in |                  |
|             |       | case of emergency          |                  |
|             |       | regardless of the day of   |                  |
|             |       | the week or time of day.   |                  |
|             |       | This contact information   |                  |
|             |       | should be kept up-to-date  |                  |
|             |       | and made available to all  |                  |
|             |       | water system personnel and |                  |
|             |       | local officials (if        |                  |
|             |       | applicable).               |                  |
|             |       |                            |                  |
|             |       | Share this ERP with tribal |                  |
|             |       | police and emergency       |                  |
|             |       | personnel. Posting contact |                  |
|             |       | information is a good idea |                  |
|             |       | only if authorized         |                  |
|             |       | personnel are the only     |                  |
|             |       | ones seeing the            |                  |
|             |       | information. These signs   |                  |
|             |       | could pose a security risk |                  |
|             |       | if posted for public       |                  |
|             |       | viewing since it gives     |                  |
|             |       | people information that    |                  |
|             |       | could be used against the  |                  |
|             |       | system.                    |                  |
+-------------+-------+----------------------------+------------------+
| 2\. Is      | Yes  | You should restrict or     |                  |
| access to   | No   | limit access to the        |                  |
| the         |       | critical components of     |                  |
| critical    |       | your water system to       |                  |
| components  |       | authorized personnel only. |                  |
| of the      |       | This is the first step in  |                  |
| water       |       | security enhancement for   |                  |
| system      |       | your water system.         |                  |
| (i.e., a    |       | Consider the following:    |                  |
| part of the |       |                            |                  |
| physical    |       |  Issue water system photo |                  |
| inf         |       | identification cards for   |                  |
| rastructure |       | employees, and require     |                  |
| of the      |       | them to be displayed       |                  |
| system that |       | within the restricted area |                  |
| is          |       | at all times.              |                  |
| essential   |       |                            |                  |
| for water   |       |  Post signs restricting   |                  |
| flow and/or |       | entry to authorized        |                  |
| water       |       | personnel and ensure that  |                  |
| quality)    |       | assigned staff escort      |                  |
| restricted  |       | people without proper ID.  |                  |
| to          |       |                            |                  |
| authorized  |       |                            |                  |
| personnel   |       |                            |                  |
| only?       |       |                            |                  |
+-------------+-------+----------------------------+------------------+

+-------------+-------+----------------------------+------------------+
| QUESTION    | A     | COMMENT                    | ACTION           |
|             | NSWER |                            | NEEDED/TAKEN     |
+-------------+-------+----------------------------+------------------+
| 8\. Is the  | Yes  | When assessing the area    |                  |
| area around | No   | around your water system's |                  |
| the         |       | critical components, look  |                  |
| critical    |       | for objects that could be  |                  |
| components  |       | used to gain entry (e.g.,  |                  |
| of your     |       | large rocks, cement        |                  |
| water       |       | blocks, pieces of wood,    |                  |
| system free |       | ladders, valve keys, and   |                  |
| of objects  |       | other tools).              |                  |
| that may be |       |                            |                  |
| used for    |       |                            |                  |
| breaking    |       |                            |                  |
| and         |       |                            |                  |
| entering?   |       |                            |                  |
+-------------+-------+----------------------------+------------------+
| 9\. Are the | Yes  | You should clear fence     |                  |
| entry       | No   | lines of all vegetation.   |                  |
| points to   |       | Overhanging or nearby      |                  |
| your water  |       | trees may also provide     |                  |
| system      |       | easy access. Avoid         |                  |
| easily      |       | landscaping that will      |                  |
| seen?       |       | permit trespassers to hide |                  |
|             |       | or conduct unnoticed       |                  |
|             |       | suspicious activities.     |                  |
|             |       |                            |                  |
|             |       | Trim trees and shrubs to   |                  |
|             |       | enhance the visibility of  |                  |
|             |       | your water system's        |                  |
|             |       | critical components.       |                  |
|             |       |                            |                  |
|             |       | If possible, park vehicles |                  |
|             |       | and equipment in places    |                  |
|             |       | where they do not block    |                  |
|             |       | the view of your water     |                  |
|             |       | system's critical          |                  |
|             |       | components.                |                  |
+-------------+-------+----------------------------+------------------+
| 10\. Do you | Yes  | Consider installing an     |                  |
| have an     | No   | alarm system that notifies |                  |
| alarm       |       | the proper authorities or  |                  |
| system that |       | your water system's        |                  |
| will detect |       | designated contact for     |                  |
| u           |       | emergencies when there has |                  |
| nauthorized |       | been a breach of security. |                  |
| entry or    |       | Inexpensive systems are    |                  |
| attempted   |       | available. An alarm system |                  |
| entry at    |       | should be considered       |                  |
| critical    |       | whenever possible for      |                  |
| components? |       | tanks, pump houses, and    |                  |
|             |       | treatment facilities.      |                  |
|             |       |                            |                  |
|             |       | You should also have an    |                  |
|             |       | audible alarm at the site  |                  |
|             |       | as a deterrent and to      |                  |
|             |       | notify neighbors of a      |                  |
|             |       | potential threat.          |                  |
+-------------+-------+----------------------------+------------------+
| 11\. Do you | Yes  | Keep a record of locks and |                  |
| have a key  | No   | associated keys, and to    |                  |
| control and |       | whom the keys have been    |                  |
| acc         |       | assigned. This record will |                  |
| ountability |       | facilitate lock            |                  |
| policy?     |       | replacement and key        |                  |
|             |       | management (e.g., after    |                  |
|             |       | employee turnover or loss  |                  |
|             |       | of keys). Vehicle and      |                  |
|             |       | building keys should be    |                  |
|             |       | kept in a lockbox when not |                  |
|             |       | in use.                    |                  |
|             |       |                            |                  |
|             |       | You should have all keys   |                  |
|             |       | stamped (engraved) "DO NOT |                  |
|             |       | DUPLICATE."                |                  |
+-------------+-------+----------------------------+------------------+
| 12\. Are    | Yes  | Suppliers and personnel    |                  |
| entry codes | No   | from co-located            |                  |
| and keys    |       | organizations (e.g.,       |                  |
| limited to  |       | organizations using your   |                  |
| water       |       | facility for               |                  |
| system      |       | telecommunications) should |                  |
| personnel   |       | be denied access to codes  |                  |
| only?       |       | and/or keys. Codes should  |                  |
|             |       | be changed frequently if   |                  |
|             |       | possible. Entry into any   |                  |
|             |       | building should always be  |                  |
|             |       | under the direct control   |                  |
|             |       | of water system personnel. |                  |
+-------------+-------+----------------------------+------------------+
| 13\. Do you | Yes  | Watchful neighbors can be  |                  |
| have a      | No   | very helpful to a security |                  |
| n           |       | program. Make sure they    |                  |
| eighborhood |       | know whom to call in the   |                  |
| watch       |       | event of an emergency or   |                  |
| program for |       | suspicious activity.       |                  |
| your water  |       |                            |                  |
| system?     |       |                            |                  |
+-------------+-------+----------------------------+------------------+

+-------------+-------+----------------------------+------------------+
| ## Wa       |       |                            |                  |
| ter Sources |       |                            |                  |
|             |       |                            |                  |
| *In         |       |                            |                  |
| addition to |       |                            |                  |
| the above   |       |                            |                  |
| general     |       |                            |                  |
| checklist   |       |                            |                  |
| for your    |       |                            |                  |
| entire      |       |                            |                  |
| water       |       |                            |                  |
| system      |       |                            |                  |
| (questions  |       |                            |                  |
| 1-13), you  |       |                            |                  |
| should give |       |                            |                  |
| special     |       |                            |                  |
| attention   |       |                            |                  |
| to the      |       |                            |                  |
| following   |       |                            |                  |
| issues,     |       |                            |                  |
| presented   |       |                            |                  |
| in separate |       |                            |                  |
| tables,     |       |                            |                  |
| related to  |       |                            |                  |
| various     |       |                            |                  |
| water       |       |                            |                  |
| system      |       |                            |                  |
| components. |       |                            |                  |
| Your water  |       |                            |                  |
| sources     |       |                            |                  |
| (surface    |       |                            |                  |
| water       |       |                            |                  |
| intakes or  |       |                            |                  |
| wells)      |       |                            |                  |
| should be   |       |                            |                  |
| secured.    |       |                            |                  |
| Surface     |       |                            |                  |
| water       |       |                            |                  |
| supplies    |       |                            |                  |
| present the |       |                            |                  |
| greatest    |       |                            |                  |
| challenge.  |       |                            |                  |
| Typically   |       |                            |                  |
| they        |       |                            |                  |
| encompass   |       |                            |                  |
| large land  |       |                            |                  |
| areas.      |       |                            |                  |
| Where areas |       |                            |                  |
| cannot be   |       |                            |                  |
| secured,    |       |                            |                  |
| steps       |       |                            |                  |
| should be   |       |                            |                  |
| taken to    |       |                            |                  |
| initiate or |       |                            |                  |
| increase    |       |                            |                  |
| law         |       |                            |                  |
| enforcement |       |                            |                  |
| patrols.    |       |                            |                  |
| Pay         |       |                            |                  |
| particular  |       |                            |                  |
| attention   |       |                            |                  |
| to surface  |       |                            |                  |
| water       |       |                            |                  |
| intakes.    |       |                            |                  |
| Ask the     |       |                            |                  |
| public to   |       |                            |                  |
| be vigilant |       |                            |                  |
| and report  |       |                            |                  |
| suspicious  |       |                            |                  |
| activity.*  |       |                            |                  |
+=============+=======+============================+==================+
| QUESTION    | A     | COMMENT                    | ACTION           |
|             | NSWER |                            | NEEDED/TAKEN     |
+-------------+-------+----------------------------+------------------+
| 14\. Are    | Yes  | A properly sealed wellhead |                  |
| your        | No   | decreases the opportunity  |                  |
| wellheads   |       | for the introduction of    |                  |
| sealed      |       | contaminants. If you are   |                  |
| properly?   |       | not sure whether your      |                  |
|             |       | wellhead is properly       |                  |
|             |       | sealed, contact your well  |                  |
|             |       | drilling/maintenance       |                  |
|             |       | company, your state Rural  |                  |
|             |       | Water Association or other |                  |
|             |       | technical assistance       |                  |
|             |       | providers.                 |                  |
+-------------+-------+----------------------------+------------------+
| 15\. Are    | Yes  | Properly installed vents   |                  |
| well vents  | No   | and caps can help prevent  |                  |
| and caps    |       | the introduction of a      |                  |
| screened    |       | contaminant into the water |                  |
| and         |       | supply.                    |                  |
| securely    |       |                            |                  |
| attached?   |       | Ensure that vents and caps |                  |
|             |       | serve their purpose, and   |                  |
|             |       | cannot be easily breached  |                  |
|             |       | or removed.                |                  |
+-------------+-------+----------------------------+------------------+
| 16\. Are    | Yes  | All observation/test and   |                  |
| obser       | No   | abandoned wells should be  |                  |
| vation/test |       | properly capped or secured |                  |
| and         |       | to prevent the             |                  |
| abandoned   |       | introduction of            |                  |
| wells       |       | contaminants into the      |                  |
| properly    |       | aquifer or water supply.   |                  |
| secured to  |       |                            |                  |
| prevent     |       |                            |                  |
| tampering?  |       |                            |                  |
+-------------+-------+----------------------------+------------------+
| 17\. Is     | Yes  | Surface water supplies     |                  |
| your        | No   | present the greatest       |                  |
| surface     |       | challenge to secure.       |                  |
| water       |       | Often, they encompass      |                  |
| source      |       | large land areas. Where    |                  |
| secured     |       | areas cannot be secured,   |                  |
| with fences |       | steps should be taken to   |                  |
| or gates?   |       | initiate or increase       |                  |
| Do water    |       | patrols by water utility   |                  |
| system      |       | personnel and law          |                  |
| personnel   |       | enforcement agents.        |                  |
| visit the   |       |                            |                  |
| source?     |       |                            |                  |
+-------------+-------+----------------------------+------------------+
|             |       |                            |                  |
+-------------+-------+----------------------------+------------------+
| ## Treatme  |       |                            |                  |
| nt Plant an |       |                            |                  |
| d Suppliers |       |                            |                  |
+-------------+-------+----------------------------+------------------+
| *Some small |       |                            |                  |
| systems     |       |                            |                  |
| provide     |       |                            |                  |
| easy access |       |                            |                  |
| to their    |       |                            |                  |
| water       |       |                            |                  |
| system for  |       |                            |                  |
| suppliers   |       |                            |                  |
| of          |       |                            |                  |
| equipment,  |       |                            |                  |
| chemicals,  |       |                            |                  |
| and other   |       |                            |                  |
| materials   |       |                            |                  |
| for the     |       |                            |                  |
| convenience |       |                            |                  |
| of both     |       |                            |                  |
| parties.    |       |                            |                  |
| This        |       |                            |                  |
| practice    |       |                            |                  |
| should be   |       |                            |                  |
| dis         |       |                            |                  |
| continued.* |       |                            |                  |
+-------------+-------+----------------------------+------------------+
| QUESTION    | A     | COMMENT                    | ACTION           |
|             | NSWER |                            | NEEDED/TAKEN     |
+-------------+-------+----------------------------+------------------+
| 18\. Are    | Yes  | Establish a policy that an |                  |
| deliveries  | No   | authorized person,         |                  |
| of          |       | designated by the water    |                  |
| chemicals   |       | system, must accompany all |                  |
| and other   |       | deliveries. Verify the     |                  |
| supplies    |       | credentials of all         |                  |
| made in the |       | drivers. This prevents     |                  |
| presence of |       | unauthorized personnel     |                  |
| water       |       | from having access to the  |                  |
| system      |       | water system.              |                  |
| personnel?  |       |                            |                  |
+-------------+-------+----------------------------+------------------+
| 19\. Have   | Yes  | Verify that your suppliers |                  |
| you         | No   | take precautions to ensure |                  |
| discussed   |       | that their products are    |                  |
| with your   |       | not contaminated. Chain of |                  |
| supplier(s) |       | custody procedures for     |                  |
| procedures  |       | delivery of chemicals      |                  |
| to ensure   |       | should be reviewed. You    |                  |
| the         |       | should inspect chemicals   |                  |
| security of |       | and other supplies at the  |                  |
| their       |       | time of delivery to verify |                  |
| products?   |       | they are sealed and in     |                  |
|             |       | unopened containers. Match |                  |
|             |       | all delivered goods with   |                  |
|             |       | purchase orders to ensure  |                  |
|             |       | that they were, in fact,   |                  |
|             |       | ordered by your water      |                  |
|             |       | system.                    |                  |
|             |       |                            |                  |
|             |       | You should keep a log or   |                  |
|             |       | journal of deliveries. It  |                  |
|             |       | should include the         |                  |
|             |       | driver's name (taken from  |                  |
|             |       | the driver's photo I.D.),  |                  |
|             |       | date, time, material       |                  |
|             |       | delivered, and the         |                  |
|             |       | supplier's name.           |                  |
+-------------+-------+----------------------------+------------------+

+-------------+-------+----------------------------+------------------+
| ## D        |       |                            |                  |
| istribution |       |                            |                  |
|             |       |                            |                  |
| *Hydrants   |       |                            |                  |
| are highly  |       |                            |                  |
| visible and |       |                            |                  |
| convenient  |       |                            |                  |
| entry       |       |                            |                  |
| points into |       |                            |                  |
| the         |       |                            |                  |
| d           |       |                            |                  |
| istribution |       |                            |                  |
| system.     |       |                            |                  |
| Maintaining |       |                            |                  |
| and         |       |                            |                  |
| monitoring  |       |                            |                  |
| positive    |       |                            |                  |
| pressure in |       |                            |                  |
| your system |       |                            |                  |
| is          |       |                            |                  |
| important   |       |                            |                  |
| to provide  |       |                            |                  |
| fire        |       |                            |                  |
| protection  |       |                            |                  |
| and prevent |       |                            |                  |
| i           |       |                            |                  |
| ntroduction |       |                            |                  |
| of          |       |                            |                  |
| con         |       |                            |                  |
| taminants.* |       |                            |                  |
+-------------+-------+----------------------------+------------------+
| QUESTION    | A     | COMMENT                    | ACTION           |
|             | NSWER |                            | NEEDED/TAKEN     |
+-------------+-------+----------------------------+------------------+
| 25\. Do you | Yes  | Your water system should   |                  |
| control the | No   | have a policy that         |                  |
| use of      |       | regulates the authorized   |                  |
| hydrants    |       | use of hydrants for        |                  |
| and valves? |       | purposes other than fire   |                  |
|             |       | protection. Require        |                  |
|             |       | authorization and backflow |                  |
|             |       | devices if a hydrant is    |                  |
|             |       | used for any purpose other |                  |
|             |       | than fire fighting.        |                  |
|             |       |                            |                  |
|             |       | Consider designating       |                  |
|             |       | specific hydrants for use  |                  |
|             |       | as filling station(s) with |                  |
|             |       | proper backflow prevention |                  |
|             |       | (e.g., to meet the needs   |                  |
|             |       | of construction firms).    |                  |
|             |       | Then, notify local law     |                  |
|             |       | enforcement officials and  |                  |
|             |       | the public that these are  |                  |
|             |       | the only sites designated  |                  |
|             |       | for this use.              |                  |
|             |       |                            |                  |
|             |       | Flush hydrants should be   |                  |
|             |       | kept locked to prevent     |                  |
|             |       | contaminants from being    |                  |
|             |       | introduced into the        |                  |
|             |       | distribution system, and   |                  |
|             |       | to prevent improper use.   |                  |
+-------------+-------+----------------------------+------------------+
| 26\. Does   | Yes  | Positive pressure is       |                  |
| your system | No   | essential for fire         |                  |
| monitor     |       | fighting and for           |                  |
| for, and    |       | preventing back-siphonage  |                  |
| maintain,   |       | that may contaminate       |                  |
| positive    |       | finished water in the      |                  |
| pressure?   |       | distribution system.       |                  |
+-------------+-------+----------------------------+------------------+
| 27\. Has    | Yes  | In addition to maintaining |                  |
| your system | No   | positive pressure,         |                  |
| implemented |       | backflow prevention        |                  |
| a backflow  |       | programs provide an added  |                  |
| prevention  |       | margin of safety by        |                  |
| program?    |       | helping to prevent the     |                  |
|             |       | intentional introduction   |                  |
|             |       | of contaminants.           |                  |
+-------------+-------+----------------------------+------------------+
|             |       |                            |                  |
+-------------+-------+----------------------------+------------------+
| #           |       |                            |                  |
| # Personnel |       |                            |                  |
+-------------+-------+----------------------------+------------------+
| *You should |       |                            |                  |
| add         |       |                            |                  |
| security    |       |                            |                  |
| procedures  |       |                            |                  |
| to your     |       |                            |                  |
| personnel   |       |                            |                  |
| policies.*  |       |                            |                  |
+-------------+-------+----------------------------+------------------+
| QUESTION    | A     | COMMENT                    | ACTION           |
|             | NSWER |                            | NEEDED/TAKEN     |
+-------------+-------+----------------------------+------------------+
| 28\. When   | Yes  | It is good practice to     |                  |
| hiring      | No   | have all job candidates    |                  |
| personnel,  |       | fill out an employment     |                  |
| do you      |       | application. You should    |                  |
| request     |       | verify professional        |                  |
| that local  |       | references. Background     |                  |
| police      |       | checks conducted during    |                  |
| perform a   |       | the hiring process may     |                  |
| criminal    |       | prevent potential          |                  |
| background  |       | employee-related security  |                  |
| check, and  |       | issues.                    |                  |
| do you      |       |                            |                  |
| verify      |       | If you use contract        |                  |
| employment  |       | personnel, check on the    |                  |
| eligibility |       | personnel practices of all |                  |
| (as         |       | providers to ensure that   |                  |
| required by |       | their hiring practices are |                  |
| the         |       | consistent with good       |                  |
| Immigration |       | security practices.        |                  |
| and         |       |                            |                  |
| Nat         |       |                            |                  |
| uralization |       |                            |                  |
| Service,    |       |                            |                  |
| Form I-9)?  |       |                            |                  |
+-------------+-------+----------------------------+------------------+

+--------------+------+-------------------------------+---------------+
| QUESTION     | AN   | COMMENT                       | ACTION        |
|              | SWER |                               | NEEDED/TAKEN  |
+--------------+------+-------------------------------+---------------+
| 35\. Is      | Yes  | Posting detailed information  |               |
| there        |  No | about your water system on a  |               |
| information  |     | Web site may make the system  |               |
| on the Web   |      | more vulnerable to attack.    |               |
| that can be  |      | Web sites should be examined  |               |
| used to      |      | to determine whether they     |               |
| disrupt your |      | contain critical information  |               |
| system or    |      | that should be removed.       |               |
| contaminate  |      |                               |               |
| your water?  |      | You should do a Web search    |               |
|              |      | (using a search engine such   |               |
|              |      | as Google, Yahoo!, or Lycos)  |               |
|              |      | using key words related to    |               |
|              |      | your water supply to find any |               |
|              |      | published data on the Web     |               |
|              |      | that is easily accessible by  |               |
|              |      | someone who may want to       |               |
|              |      | damage your water supply.     |               |
+--------------+------+-------------------------------+---------------+
| 36\. Are     | Yes  | Records, maps, and other      |               |
| maps,        |  No | information should be stored  |               |
| records, and |     | in a secure location when not |               |
| other        |      | in use. Access should be      |               |
| information  |      | limited to authorized         |               |
| stored in a  |      | personnel only.               |               |
| secure       |      |                               |               |
| location?    |      | You should make back-up       |               |
|              |      | copies of all data and        |               |
|              |      | sensitive documents. These    |               |
|              |      | should be stored in a secure  |               |
|              |      | off-site location on a        |               |
|              |      | regular basis.                |               |
+--------------+------+-------------------------------+---------------+
| 37\. Are     | Yes  | Sensitive documents (e.g.,    |               |
| copies of    |  No | schematics, maps, and plans   |               |
| records,     |     | and specifications)           |               |
| maps, and    |      | distributed for construction  |               |
| other        |      | projects or other uses should |               |
| sensitive    |      | be recorded and recovered     |               |
| information  |      | after use. You should discuss |               |
| labeled      |      | measures to safeguard your    |               |
| c            |      | documents with bidders for    |               |
| onfidential, |      | new projects.                 |               |
| and are all  |      |                               |               |
| copies       |      |                               |               |
| controlled   |      |                               |               |
| and returned |      |                               |               |
| to the water |      |                               |               |
| system?      |      |                               |               |
+--------------+------+-------------------------------+---------------+
| 38\. Are     | Yes  | Vehicles are essential to any |               |
| vehicles     |  No | water system. They typically  |               |
| locked and   |     | contain maps and other        |               |
| secured at   |      | information about the         |               |
| all times?   |      | operation of the water        |               |
|              |      | system. Water system          |               |
|              |      | personnel should exercise     |               |
|              |      | caution to ensure that this   |               |
|              |      | information is secure.        |               |
|              |      |                               |               |
|              |      | Water system vehicles should  |               |
|              |      | be locked when they are not   |               |
|              |      | in use or left unattended.    |               |
|              |      |                               |               |
|              |      | Remove any critical           |               |
|              |      | information about the system  |               |
|              |      | before parking vehicles for   |               |
|              |      | the night.                    |               |
|              |      |                               |               |
|              |      | Vehicles also usually contain |               |
|              |      | tools (e.g., valve wrenches)  |               |
|              |      | that could be used to access  |               |
|              |      | critical components of your   |               |
|              |      | water system. These tools     |               |
|              |      | should be secured and         |               |
|              |      | accounted for daily.          |               |
+--------------+------+-------------------------------+---------------+
|              |      |                               |               |
+--------------+------+-------------------------------+---------------+
| ## Publ      |      |                               |               |
| ic Relations |      |                               |               |
+--------------+------+-------------------------------+---------------+
| *You should  |      |                               |               |
| educate your |      |                               |               |
| customers    |      |                               |               |
| about your   |      |                               |               |
| system. You  |      |                               |               |
| should       |      |                               |               |
| encourage    |      |                               |               |
| them to be   |      |                               |               |
| alert and to |      |                               |               |
| report any   |      |                               |               |
| suspicious   |      |                               |               |
| activity to  |      |                               |               |
| law          |      |                               |               |
| enforcement  |      |                               |               |
| a            |      |                               |               |
| uthorities.* |      |                               |               |
+--------------+------+-------------------------------+---------------+
| **QUESTION** | **   | **COMMENT**                   | **ACTION      |
|              | ANSW |                               | N             |
|              | ER** |                               | EEDED/TAKEN** |
+--------------+------+-------------------------------+---------------+
| 39\. Do you  | Yes  | Advise your customers and the |               |
| have a       |  No | public that your system has   |               |
| program to   |     | increased preventive security |               |
| educate and  |      | measures to protect the water |               |
| encourage    |      | supply from vandalism. Ask    |               |
| the public   |      | for their help. Provide       |               |
| to be        |      | customers with your telephone |               |
| vigilant and |      | number and the telephone      |               |
| report       |      | number of the local law       |               |
| suspicious   |      | enforcement authority so that |               |
| activity to  |      | they can report suspicious    |               |
| assist in    |      | activities. The telephone     |               |
| the security |      | number can be made available  |               |
| protection   |      | through direct mail, billing  |               |
| of your      |      | inserts, notices on community |               |
| water        |      | bulletin boards, flyers, and  |               |
| system?      |      | consumer confidence reports.  |               |
+--------------+------+-------------------------------+---------------+

***Now that you have completed the "Security Vulnerability
Self-Assessment Guide for Small Water Systems," review your needed
actions and then prioritize them based on the most likely threats. A
Table to assist you in prioritizing actions is provided in Attachment
1.***

# Attachment 1. Prioritization of Needed Actions

Once you have completed the "Security Vulnerability Self-Assessment
Guide for Small Drinking Water Systems," review the actions you need to
take to improve your system's security. Note the questions to which you
answered "no" on this worksheet. You can use it to summarize the areas
where your system has vulnerability concerns. It can also help you
prioritize the actions you should take to protect your system from
vulnerabilities. Make sure to prioritize your actions based on the most
likely threats to your water system.

  ----------- ------------------------------------------------- ------------
  Question    Needed Action                                     Scheduled
  Number                                                        Completion

                                                                

                                                                

                                                                

                                                                

                                                                

                                                                

                                                                

                                                                

                                                                

                                                                

                                                                

                                                                

                                                                

                                                                
  ----------- ------------------------------------------------- ------------

# Attachment 2. Emergency Contact List

We urge all public water systems to adopt an emergency response plan
(ERP). Emergency plans are action steps to follow if a primary source of
drinking water becomes contaminated or if the flow of water is
disrupted.

This sample document is an "Emergency Contact List." It is an essential
part of your ERP. It contains the names and telephone numbers of people
you might need to call in the event of an emergency. This is a critical
document to have at your disposal at all times. It gives you a quick
reference to all names and telephone numbers that you need for support
in the case of an emergency.

Filling out this Emergency Contact List reminds you to think about all
of the people you might need to contact in an emergency. It also may
encourage you to talk with these people about what you and they would do
if an emergency were to occur.

## Section 1. System Identification

  ---------------------------- -------------------- ---------------------
  Public Water System (PWS) ID                      
  Number                                            

  System Name                                       

  Town/City                                         

  Telephone Numbers            System Telephone     Evening/Weekend
                                                    Telephone

  Other Contact Information    System Fax           Email

  Population Served and Number People Served        Connections
  of Service Connections                            

  System Manager (The manager                       
  must be listed as a person's                      
  name)                                             

  Name, title, and telephone   Name and title       Telephone
  number of person responsible                      
  for maintaining this                              
  emergency contact list                            
  ---------------------------- -------------------- ---------------------

## Section 2. Notification/Contact Information

######## Local Notification List

  --------------------- -------------- ---------------- -------------- ------------------
  Number range          CONTACT        TELEPHONE (DAY)  TELEPHONE      EMAIL
  CHAPTERORGANIZATION   NAME/TITLE                      (NIGHT)        

  Fire Department - 911                                                

  Police Department -                                                  
  911                                                                  

  Local Health                                                         
  Department                                                           

  EPA Regional Office                                                  

  IHS District Office                                                  

  Local Schools                                                        

  Local Government                                                     
  Official                                                             

  Water System Operator                                                

  Neighboring Water                                                    
  System                                                               

  Neighboring Water                                                    
  System                                                               

  Local Analytical                                                     
  Laboratory                                                           

  State Rural Water     Evergreen      1-800-272-5981   Same           <info@erwow.org>
  Association           Rural Water                     (answering     
                        (WA)                            machine)       

  Other                                                                
  --------------------- -------------- ---------------- -------------- ------------------

Service/Repair Notification List

  --------------------- --------------- -------------- -------------- -------
  Number range          CONTACT         TELEPHONE      TELEPHONE      EMAIL
  CHAPTERORGANIZATION   NAME/TITLE      (DAY)          (NIGHT)        

  Electrician                                                         

  Electric Utility                                                    
  Company                                                             

  Gas Utility Company                                                 

  Sewer Utility Company                                               

  Telephone Utility                                                   
  Company                                                             

  Plumber                                                             

  Pump Specialist                                                     

  Utilities Underground                                               
  Location Center                                                     

  Soil                                                                
  Excavator/Backhoe                                                   
  Operator                                                            

  Equipment Rental                                                    
  (Power Generators)                                                  

  Equipment Rental                                                    
  (Chlorinators)                                                      

  Equipment Rental                                                    
  (Portable Fencing)                                                  

  Equipment Repairman                                                 

  Radio/Telemetry                                                     
  Repair Service                                                      

  Bottled Water Source                                                

  Bulk Water Hauler                                                   

  Pump Supplier                                                       

  Well Drillers                                                       

  Pipe Supplier                                                       

  Chemical Supplier                                                   

  Local/Regional                                                      
  Analytical Laboratory                                               
  --------------------- --------------- -------------- -------------- -------

######## Regional Notification List

  ---------------- --------------- ------------- -------------- -----------
  ORGANIZATION     CONTACT         TELEPHONE     TELEPHONE      EMAIL
                   NAME/TITLE      (DAY)         (NIGHT)        

  EPA Regional                                                  
  Office (WA)                                                   

  State Emergency                                               
  Management                                                    
  Division                                                      

  Tribal/Local                                                  
  Police                                                        

  Spill Response                                                
  ---------------- --------------- ------------- -------------- -----------

######## Media Notification List 

  --------------------- --------------- ------------- -------------- -----------
  Number range          CONTACT         TELEPHONE     TELEPHONE      EMAIL
  CHAPTERORGANIZATION   NAME/TITLE      (DAY)         (NIGHT)        

  Designated Water                                                   
  System Spokesperson                                                

  Newspaper - Local                                                  

  Newspaper --                                                       
  Regional/State                                                     

  Radio                                                              

  Radio                                                              

  Radio                                                              

  Television                                                         

  Television                                                         

  Television                                                         
  --------------------- --------------- ------------- -------------- -----------

## Section 3. Communication and Outreach

######### Communication

Communications during an emergency poses some special problems. A
standard response might be to call "911" for local fire and police
departments. But what if your emergency had disrupted telephone lines
and over-loaded cell phone lines? Talk with your local emergency
management committee about local emergency preparedness and solutions to
these problems. Increasingly, emergency management agencies are
establishing secure lines of communication with limited access. Learn
how you can access those lines of communication if all others fail.

*Outreach*

If there is an incident of contamination in your water supply, you will
need to notify the public and work with EPA and health officials to make
public health recommendations (e.g., boil water, or use bottled water).
To do this, you need a plan.

 How will you reach all customers in the first 24 hours of an
emergency?

 Appoint a media spokesperson---a single person in your water system
who will be authorized to make all public statements to the media.

 Make arrangements for contacting institutions with large numbers of
people, some of whom may be immuno-compromised:

> \- Nursing homes
>
> \- Hospitals
>
> \- Schools
>
> \- Prisons

#  

# 

# Attachment 3: Threat Identification Checklists

## Water System Telephone Threat Identification Checklist

In the event your water system receives a threatening phone call, remain
calm and try to keep the caller on the line. Use the following checklist
to collect as much detail as possible about the nature of the threat and
the description of the caller.

<table>
<colgroup>
<col style="width: 14%" />
<col style="width: 1%" />
<col style="width: 17%" />
<col style="width: 10%" />
<col style="width: 5%" />
<col style="width: 7%" />
<col style="width: 15%" />
<col style="width: 2%" />
<col style="width: 11%" />
<col style="width: 14%" />
</colgroup>
<tbody>
<tr class="odd">
<td colspan="3"><p><strong>Number range CHAPTER1. Types of
Tampering/Threat:</strong></p>
<p> Contamination</p>
<p> Biological</p>
<p> Chemical</p></td>
<td colspan="7"><p> Threat to tamper</p>
<p> Bombs, explosives, etc.</p>
<p> Other (explain)</p></td>
</tr>
<tr class="even">
<td colspan="10"><p><strong>2. Water System Identification:</strong></p>
<p>Name:</p>
<p>Address:</p>
<p>Telephone:</p>
<p>PWS Owner or Manager’s Name:</p></td>
</tr>
<tr class="odd">
<td colspan="10"><strong>3. Location of Tampering:</strong></td>
</tr>
<tr class="even">
<td colspan="2"><p> Distribution Line</p>
<p> Other (explain):</p></td>
<td> Water Storage Facilities</td>
<td colspan="2">Treatment Plant</td>
<td colspan="3"> Raw Water Source</td>
<td colspan="2"> Treatment Chemicals</td>
</tr>
<tr class="odd">
<td colspan="10"><strong>4. Contaminant Source and
Quantity:</strong></td>
</tr>
<tr class="even">
<td colspan="10"><strong>5. Date and Time of
Tampering/Threat:</strong></td>
</tr>
<tr class="odd">
<td colspan="10"><strong>6. Caller’s Name/Alias, Address, and Telephone
Number:</strong></td>
</tr>
<tr class="even">
<td colspan="10"><strong>7. Is the Caller (check all that
apply):</strong></td>
</tr>
<tr class="odd">
<td> Male</td>
<td colspan="2"> Female</td>
<td> Foul</td>
<td colspan="2"> Illiterate</td>
<td> Well Spoken</td>
<td colspan="2"> Irrational</td>
<td> Incoherent</td>
</tr>
</tbody>
</table>

+-------------+-------------+-------------+-------------+-------------+
| Number      |             |             |             |             |
| range       |             |             |             |             |
| CHAPTER**8. |             |             |             |             |
| Is the      |             |             |             |             |
| Caller's    |             |             |             |             |
| Voice       |             |             |             |             |
| (check all  |             |             |             |             |
| that        |             |             |             |             |
| apply):**   |             |             |             |             |
+-------------+-------------+-------------+-------------+-------------+
|  Soft      |  Calm      |  Angry     |  Slow      |  Rapid     |
|             |             |             |             |             |
|  Slurred   |  Loud      |  Laughing  |  Crying    |  Normal    |
|             |             |             |             |             |
|  Deep      |  Nasal     |  Clear     |  Lisping   |            |
|             |             |             |             | Stuttering  |
|  Old       |  High      |  Cracking  |  Excited   |             |
|             |             |             |             |  Young     |
+-------------+-------------+-------------+-------------+-------------+
|  Familiar  |             |             |             |             |
| (who did it |             |             |             |             |
| sound       |             |             |             |             |
| like?)      |             |             |             |             |
|             |             |             |             |             |
|  Accented  |             |             |             |             |
| (which      |             |             |             |             |
| nationality |             |             |             |             |
| or region?) |             |             |             |             |
+-------------+-------------+-------------+-------------+-------------+
| **9. Is the |             |             |             |             |
| Connection  |             |             |             |             |
| Clear?      |             |             |             |             |
| (Could it   |             |             |             |             |
| have been a |             |             |             |             |
| wireless or |             |             |             |             |
| cell        |             |             |             |             |
| phone?)**   |             |             |             |             |
+-------------+-------------+-------------+-------------+-------------+
| **10. Are   |             |             |             |             |
| There       |             |             |             |             |
| Background  |             |             |             |             |
| Noises?**   |             |             |             |             |
+-------------+-------------+-------------+-------------+-------------+
| >  Street  |             |             |             |             |
| > noises    |             |             |             |             |
| > (what     |             |             |             |             |
| > kind?)    |             |             |             |             |
+-------------+-------------+-------------+-------------+-------------+
| >          |             |             |             |             |
| > Machinery |             |             |             |             |
| > (what     |             |             |             |             |
| > type?)    |             |             |             |             |
+-------------+-------------+-------------+-------------+-------------+
| >  Voices  |             |             |             |             |
| >           |             |             |             |             |
|  (describe) |             |             |             |             |
+-------------+-------------+-------------+-------------+-------------+
| >          |             |             |             |             |
| > Children  |             |             |             |             |
| >           |             |             |             |             |
|  (describe) |             |             |             |             |
+-------------+-------------+-------------+-------------+-------------+
| >  Animals |             |             |             |             |
| > (what     |             |             |             |             |
| > kind?)    |             |             |             |             |
+-------------+-------------+-------------+-------------+-------------+
| >          |             |             |             |             |
| > Computer  |             |             |             |             |
| > Keyboard, |             |             |             |             |
| > Office    |             |             |             |             |
+-------------+-------------+-------------+-------------+-------------+
| >  Motors  |             |             |             |             |
| >           |             |             |             |             |
|  (describe) |             |             |             |             |
+-------------+-------------+-------------+-------------+-------------+
| >  Music   |             |             |             |             |
| > (what     |             |             |             |             |
| > kind?)    |             |             |             |             |
+-------------+-------------+-------------+-------------+-------------+
| >  Other   |             |             |             |             |
+-------------+-------------+-------------+-------------+-------------+
| **11. Call  |             |             |             |             |
| Received By |             |             |             |             |
| (Name,      |             |             |             |             |
| Address,    |             |             |             |             |
| and         |             |             |             |             |
| Telephone   |             |             |             |             |
| Number):**  |             |             |             |             |
|             |             |             |             |             |
| > **Date    |             |             |             |             |
| > Call      |             |             |             |             |
| >           |             |             |             |             |
| Received:** |             |             |             |             |
|             |             |             |             |             |
| **Time of   |             |             |             |             |
| Call:**     |             |             |             |             |
+-------------+-------------+-------------+-------------+-------------+
| **12. Call  |             |             |             |             |
| Reported    |             |             |             |             |
| to:         |             |             |             |             |
| Date/Time** |             |             |             |             |
+-------------+-------------+-------------+-------------+-------------+
| **13.       |             |             |             |             |
| Action(s)   |             |             |             |             |
| Taken       |             |             |             |             |
| Following   |             |             |             |             |
| Receipt of  |             |             |             |             |
| Call:**     |             |             |             |             |
+-------------+-------------+-------------+-------------+-------------+

## Water System Report of Suspicious Activity

In the event personnel from your water system (or neighbors of your
water system) observe suspicious activity, use the following checklist
to collect as much detail about the nature of the activity.

+-------------+-------------+------+------+-------------+-------------+
| **1. Types  |             |      |      |             |             |
| of          |             |      |      |             |             |
| Suspicious  |             |      |      |             |             |
| Activity:** |             |      |      |             |             |
+-------------+-------------+------+------+-------------+-------------+
|  Breach of |             |      |     |             |             |
| security    |             |      | Cha  |             |             |
| systems     |             |      | nges |             |             |
| (e.g., lock |             |      | in   |             |             |
| cut, door   |             |      | w    |             |             |
| forced      |             |      | ater |             |             |
|             |             |      | qua  |             |             |
| open)       |             |      | lity |             |             |
|             |             |      | not  |             |             |
|            |             |      | iced |             |             |
| U           |             |      | by   |             |             |
| nauthorized |             |      | c    |             |             |
| personnel   |             |      | usto |             |             |
| on water    |             |      | mers |             |             |
| system      |             |      | (e   |             |             |
| property.   |             |      | .g., |             |             |
|             |             |      |      |             |             |
|  Presence  |             |      | ch   |             |             |
| of          |             |      | ange |             |             |
| personnel   |             |      | in   |             |             |
| at the      |             |      | co   |             |             |
| water       |             |      | lor, |             |             |
| system at   |             |      | o    |             |             |
| unusual     |             |      | dor, |             |             |
|             |             |      | ta   |             |             |
| hours       |             |      | ste) |             |             |
|             |             |      | that |             |             |
|             |             |      | were |             |             |
|             |             |      | not  |             |             |
|             |             |      | pla  |             |             |
|             |             |      | nned |             |             |
|             |             |      | or   |             |             |
|             |             |      |      |             |             |
|             |             |      | a    |             |             |
|             |             |      | nnou |             |             |
|             |             |      | nced |             |             |
|             |             |      | by   |             |             |
|             |             |      | the  |             |             |
|             |             |      | w    |             |             |
|             |             |      | ater |             |             |
|             |             |      | sys  |             |             |
|             |             |      | tem. |             |             |
|             |             |      |      |             |             |
|             |             |      |     |             |             |
|             |             |      | O    |             |             |
|             |             |      | ther |             |             |
|             |             |      | (    |             |             |
|             |             |      | date |             |             |
|             |             |      | and  |             |             |
|             |             |      | time |             |             |
|             |             |      | dis  |             |             |
|             |             |      | cove |             |             |
|             |             |      | red) |             |             |
+-------------+-------------+------+------+-------------+-------------+
| **2. Water  |             |      |      |             |             |
| System      |             |      |      |             |             |
| Identi      |             |      |      |             |             |
| fication:** |             |      |      |             |             |
|             |             |      |      |             |             |
| Name:       |             |      |      |             |             |
|             |             |      |      |             |             |
| Address:    |             |      |      |             |             |
|             |             |      |      |             |             |
| Telephone:  |             |      |      |             |             |
|             |             |      |      |             |             |
| PWS Owner   |             |      |      |             |             |
| or          |             |      |      |             |             |
| Manager's   |             |      |      |             |             |
| Name:       |             |      |      |             |             |
+-------------+-------------+------+------+-------------+-------------+
| **3.        |             |      |      |             |             |
| Location of |             |      |      |             |             |
| Suspicious  |             |      |      |             |             |
| Activity:** |             |      |      |             |             |
+-------------+-------------+------+------+-------------+-------------+
|            |  Water     | T   |      |  Raw Water |  Treatment |
| D           | Storage     | reat |      | Source      |             |
| istribution |             | ment |      |             | Chemicals   |
| Line        | Facilities  | P    |      |             |             |
|             |             | lant |      |             |             |
|  Other     |             |      |      |             |             |
| (explain):  |             |      |      |             |             |
+-------------+-------------+------+------+-------------+-------------+
| **4.        |             |      |      |             |             |
| Agencies /  |             |      |      |             |             |
| Entities    |             |      |      |             |             |
| Notified**  |             |      |      |             |             |
+-------------+-------------+------+------+-------------+-------------+
| Agency      |             |      |      |             |             |
| Name: Date: |             |      |      |             |             |
| Time:       |             |      |      |             |             |
+-------------+-------------+------+------+-------------+-------------+

+-----------------------------------------------------------------------+
| **5. If Breach of Security, What was the Nature of the Breach?**      |
+-----------------------------------------------------------------------+
|  Lock was cut or broken, permitting unauthorized entry.              |
|                                                                       |
| Specify location                                                      |
|                                                                       |
|  Lock was tampered with, but not sufficiently to allow unauthorized  |
| entry.                                                                |
|                                                                       |
| Specify location                                                      |
|                                                                       |
|  Door, gate, window, or any other point of entry (vent, hatch, etc.) |
| was open and unsecured                                                |
|                                                                       |
| Specify location                                                      |
|                                                                       |
|  Other                                                               |
|                                                                       |
| Specify nature and location                                           |
+-----------------------------------------------------------------------+
| **6. Unauthorized personnel on site?**                                |
|                                                                       |
| Where were these people?                                              |
|                                                                       |
| Specify location                                                      |
|                                                                       |
| What made them suspicious?                                            |
|                                                                       |
|  Not wearing water system uniforms                                   |
|                                                                       |
|  Something else? (Specify)                                           |
|                                                                       |
| What were they doing?                                                 |
+-----------------------------------------------------------------------+
| **7.** **Please describe these personnel (height, weight, hair color, |
| clothes, facial hair, any distinguishing**                            |
|                                                                       |
| **marks):**                                                           |
+-----------------------------------------------------------------------+
| **8. Call Received By (Name, Address, and Telephone Number):**        |
|                                                                       |
| > **Date Call Received:**                                             |
|                                                                       |
| **Time of Call:**                                                     |
+-----------------------------------------------------------------------+
| **9. Call Reported to: Date/Time:**                                   |
+-----------------------------------------------------------------------+
| **10. Action(s) Taken Following Receipt of Call:**                    |
+-----------------------------------------------------------------------+

# Certification of Completion

A final step in completing the "Security Vulnerability Self-Assessment
Guide for Small Drinking Water Systems" is to notify regulators that the
assessment has been conducted. Please fill in the following information
and send this page only to the appropriate regulatory contact.

  ------------------- ------------------------ -------- ------------------
  Number range                                          
  CHAPTERPublic Water                                   
  System (PWS) ID:                                      
  Number:                                               

  System Name:                                          

  Address:                                              

  Town/City:                                   State:   

  ZIP Code:                                             

  Phone:                                       Fax:     

  Email:                                                

  Person Name:                                          

  Title:                                                

  Address:                                              

  Town/City:                                   State:   

  ZIP Code:                                             

  Phone:                                       Fax:     

  Email:                                                
  ------------------- ------------------------ -------- ------------------

I certify that the information in this vulnerability assessment has been
completed to the best of my knowledge and that the appropriate parties
have been notified of the assessment and recommended steps to be taken
to enhance the security of the water system. Furthermore, a copy of the
completed assessment will be retained at the pubic water system, in a
secure location, for state review as requested.

Signed\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Date\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_