Individual states have different names for drinking water advisories depending on the situation. Advisories are frequently called "notices," "alerts," and "orders."Advisories can include information about preparing food, beverages, or ice; dishwashing; and hygiene, such as brushing teeth, bathing, and flushing toilets.Public encouraged to take immediate action Severity of situation (lesser) (greater)Address potential call center issues in advisory protocols. Considerations include: - Are there enough phone lines#
Drinking Water Advisory Communication Toolbox  Table 1:

# List of Figures
Our goal is to provide a protocol and practical toolbox for communicating with stakeholders and the public about water advisories that is based upon research and identified practices. The project focuses on water systems and addresses the range of situations that generate drinking water advisories. This project was a collaborative effort among the U.S. Centers for Disease Control and Prevention (CDC), the U.S. Environmental Protection Agency (EPA), the American Water Works Association (AWWA), the Association of State and Territorial Health Officials (ASTHO), the Association of State Drinking Water Administrators (ASDWA), and the National Environmental Health Association (NEHA).
A technical workgroup of public health and drinking water agencies and drinking water system experts advised and guided the project. The project also engaged a broad cross-section of relevant stakeholders and technical experts including local government officials and emergency response and hazard communication experts. This toolbox was reviewed by EPA and state primacy agencies. Every effort was made to ensure that the toolbox complies with the Public Notification Rule when necessary.
More than 500 documents, protocols, regulations, and other resources related to the issuing of drinking water advisories were compiled. Nearly 100 interviews were conducted with water systems, primacy agencies, and local public health departments in the United States and Canada. These findings revealed:
- Advice to the public varies widely from state to state and community to community.
- Advisories are a common occurrence in some states and a rare event in others.
- Major events or disasters were the primary reasons for collaboration between drinking water systems and health departments.
- Terminology for advisories is inconsistent.
- Templates and advisory content are difficult to change or adapt to specific audiences or needs.
- The EPA Public Notification Handbook is the primary information source for drinking water advisories.
- Agency responsibilities for communicating with institutions, such as hospitals, schools, and restaurants, are highly variable.
- Good relationships between water systems and local public health departments are often dependent on established relationships between individuals.
- Local health departments may lack the resources or expertise to address drinking water issues.
- Local health departments are willing to be consulted by water systems when requested.

# About the Drinking Water Advisory Communication Toolbox

# Introduction
- Overview
- Why Are Drinking Water Advisories Issued?
- Small Water Systems
The Drinking Water Advisory Communication Toolbox provides information on how to plan for, develop, implement, and evaluate drinking water advisories. The approach presented recognizes the differences in scope, scale, and severity of situations that trigger advisories-a main break, a hurricane, a drop in pressure, or intentional contamination. These differences affect the types of tools, planning, and communication used by drinking water systems.
This toolbox includes instructions on how to prepare before an event, what to do during an event, templates and tools to use, and recommendations for follow-up actions and assessments after an event.
The purpose of the toolbox is to enable water systems to communicate effectively with partners and the public in order to protect public health.
Figure 1 shows the process for preparing for, issuing, and following up after a drinking water advisory. Each toolbox section includes a checklist of steps. Not every step applies in all circumstances. Each section has a set of tools that applies to its content. The tools can be adapted by water systems to fit their needs.

# Overview
Before an Event

# Interagency Communication
- Communication Planning

# Testing
During an Event

# Icon Key

# Tools and Templates

# Resources
This toolbox complements the EPA's Revised Public Notification Handbook.
Water systems and state or local agencies issue drinking water advisories when they believe water quality is or may be compromised. Advisories tell individuals, schools, hospitals, businesses, and others about the situation and how to take immediate action.
Drinking water advisories:
- Provide information-An advisory may be issued when consumers need to receive important information but do not need to take any action. For example, a water system may issue an advisory to inform households about seasonal changes in water taste.
- Encourage preparedness-Advisories may help customers prepare for planned disruption in service or anticipated water quality threats. Advisories may affect a small area, such as during distribution system construction or repair. Advisories also can urge customers to prepare for a large area event, such as an approaching hurricane. This type of advisory alerts people to watch or listen for more information.
- Recommend action-Advisories may tell customers to take specific actions, such as to boil water or use bottled water. These advisories may be issued as a precaution or in response to a waterborne disease outbreak.
- Meet public notification requirements-Advisories are required by the Safe Drinking Water Act (SDWA) when specific circumstances exist. The SDWA requires communication with customers when the water system does not comply with a regulation.

# Precautionary and Mandatory Advisories
State and federal regulations specify when drinking water advisories are required. In other instances, water systems or the local public health department may issue precautionary advisories at their discretion.
- Precautionary advisories are issued as a protective measure.
- Mandatory advisories are issued as required by state and federal law to protect public health.

# Main Types of Advisories
- Informational-Communicate planned or anticipated changes in water quality and provide advice on appropriate action.
- Boil Water-Tells customers to boil water before use. Most common type of advisory. They may be precautionary if there is a potential threat to the drinking water supply, or they may be mandatory as required by state and federal regulations. Boil water advisories typically are issued because of concern about microbial contamination.
- Do Not Drink-Tells customers to use an alternative source of water. Do Not Drink advisories are typically issued for chemical contamination.
- Do Not Use-Warns customers not to use tap water for any purpose, including flushing toilets and bathing. Do Not Use advisories are typically used only in cases of known microbial, chemical, or radiological contamination when any contact, even with the skin, lungs, or eyes, can be dangerous. Such advisories are rare because of the risks associated with the lack of water for sanitation and fire protection.
Figure 2 shows the range of situations that might trigger a drinking water advisory and the type of advisory that would be issued in each situation.
Consult with state primacy agency when developing drinking water advisory protocols.

# Informational Boil Water Do Not Drink Do Not Use Occasional
Used for a range of purposes:
- Failure to meet drinking water standards with non-acute endpoints or administrative requirements
- Efforts to build rapport with customers
- Customer education to increase preparedness for emergencies

# Water conservation messaging

# Frequent
Used for potential or demonstrated microbial contamination:
- Low/loss of pressure
- Tier 1 microbial violation (e.g., high turbidity, positive E. coli)
- Natural disasters (e.g., flooding, hurricanes)
- Vandalism

# Infrequent
Used for potential or demonstrated contamination that could cause acute health effects:
- Nitrite/nitrate MCL violation*
- Chemical overfeed into the water supply

# Rare
Used with caution due to risk associated with lack of sanitation and fire protection:
- Microbial, chemical, or radiological contamination in which any contact is hazardous to public health
- Error in treatment leading to water with a high or low pH that could lead to chemical burns Note: These are examples of potential reasons to issue an advisory; this is not intended to be a comprehensive list. Consult your primacy agency for more information.

# Figure 2: Range of Situations for Drinking Water Advisories
Because small water systems often have less capacity to implement advisory protocols than larger systems, this toolbox also was designed and tested with small water systems in mind.
Implementing the actions described in this toolbox generally should not require outside support from consultants or others. However, building an effective network by collaborating with other public sector partners and community organizations will help small systems succeed in their efforts.

# Suggestions for Small Systems
- Identify and prioritize specific tools or sections from this toolbox to use.
- Incorporate water advisory protocol planning into regular activities, such as sanitary surveys and updating emergency response plans (ERPs).
- Build water advisory protocols into regular communication, such as customer updates.
- Partner with local public health authorities and neighboring water systems

# Small Water Systems

# Section 1: Before an Event-Preparing for an Advisory
To issue a drinking water advisory, a water system must act quickly and in close coordination within its organization and among its partner agencies. Preparation is essential. Most of the work can be done in advance of a planned or unplanned event.
Pre-event planning allows a water system to design advisories and issue them through a predetermined process. Advance preparation speeds delivery of accurate and useful information to affected customers. This information can be reused for future events.

# Overview
Icon Key

# Organizing for Drinking Water Advisories
Conduct an assessment of assets and resources needed to issue a drinking water advisory.
Review state regulations and guidance for public notification and the EPA Revised Public Notification Handbook.
Consult your organization's strategic communication plan.
Plan for media activities.
Integrate communications as part of your emergency response standard operating procedures (SOPs).

# Collaborating with Partners
Identify partners and critical and wholesale customers.
Record and regularly update contact information.
Develop a communication network of public agencies and private entities for collaboration during an advisory.
Meet and discuss protocols and resources for drinking water advisories with agency partners and community organizations.
Plan and conduct regular communication among partner agencies and private organizations.

# Notes

# Developing a Message
Collaborate with your communication network to develop messages for various advisories and specific audiences.
Translate and format messages for special populations (e.g., non-English speakers, visually impaired).

# Conducting Exercises
Refer to the National Incident Management System (NIMS) and the Homeland Security Exercise and Evaluation Program (HSEEP).
Plan exercises.
Conduct exercises.
Debrief after exercises and incorporate appropriate changes in protocols.

# Conduct an Assessment
Understanding your system's operations, vulnerabilities, stakeholders, partners, and audiences is an important first step in your planning efforts. Begin by evaluating the following:
- Existing relationships among partners, including public health, public safety, schools, businesses, and local government.
See Table 1 for examples.
- Internal and external audiences and stakeholders.
- Information needs of different audiences.
- Existing communication plans and resources (e.g., bill inserts, Consumer Confidence Reports, media contacts).
- Skills, technologies, staff, time, and money available to support an exchange of information with target audiences and agencies. See Table 1 for examples.
- Resources for public outreach, such as Reverse 911 or e-mail alerts.
- Existing requirements set by state or local agencies or by the water system's governing body.
- Threats and infrastructure vulnerabilities.
- Emergency response plans (ERPs).

# Gap Analysis
Once you've conducted the assessment, it is important to identify the gaps and additional resources needed to meet responsibilities for issuing drinking water advisories.

# Organizing for Drinking Water Advisories

# Considerations
When planning for a drinking water advisory, consider:
- A range of event scenarios
- Normal and challenging operating conditions
- Time of day, day of the week, and season of the year

# Review Regulations and Guidance

# Primacy Agency
Each state that has primacy has specific regulations for public notification and information sharing. Local public health and water systems personnel need information for a 24/7 point of contact at the primacy agency.

# Federal Guidance
There is federal guidance for developing public notices under the Safe Drinking Water Act (SDWA). Resources are also available from the Environmental Protection Agency (EPA):
- PNiWriter-A web-based tool for preparing public notices.
- Revised Public Notification Handbook-EPA guidance explaining regulatory requirements.

# Know Your Primacy Agency

# Consult Strategic Communication Plan
A strategic communication plan is the foundation for decision-making and resource allocation, both ongoing and in times of crisis.
A strategic communication plan helps a water system prepare to issue a drinking water advisory by identifying ahead of time:
- Audiences and stakeholders.
- Critical issues for the water system (e.g., risk, safety, quality, infrastructure).
- Points of integration for operations and communication SOPs.
- Communication objectives (e.g., information, preparedness).
- Strategies to accomplish objectives.
- Actions required to carry out the strategies.
See Information for Communication Planning for more information.

# Effective Risk Communication
Drinking water advisories are a form of risk communication.
The protocols for issuing an advisory must effectively describe:
- When to distribute an advisory (and when not to).
- What information to provide.
- Who is(are) the specific audience(s) for that event (including susceptible populations).
- How to recognize and communicate the conclusion of the event.
- Where to distribute messages.
- What actions must be taken.
- Why these actions must be taken.
- For more information on effective risk communication, see Appendix B: Online Resources, Risk Communication.

# Where to Find Help
If your water system does not have a strategic communication plan, see Appendix B: Online Resources, Risk Communication for more information that may be helpful in developing one.

# Plan for Media Activities
Successful advisories rely on multiple types of communication. Door hangers, websites, automated messages, and other methods of communication must be combined for an effective drinking water advisory. The media is a primary channel for public notification and is critical to issuing an advisory.
Planning for media activities can improve implementation of the advisory. Scope, scale, and severity determine the level of media involvement-the larger the event, the larger the media effort. Factors to consider include the following:
- Timing: Consider the operations of your local media. Many media outlets are not able to respond on weekends or after hours. Contact local media outlets to understand their staffing, hours, or other limitations. Plan appropriately for media outlets and communication channels. For example, if an advisory is issued during business hours or commuting times, radio reaches homes, offices, and cars.
- Audiences: If an advisory covers a wide area, use a media release to multiple outlets. Smaller areas may call for use of specific media channels as well as other methods of communication. Audiences with special needs, such as a large population of people who speak little or no English, are part of the decisions about media, including ethnic media. See the Communicating with Susceptible Populations Worksheet and Appendix B: Online Resources, Risk Communication.
- Channels: Identify the media outlets that cover specific areas of the water system service area and the region. In rural areas, television news may come out of a large urban area far away. Partners and their communication networks will have additional information about communication channels. Identify criteria on which to prioritize media outlets based on the scope, scale, and severity of the situation. For example, if an advisory is issued during working hours, radio, e-mails, and news websites may be the most immediate and viable outlets to use to distribute the message to the working public.

# Media Messages: Use the Message Mapping Template and Sample Message Map or the Single Overriding Communication Objectives (SOCO) Worksheet
to prepare press releases and statement templates specific to the water system and different scenarios. These materials can be generalized

# Tip
Ask media outlets about their timing. How long will it take them to post and announce information on websites and announce on television? Also ask how they would use maps and graphics to show the advisory area.

# Small System Note
If a press list or wire service is not available, work with partners and local government to set up access for communicating advisories to the media and put into electronic or paper formats. Insert the prepared materials into emergency response plans (ERPs) and protocols.
- Approval: Note the procedures on how media materials will be reviewed and who will approve them. Work with partners in the communication network and understand their approval process.
- Other Information: Include external sources of additional information in media materials. Contact names and numbers for primacy agencies and local public health departments are good sources for reporters. Links to primacy agencies and health departments can be added to media websites to help answer customer questions. Work with partners to identify additional information sources. See Appendix B: Online Resources, Risk Communication.

# Designate and Train Spokespersons
The spokesperson's role is to communicate directly with media through briefings and interviews and to interact with the public. Designate a primary and backup spokesperson during planning activities. The spokesperson may be the water system's Public Information Officer (PIO), a manager assigned to communication, or someone within the communication network, such as a local public health department representative. The spokesperson is someone in authority who is honest, credible, competent, accessible, and sensitive to public concerns. Use the Spokesperson Assessment Tool.
The spokesperson must be ready to interpret scientific and technical information into clear language and must understand the water system's operations. Professional training in media management, effective listening, and handling sensitive situations is helpful in preparing a spokesperson to be ready to meet the media and the public at any time.

# Integrate Communication into Emergency Response and SOPs
SOPs must be clear and allow users to take actions based on the information they will have at the time. SOPs should establish clear chains of command and communication so that authorized personnel can make situation-specific decisions. SOPs may include the following:
- Purpose: Objective of the SOP (e.g., delineation of authority, roles, and procedures).
- Scope: People involved, and the authority and responsibilities they have. - Communication Structure: Organizational chart that demonstrates levels of command and communication linkages.

# Notes
- Protocols: Procedures for action within the SOP's purpose.
- Training: Requirement(s) and schedule.
- Exercising: Procedures and schedule.
- Oversight/Update: Person(s) responsible for assuring compliance with and maintenance of SOP.

# Customer Call Center
Call centers and customer service (CS) staff are on the front lines during an advisory. Call centers must have the resources to respond to customers above and beyond normal operations and hours. Information provided through the call center must be accurate, timely, and consistent.
The actions described below apply to local government call lines such as 411, community lines such as 211, or other agencies that may respond to an advisory.
- Briefings: Meet with call center and CS staff before issuing the advisory and provide essential information on the scope, scale, and severity of the advisory.
- Scripts: Provide scripts to call center and CS staff developed with essential information and frequently asked questions (FAQs).
- Updates: Meet with call center and CS staff to check for adequate staffing and customer concerns. Add and revise information in scripts as needed.
- Resources: Ensure enough phone lines and staff for the scope and scale of the advisory. Staff will need current information and referral contacts.
- Debriefing: Include call center and CS staff in the advisory debriefing to identify communication activities and resources.
- Are other phone lines available if they are needed?
- Are off-site phone lines or call centers available?
- Is there a backup plan if phone lines are not available or power is out during an emergency response?
- Are there enough people to staff the call center 24/7, if needed?

# Identify Partners
Partners are simply any organization or agency that can help you plan, develop, and distribute messages. Having a network of agencies and organizations can help advisories to be more effective and timely.
To identify partners, start with public agencies, especially those focused on local public health. Agencies and organizations to consider include the following:
- Drinking water primacy agency.
- Local and state public health departments.
- Consecutive, wholesale, and neighboring water systems.
- Critical and priority customers, including hospitals and businesses.
- Emergency management, public works, public safety, social services, and other government agencies.
- Community organizations.
See the Critical Customer Checklist for more information.
Table 1 provides examples of target audiences and partner organizations and agencies.

# Collaborating with Partners

# Key Questions for Collaboration with Partners
- Who needs to know?
- Who is responsible for coordinating communication?
- Who makes decisions related to advisories?
- Who needs specific types of information, including technical information?
- What are the procedures to inform public officials?
- What are partners' capacities for outreach?

# Public Health: A Key Partner
Developing a working relationship with local and state public health authorities can help water systems identify community organizations, develop specific messages and materials, and work through issues like translation. Working with the public health officer can put the risk of illness into perspective for public outreach.
Public health departments at the local, regional, and/or state levels work with susceptible populations and critical customers such as:
- Hospitals and medical facilities.
- Health care providers (HCPs), physicians, pharmacists, home health nurses.
- People who are elderly, low income, and homebound.
- Schools and childcare providers.
- Pregnant women and parents of young children.
- Food establishments.
Include public health departments in planning and discussions about advisories. Since in many cases they license these establishments, they can help with notifying these groups and developing specific messages. This allows water systems to focus on their core responsibilities. Local public health can assist with outreach through contact lists, websites, and newsletters.
See Communicating with Susceptible Populations Worksheet.
Planning before an advisory is crucial to understanding the capacity of local public health departments to participate in a communication network. Formalized agreements, such as a memorandum of understanding (MOU), will clearly define capacity and responsibilities for both the health department and the water system.
Public health codes may have different requirements for the various types of establishments that prepare or process food, such as restaurants, community kitchens, grocery stores, and cafeterias. Knowing these codes for each locality will help water systems work with critical customers.
For more information about public health and outreach, refer to the guidance for the Lead and Copper Rule (LCR). See Appendix B: Online Resources, Safe Drinking Water Act.

# Public Health Capacity
Capacity is the ability to respond to a situation with resources such as staff, materials, and expertise. Local, regional, and state public health departments vary greatly in their ability to support activities around drinking water advisories.

# Public Health and Critical Customers
Local public health departments often license food establishments and childcare facilities. They are good resources for contact information.

# Record Contact Information
Collect and record the contact information of each partner in a list or database. Include name, phone numbers, postal and e-mail addresses, after-hours contact information, and social media information. (The Information for Communication Planning and Point of Contact Template will help with this activity.) Be sure to verify and update all contact information on a regularly scheduled basis.

# Develop a Communication Network
Water systems generally are responsible for issuing advisories. However, timely, effective, and extensive outreach simply cannot be done by one entity. Water systems must work collaboratively with public health and other partners to get the job done effectively. Some communities have an established communication network, usually coordinated around emergency management. If there is a communication network in your community, learn how to become a part of it. If there is no such network, develop one.

# Collaborations for Reaching Susceptible Populations
A key element of effective communication planning is to consider populations that can be defined as a group with common characteristics that make them a susceptible population. For a drinking water advisory, water systems and public health agencies need to communicate with three specific susceptible populations:
1. Persons with communication needs, including low literacy levels, limited English proficiency, cognitive disabilities, and hearing or vision impairments.
2. Persons with medical needs that make them sensitive to water quality issues, such as babies, young children, pregnant women, and people who are immunocompromised, elderly, or on dialysis.
3. Persons with low income or who may lack the resources to act on information in a drinking water advisory or the awareness of a possible threat to their health and their family's well-being.
For more information, see the Communicating with Susceptible Populations Worksheet.

# Did you know?

# Communication Network
Advance collaboration, communication, and cooperation with other public agencies and private organizations before an actual event provides the opportunity to:
- Determine existing resources.
- Distribute advisories quickly and effectively.
- Develop protocols to assure coordinated, consistent messaging during an advisory.
- Share the communication tasks amongst partners.
Figure 3 shows how creating a local network can extend an agency's outreach capacity.

# Meet and Discuss Protocols and Resources
Schedule a meeting with partners to discuss how collaboration can improve drinking water advisory communication. Determine where and when you will meet and for how long. Set a brief agenda that includes communication protocols within the network and resources (translation services, other contact information, websites) that are available for message distribution.

# Plan and Conduct Regular Communication
Keep partners engaged through regular communication within the network. Send copies of meeting notes. At least four times a year, send e-mails or make phone calls to ask partners about:
- Additional information they may want to know;
- Their suggestions for activities, such as participating in an exercise; and
- Other organizations that can be invited into the network.
Plan meetings to address other issues that network members may have in common.

# Collaborate with Your Communication Network
Drinking water advisories are issued in response to a specific event or situation. Communication materials can be prepared in advance by collaborating with your partners. The Essential Information list outlines the questions and information that a drinking water advisory must address.

# Message Development
Tools and templates that can help guide pre-event message development include:
- Worksheets:

# Developing a Message

# What's a Message?
Information a specific audience MOST needs or wants to know.

# Essential Information

# Health Literacy
Health literacy is the ability to receive, understand, and act on basic health information needed to make good decisions. Nine out of 10 people in the United States have limited health literacy-regardless of their education levels. Since advisories require customers to understand a message and take action, health literacy is an important factor for messages and materials.
A first step to ensuring that your advisory can be easily understood by most audiences is to check the readability and grade level of the advisory content. For a general audience, the grade level should be between 5th and 8th grades. Word-processing programs can provide information about a document's readability. If you are not sure how to check for readability, go to the "Help" section on your word-processing program and search for the term "readability. "
For more information on health literacy guidelines, see Appendix B: Online Resources, Health Literacy.

# Translate and Format Messages
Advisories need to be translated to reach many customers. Consult with local government to identify the main languages in the service area. Public health departments are a very good resource. Many states and local governments have programs and resources specifically for translation, including sign language and Braille.

# Writing Messages
Provide the public with a clear concise advisory by:
- Limiting messages

# Plan Exercises
Preparation for a drinking water advisory entails the consideration of a range of situations relevant to the water system and its community so that:
- Pertinent information is compiled and evaluated to support sound decisions.
- Credibility with customers is maintained through coordination with state and local agencies.
- Public outreach is effective.

# Conduct Exercises
A communication network for issuing drinking water advisories must be tested in advance to determine if it works and where gaps in outreach remain. Testing the network can prevent illness and even save lives during a real drinking water advisory event. Exercises are one way to test the network.
- Seminars, workshops, tabletop exercises, games, drills, functional exercises, and full-scale exercises are terms for various types of practice sessions based on a scenario. A scenario could include developing messages and testing the dissemination of an advisory.
- Larger events can include other agencies and can evaluate collaboration.
- Exercises can be scaled to the size of an advisory and to community needs.

# Exercise Plan
Numerous resources and opportunities exist for exercises. While most of these resources are associated with preparedness and security, they can be used for the full range of advisories. All-hazards planning can incorporate advisory scenarios. After action reports, comments, and observations are used to revise communication and operations protocols.

# Exercise Basics
Exercises come in many sizes and creating them can seem complex. Water systems have multiple opportunities for exercises. Both small exercises limited to the water system or water sector and larger drills and exercises at the community and state level are important in community planning. These exercises help water systems connect with public health, emergency management, and other sectors to build relationships and networks in preparation for advisories.
Exercise resources in this Toolbox give some basic tools for water systems to create and conduct their own drinking water advisory exercises. These exercises can be scaled for water system staff and other partners, such as public health. See Appendix B: Online Resources, Exercise Planning and Preparedness.
- Design a scenario: Scenarios can be based on an actual advisory or can test a new protocol. The scenario should unfold in stages; participants act on one decision point or action before moving to the next.

# Did You Know?
Exercises can be for one water system or multiple systems and partners.

# Communicating with Susceptible Populations Worksheet

# PURPOSE
Advisories and risk communication plans must consider the needs of specific populations who may be sensitive to water quality issues or who have communication barriers, such as limited English proficiency or limited vision.
The advisory network is critical for reaching these populations. Regulations and public expectations for outreach require collaboration with public health departments, other local agencies, including schools, and community organizations.

# DIRECTIONS
Use the contact list or database to identify, list, and note contacts for public health, local government agencies, and community organizations to help with outreach to susceptible populations.
- Complete this form with public health, local agencies, and community partners.
- Include responsibilities and a time frame for developing materials and taking actions. Review the Lead and Copper Rule (LCR) Guidance (see Appendix B: Online Resources, Susceptible Populations ).
- Include completed contact lists in emergency response plans (ERPs) and standard operating procedures (SOPs).
- Adapt them to reflect specific needs in a community. Some strategies may work for several populations. Include a schedule for updates. Add identified facilities to the water system's critical customer list.

# Low Literacy
Encourage television news stations to announce advisory and contact phone numbers in addition to posting them on screen. Follow up with press releases.
Use radio to distribute information. Radio is a key accessible source of information.
Identify and coordinate with local organizations that serve low literacy populations and can help disseminate drinking water advisories in appropriate formats.

# Limited English Proficiency
Identify languages widely spoken in the area. See www.mla.org/map or www.census.gov.
Determine local government and agency translation services and providers.
Consider contracting for professional translation services.
Work with public health, local government, and schools to identify, coordinate, and contract with skilled translators in the community.
Use ethnic media outlets.
List resources, specific messages, and materials needed to communicate with this population group.

# Blind or Visually Impaired
Work with social services and local government to identify organizations and communication options that serve people who are blind or visually impaired. Consider how a boil water advisory could be tailored for this audience.
Use radio to distribute information. Radio is a key accessible source of information.
Encourage television stations to announce advisories and contact numbers.
Identify formats and tools to make written materials and web pages accessible for this audience.
List resources, specific messages, and materials needed to communicate with this population group.

# Communicating with Susceptible Populations Worksheet, continued

# Deaf or Hard of Hearing
Coordinate with local government, schools, and other agencies on policies for interpretation and resources.
Encourage television news stations to broadcast all drinking water advisory information in open caption format and in their on-screen scrolls.
Identify, coordinate, and contract with a sign language interpreter for news conferences in public forums and other events.
Use automated messages in text and e-mail formats. They are a good method of distribution for this audience.
Check with water system and local government on capacity to handle calls through Video Relay Service.
List resources, specific messages, and materials needed to communicate with this population group.

# Older Adults and Frail Elderly
Work with public health, local government agencies, and community organizations to identify nursing homes, agencies, and organizations that assist older adults to help disseminate drinking water advisory information.
Design messages with a clear alternative to boiling water. Boiling water may not be an option for this population.
Identify resources, such as home health care, to help older adults and the elderly with support services during an emergency.
Add meal delivery services, such as Meals on Wheels, to critical customer lists.
List resources, specific messages, and materials needed to communicate with this population group.

# Communicating with Susceptible Populations Worksheet, continued Children
Identify and coordinate with local health departments, school districts, pediatrician offices and clinics, and other agencies to disseminate drinking water advisory information.
Target materials and messages to parents and teachers. Visual cues, such as posters or covering water fountains, will assist this group.
List resources, specific messages, and materials needed to communicate with this population group.

# Pregnant Women
Identify and coordinate with local health departments, health clinics, hospitals, other health care facilities, obstetrician offices, and schools to disseminate drinking water advisory information relevant to pregnant women.
List resources, specific messages, and materials needed to communicate with this population group.

# Physically and Mentally Impaired
Work with public health and local government agencies to identify community organizations, such as independent living facilities and home health care, that assist people with physical and mental impairments to help disseminate drinking water advisories.
Consider targeting messages both to care providers and to individuals.
List resources, specific messages, and materials needed to communicate with this population group.

# Communicating with Susceptible Populations Worksheet, continued Homeless
Identify locations where drinking water advisories can be posted (e.g., libraries, shelters, soup kitchens).
Add homeless shelters and meal centers/food banks to critical customer lists.
Design messages with a clear alternative to boiling water. Boiling water may not be an option for this population.
List resources, specific messages, and materials needed to communicate with this population group.

# People with Compromised Immune Systems
Work with the local public health department to identify and coordinate with medical facilities, health care providers and organizations that serve people with compromised immune systems to disseminate drinking water advisories.
Design messages with a clear alternative to boiling water. Boiling water may not be an option for this population. This information is for Tier 1 Public Notices. For a waterborne disease outbreak, consult with local and state public health authorities to adapt the information.

# DIRECTIONS
- Brackets  indicate places to insert specific information, such as the water system name, health department information, or the contaminant.
- Limit fact sheets for customers to one page front and back.
- Spanish versions are available for selected Q&As on pages 61-63 and 70-71.
- Refer to the fact sheets on pages 51-76 for additional topics.
Uses include:
- Briefing materials for public health departments and other partners

# Quick Reference Facts

# PURPOSE:
This is an easy-to-use, quick reference tool for customers.

# DIRECTIONS:
Use this information in fact sheets and on websites; adapt as necessary to suit the type of advisory (e.g., Boil Water, Do Not Drink, Do Not Use) and primacy agency guidance. Be sure to provide links to additional information or guidance. This information is for Tier 1 Public Notices. For a waterborne disease outbreak, consult with local and state public health authorities to adapt the information.

# DIRECTIONS
- Brackets  indicate places to insert specific information, such as the water system name, health department information, or the contaminant.
- Limit fact sheets for customers to one page front and back.
- Refer to the fact sheets from the "Tools and Templates" in Section 1 and Section 2 of this toolbox for additional topics.
Use the Q&As to develop scripts or fact sheets for water system staff, especially customer service and field crews. Uses include
- Briefing materials for public health departments and other partners.
- Media kits and updates.
- Customer fact sheets.
- Websites and widgets.

# Boiling Water
How do I boil my water during an advisory?
- Fill a pot with water.
- Heat the water until bubbles come from the bottom of the pot to the top.
- Once the water reaches a rolling boil, let it boil for 1 minute.
- Turn off the heat source and let the water cool.
- Pour water into a clean container with a cover for storage

# Why do I have to boil my water?
Your water  contaminated by . Contamination  due to . The Boil Water Advisory gives you information so you can take action to protect your health.

# I cannot boil my water. How do I disinfect my water to make it safe to drink?
(Caution: Water contaminated with fuel or a toxic chemical will not be made safe by boiling or disinfection. Use another source of water if you know or suspect that water might be contaminated with fuel or a toxic chemical.)
If tap water is clear:
- Use unscented bleach (bleach that does not have an added scent).
- Add 1/8 teaspoon (8 drops or about 0.75 milliliters) of unscented household liquid bleach to 1 gallon (16 cups) of water.
- Mix well and wait 30 minutes or more before drinking.
- Store disinfected water in a clean contain with a cover.
If tap water is cloudy:
- Filter through a clean cloth
- Use unscented bleach (bleach that does not have an added scent).
- Add 1/4 teaspoon (16 drops or 1.5 milliliters) of unscented household liquid bleach to 1 gallon (16 cups) of water.
- Mix well and wait 30 minutes or more before drinking.
- Store disinfected water in a clean container with a cover.
Remember that containers may need to be sanitized before using them to store safe water:
To sanitize containers:
- Use unscented bleach (bleach that does not have an added scent).
- Make a sanitizing solution by mixing 1 teaspoon (5 milliliters) of unscented household liquid bleach in 1 quart (32 ounces, 4 cups, or about 1 liter) of water.
- Pour this sanitizing solution into a clean storage container and shake well, making sure that the solution coats the entire inside of the container.

# Comprehensive List of Q&As for Boil Water Advisories, continued
- Let the clean storage container sit at least 30 seconds, and then pour the solution out of the container.
- Let the empty container air dry OR rinse it with clean water that has already been made safe, if available.
Never mix bleach with ammonia or other cleaners. Open windows and doors to get fresh air when you use bleach.

# Should I use bottled water?
You may choose to use bottled water if it is available.

# I don't like the taste of boiled water. What can I do?
To improve the taste of boiled water you can:
- Pour cooled boiled water back and forth from one clean glass or container into another to add air to the water, or
- Let the water stand for a few hours, or
- Add a pinch of salt to each quart of boiled water.

# Food and Beverages
Can I use my coffee maker, ice machine, or water or soda dispenser?
Do not use water from any appliance connected to your water lines. This includes the water and ice dispensers in your refrigerator/freezer. Most kitchen and other household water filters typically do not remove or kill all bacteria or viruses.
- Use boiled or bottled water to make coffee and ice.
- Most kitchen and other household water filters typically do not remove or kill all bacteria or viruses.
- When the boil water advisory is lifted, consult the owner's manual to find out how to sanitize appliances.

# Can I use ice from my refrigerator/freezer ?
- Do not use ice from ice trays, ice dispensers, or ice makers.
- Throw out all ice made with tap water.
- Make new ice with boiled or bottled water.

# Comprehensive List of Q&As for Boil Water Advisories, continued
What should I do about preparing food and beverages? How should I wash fruit, vegetables, and food preparation surfaces?
- Wash fruits and vegetables with boiled water that has cooled or bottled water.
- Bring water to a rolling boil for 1 minute before adding food to cook.
- Use boiled water when preparing drinks, such as coffee, tea, and lemonade.
- Wash food preparation surfaces with boiled water.

# What should I do about feeding my baby?
Breastfeeding is best. Continue to breastfeed. If breastfeeding is not an option:
- Use ready-to-use baby formula, if possible.
- Prepare powdered or concentrated baby formula with bottled water. Use boiled water if you do not have bottled water. Disinfect water for baby formula if you cannot boil your water (see above for directions on how to use bleach to disinfect water).
- Wash and sterilize bottles and nipples before use.
- If you cannot sterilize bottles, try to use single-serve, ready-to-feed bottles.

# How do I wash dishes during a Boil Water Advisory?
Household dishwashers generally are safe to use if the water reaches a final rinse temperature of at least 150F or if the dishwasher has a sanitizing cycle.
To wash dishes by hand:
- Wash and rinse the dishes as you normally would using hot water.
- In a separate basin, add 1 teaspoon of unscented household liquid bleach for each gallon of warm water.
- Soak the rinsed dishes in the water for at least 1 minute.
- Let the dishes air dry completely.

# Health I already drank the water. Will I get sick?
Most people who happen to drink this water will not get sick. If you do get sick, the symptoms are similar to food poisoning: nausea, diarrhea, cramps, and possibly a mild fever.

# Comprehensive List of Q&As for Boil Water Advisories, continued
What should I do if I have symptoms?
The most important thing to do is avoid dehydration. Drink plenty of fluids and avoid drinks with caffeine, such as soda, coffee, and tea. If you are concerned about your health or the health of a family member, contact your health care provider or .

# Household Information
Should I give my pets boiled water?
Pets can get some of the same diseases as people. It is a good idea to give them boiled water that has been cooled.
Do I need to worry about my fish or aquatic pets (e.g., reptiles, frogs)?
Most germs that infect people do not infect reptiles or fish. If your water system is using more chlorine or changing disinfection, be cautious about changing the water in your fish tank or aquarium. Contact your local pet store or veterinarian for more advice.

# Is it safe to water my garden and house plants?
You can use tap water for household plants and gardens.

# What  might be in the water?
Many types of microbes could be in the water. Water systems are concerned about bacteria such as E. coli, viruses such as norovirus, and parasites such as (Cryptosporidium).
Human illness from these microbes is usually caused by eating raw or undercooked food, ingesting contaminated recreational or other untreated water, or poor hand-washing. Diarrheal illness from these microbes is not usually life threatening, except in the elderly, the very young, or those with weak immune systems. If you are concerned, consult your health care provider or contact .

# Hygiene
Can I use tap water to brush my teeth?
No. Do not use untreated tap water to brush your teeth. Use boiled or bottled water.

# Is it safe to take a shower or bath?
Yes, it is safe to take a bath or shower, but be careful not to swallow any water. Use caution when bathing babies and young children. Consider giving them a sponge bath to reduce the chance of them swallowing water.

# Comprehensive List of Q&As for Boil Water Advisories, continued
What about shaving?
Yes, you can shave as usual.

# What about doing laundry?
Yes, it is safe to do laundry as usual.
Where can I get more information?
- Personal Preparation and Storage of Safe Water: CDC provides guidance on the amount of water needed for good health, as well as how to prepare and store safe water before and during an emergency.
- Hygiene and Handwashing: CDC provides guidance on alternative hygienic practices when water is not available or is contaminated.
- A Guide to Water Filters: CDC maintains a guide for filters that remove Cryptosporidium or Giardia.
- EPA Safe Drinking Water Hotline: 1-800-426-4791
- Consumer Information: EPA provides information and guidance about drinking water quality, emergencies, contaminants, public health issues, and treatment and storage. - Fill a pot with water.
- Heat the water until bubbles come from the bottom of the pot to the top.
- Once the water reaches a rolling boil, let it boil for 1 minute.
- Turn off the heat source and let the water cool.
- Pour the water into a clean container with a cover for storage.

# Disinfecting water
If you are unable to boil your water, disinfect it instead.

# If tap water is clear:
- Use unscented bleach (bleach that does not have an added scent).
- Add 1/8 teaspoon (8 drops or about 0.75 milliliters) of unscented household liquid bleach to 1 gallon (16 cups) of water.
- Mix well and wait 30 minutes or more before drinking.
- Store disinfected water in clean container with a cover.

# If tap water is cloudy:
- Filter water using clean cloth.
- Use unscented bleach (bleach that does not have an added scent).
- Add 1/4 teaspoon (16 drops or 1.5 milliliters) of unscented household liquid bleach to 1 gallon (16 cups) of water.
- Mix well and wait 30 minutes or more before drinking.
- Store disinfected water in clean container with a cover.
Remember that containers may need to be sanitized before using them to store safe water.
To sanitize containers:
- Use unscented bleach (bleach that does not have an added scent).
- Make a sanitizing solution by mixing 1 teaspoon (5 milliliters) of unscented household liquid bleach in 1 quart (32 ounces, 4 cups, or about 1 liter) of water.
- Pour this sanitizing solution into a clean storage container and shake well, making sure that the solution coats the entire inside of the container.
- Let the clean storage container sit at least 30 seconds, and then pour the solution out of the container.
- Let empty container air dry OR rinse it with clean water that has already been made safe, if available.
Never mix bleach with ammonia or other cleaners. Open windows and doors to get fresh air when you use bleach.

# Water filters
Boil tap water even if it is filtered. Most kitchen and other household water filters typically do not remove bacteria or viruses.

# Preparing and cooking food
- Wash all fruits and vegetables with boiled water that has cooled or bottled water.
- Bring water to a rolling boil for 1 minute before adding food to cook.
- Use boiled water when preparing drinks, such as coffee, tea, and lemonade
- Wash food preparation surfaces with boiled water.

# Feeding babies and using formula
Breastfeeding is best. Continue to breastfeed. If breastfeeding is not an option:
- Use ready-to-use baby formula, if possible.
- Prepare powdered or concentrated baby formula with bottled water. Use boiled water if you do not have bottled water. Disinfect water for baby formula if you cannot boil your water (see above for directions on how to use bleach to disinfect water).
- Wash and sterilize bottles and nipples before use.
- If you cannot sterilize bottles, try to use single-serve, ready-to-feed bottles.

# Ice
- Do not use ice from ice trays, ice dispensers, or ice makers.
- Throw out all ice made with tap water.
- Make new ice with boiled or bottled water.

# Bathing and showering
Be careful not to swallow any water when bathing or showering.
Use caution when bathing babies and young children. Consider giving them a sponge bath to reduce the chance of them swallowing water.

# Fact Sheet About What to Do During a Boil Water Advisory, continued

# Brushing teeth
Brush teeth with boiled or bottled water. Do not use untreated tap water.

# Washing dishes
Household dishwashers generally are safe to use if the water reaches a final rinse temperature of at least 150 degrees or if the dishwasher has a sanitizing cycle.
To wash dishes by hand:
- Wash and rinse the dishes as you normally would using hot water.
- In a separate basin, add 1 teaspoon of unscented household liquid bleach for each gallon of warm water.
- Soak the rinsed dishes in the water for at least one minute.
- Let the dishes air dry completely.

# Laundry
It is safe to do laundry as usual.

# Pets
Pets can get some of the same diseases as people. It is a good idea to give them boiled water that has been cooled.
For more information, see or contact:
- Personal Preparation and Storage of Safe Water: CDC provides guidance on the amount of water needed for good health, as well how to prepare and store safe water before and during an emergency.
- Hygiene and Handwashing: CDC provides guidance on alternative hygienic practices when water is not available or is contaminated.
- A Guide to Water Filters: CDC maintains a guide for filters that remove Cryptosporidium or Giardia.
- EPA Safe Drinking Water Hotline: 1-800-426-4791
- Consumer Information: EPA provides information and guidance about drinking water quality, emergencies, contaminants, public health issues, and treatment and storage. - Llene una olla con agua fria.
- Caliente el agua hasta que se formen burbujas desde el fondo de la olla.
- Una vez que el agua llegue a hervir con fuerza, deje que hierva asi durante un minuto.
- Apague la fuente de calor y deje que el agua se enfrie.
- Para guardar el agua, vaciela en un recipiente limpio que tenga tapa.

# Para desinfectar el agua
Si no hay forma de hervir el agua, desinfectela en vez de hervirla.
Si el agua de la llave esta transparente:
- Use blanqueador de cloro al que no se le haya anadido aromatizante (como olor a limon).
- Agregue 1/8 de cucharadita (8 gotas o aproximadamente 0.75 mililitros) de blanqueador de cloro para uso domestico a 1 galon (16 tazas) de agua.
- Mezcle bien y espere 30 minutos o mas antes de beber el agua.
- Guarde el agua desinfectada en un recipiente limpio que tenga tapa.
Si el agua de la llave esta turbia:
- Filtre el agua con un trapo limpio.
- Use blanqueador de cloro al que no se le haya anadido aromatizante (como olor a limon).
- Agregue 1/4 de cucharadita (16 gotas o aproximadamente 1.5 mililitros) de blanqueador de cloro para uso domestico a 1 galon (16 tazas) de agua.
- Mezcle bien y espere 30 minutos o mas antes de beber el agua.
- Guarde el agua desinfectada en un recipiente limpio que tenga tapa.
Recuerde que es posible que deba desinfectar los envases antes de usarlos para almacenar agua adecuada para beber.

# Para desinfectar los envases:
- Use blanqueador de cloro al que no se le haya anadido aromatizante (como olor a limon).
- Agregue 1 cucharadita (64 gotas o 5 mililitros) de blanqueador de cloro para uso domestico a 1 cuarto de galon (32 oz, 4 tazas, o aproximadamente 1 litro) de agua.
- Ponga esta solucion en un envase limpio y agite bien, asegurandose de que la solucion haga contacto con todo el interior del envase.
- Deje esta solucion en el envase por lo menos durante 30 segundos, y luego vacie el envase.
- Deje que el envase se seque al aire o enjuaguelo con agua que ya haya desinfectado, si es que la tiene.
Nunca mezcle blanqueador de cloro con amoniaco o con algun otro tipo de producto de limpieza. Abra las ventanas y las puertas cuando use blanqueador de cloro para que entre el aire fresco.

# Filtros para el agua
Hierva el agua de la llave, incluso si esta filtrada. Los filtros de agua no eliminan las bacterias ni los virus.

# Preparacion de alimentos
- Lave todas las frutas y las verduras con agua hervida.
- Deje hervir bien el agua durante un minuto antes de agregarle los alimentos.
- Prepare bebidas como cafe, te o limonada con agua hervida.

# Alimentacion de bebes y uso de leche preparada para lactantes
Lo mejor es amamantar. Continue amamantando al bebe. Si amamantar no es posible:
- De ser posible use leche preparada para lactantes ya lista para usarse.
- Use agua embotellada para preparar leche para lactantes en polvo o concentrada. Si no tiene agua embotellada, use agua hervida. Si no puede hervir el agua, desinfecte el agua que usara para la leche preparada para lactantes siguiendo las instrucciones mencionadas anteriormente sobre la forma de usar blanqueador).
- Recuerde que debe esterilizar las botellas y los chupones antes de usarlos.
- Si no puede esterilizar las botellas, trate de usar botellas listas para usar y no reciclables (que se puedan usar solo una vez).

# Hielo
- No use hielo del fabricador de cubitos de hielo ni del recipiente de hielo del congelador.
- Deseche todo el hielo que haya hecho con agua de la llave.
- Haga hielo nuevo con agua hervida o embotellada.
Hoja informativa sobre que hacer durante una advertencia para hervir el agua, continuacion

# Limpieza del cuerpo
Debe tener cuidado de no tragar agua al banarse en la tina o la regadera.
Tenga cuidado al banar a bebes y a ninos pequenos. Considere darles banos de esponja para evitar que traguen agua.

# Lavado de dientes
Para lavarse los dientes use agua hervida o embotellada.

# Para lavar los trastes
Se puede usar el lavador de platos sin problemas si el agua llega a una temperatura de por lo menos 160 grados, o si el lavador de platos tiene un ciclo de sanitacion.
Para lavar los trastes a mano:
- Lave y enjuague los trastes como lo hace normalmente, pero con agua caliente.
- En otra pileta, agregue 1 cucharadita de cloro para uso domestico, sin aromatizante, por cada galon de agua tibia.
- Remoje los trastes ya enjuagados en el agua con cloro por lo menos durante un minuto.
- Deje que los trastes se sequen por completo al aire.

# Lavanderia
Puede lavar la ropa sin problemas de la forma en que acostumbra a hacerlo.

# Mascotas caseras
Las mascotas caseras sufren de las mismas enfermedades que los humanos. Es una buena idea darles agua hervida para tomar.

# Para obtener mas informacion, comuniquese con:
- Preparacion personal y almacenamiento de agua segura: Los CDC ofrecen una guia acerca de la cantidad de agua necesaria para la buena salud, asi como la forma de preparar y almacenar el agua segura antes y durante una emergencia.
- Higiene y lavado de manos: Los CDC ofrecen una guia acerca metodos de higiene alternativos cuando no hay agua disponible o esta contaminada.
Hoja informativa sobre que hacer durante una advertencia para hervir el agua, continuacion
- Una guia sobre los filtros de agua: Los CDC tienen una guia de los filtros que eliminan el criptosporidio o la giardia.
- Linea gratuita sobre agua potable segura de la EPA: 1-800-426-4791
- Informacion para el consumidor: La Agencia de Proteccion Ambiental de los Estados Unidos (EPA, por sus siglas en ingles) ofrece informacion sobre la calidad del agua potable, emergencias, contaminantes, problemas de salud publica, y tratamiento y almacenamiento. Coliforms are a group of bacteria found in plant material, water, and soil. Coliforms are also present in the digestive tracts and feces of humans and animals. Most of the time, these bacteria are not harmful.

# Why does a water system test for coliforms?
Water systems test for indicators such as total coliforms, fecal coliforms, or E. coli to monitor water quality. If the water system has a positive test for one of these indicators, it can mean recent contamination with soil or human feces.

# What does a positive coliform test result mean?
A positive coliform test means possible contamination and a risk of waterborne disease. A positive test for total coliforms always requires more tests for fecal coliforms or E. coli. A confirmed positive test for fecal coliforms or E. coli means you need to take action as advised by your water system.

# Will coliform bacteria make me sick?
Most coliform bacteria are a normal part of the environment. They do not cause disease but do indicate the water might be contaminated by soil or feces. Some rare types of coliforms, such as E. coli O157:H7, can cause serious illness. Although most E. coli O157:H7 outbreaks are from eating raw or undercooked food, cases from contaminated drinking water can occur, but are rare.

# Why test for indicator organisms?
A biological pathogen is any organism, such as a bacteria, virus, protozoa, or parasite, that causes a disease. Biological pathogens are commonly called "germs. " There are many different possible pathogens. It is not possible to test for every type of pathogen in every water sample, so water systems use indicators instead.
Water systems test for indicator organisms, like coliforms, to check for possible contamination by biological pathogens. Most coliforms are not harmful, but they come from the same sources as other bacteria and organisms that could make you sick.
What are "indicator" organisms?
- Indicator organisms come from the same sources as organisms that make you sick. Indicator organisms are easier to identify, are present in larger numbers, and respond to water treatment the same way as harmful bacteria and many other biological pathogens. A biological pathogen is any organism, such as a bacteria, virus, protozoa, or parasite, that causes a disease. Biological pathogens are commonly called "germs".
- Total coliforms is another term for the full group of coliforms. They are indicators of possible water contamination.
- Fecal coliforms are one type of coliform bacteria that is found found mainly in animal digestive tracts and feces. Fecal coliforms are a more specific indicator of fecal contamination of water.
- E. coli (Escherichia coli) is a species of fecal coliform bacteria. E. coli almost always comes from animal feces. E. coli is considered the best indicator of fecal water contamination.
If E. coli is present, harmful bacteria or other pathogens may also be present.
For more information see or contact:
- Personal Preparation and Storage of Safe Water: CDC provides guidance on the amount of water needed for good health, as well as how to prepare and store safe water before and during an emergency.
- Hygiene and Handwashing: CDC provides guidance on alternative hygienic practices when water is not available or is contaminated.
- A Guide to Water Filters: CDC maintains a guide for filters that remove Cryptosporidium or Giardia.
- EPA Safe Drinking Water Hotline: 1-800-426-4791
- Consumer Information: EPA provides information and guidance about drinking water quality, emergencies, contaminants, public health issues, and treatment and storage.

# What's different about the Groundwater Rule?
We used to think that groundwater was protected from fecal contamination. New information shows that groundwater can have fecal contamination and people could get sick. This is why EPA developed the Groundwater Rule.

# What indicator organisms does a groundwater system test for?
Groundwater systems test for one of three indicator organisms-E. coli, enterococci, or coliphages-to monitor water quality. If the water system has a positive test for any one of these three organisms, it can mean recent contamination with human feces.
Water systems test for indicator organisms to check for possible contamination. There are many different possible pathogens. It is not possible to test for every pathogen in every water sample, so they test for indicators instead.

# What are "indicator" organisms?
Indicator organisms come from the same sources as organisms that might make you sick. Indicator organisms are easier to identify, are present in larger numbers, and respond to water treatment in the same way as harmful bacteria and many other biological pathogens. A biological pathogen is any organism, such as a bacteria, virus, protozoa, or parasite that causes disease. Biological pathogens are commonly called "germs. "

# What does a positive test result for an indicator organism mean?
A positive test for an indicator means possible water contamination and a risk of waterborne disease. A positive test in groundwater for E. coli, enterococci, or coliphages means you and your water system need to take action.

# Will indicator organisms make me sick?
Coliphages do not infect humans or cause illness. Some enterococci can cause disease in humans. Most coliform bacteria are a normal part of the environment and do not cause disease. However, some rare types of E. coli, such as O157:H7, can cause serious illness. Although most E. coli O157:H7 outbreaks are from eating raw or undercooked food, cases from contaminated drinking water can occur, but are rare.

# What are coliphages?
A virus that infects bacteria is called a phage. Phages infect specific species of bacteria. Coliphages infect coliform bacteria. Coliphages do not infect humans or cause illness. A positive test for coliphages indicates the water may be contaminated with feces or E. coli.

# Frequently Asked Questions About Groundwater Rule Advisories
What are coliforms?
Coliforms are a group of bacteria found in plant material, water, and soil. Coliforms are also present in the digestive tracts and feces of humans and animals. Most of the time, these bacteria are not harmful.
Total coliforms is another term for the full group of coliforms. They are indicators of possible water contamination. Fecal coliforms is one type of coliform bacteria found mainly in animal digestive tracts and feces. Fecal coliform tests are a more specific indicator of water contamination. E. coli is a species of fecal coliform bacteria. E. coli almost always comes from animal feces and is considered the best indicator of fecal water contamination. If E. coli is present, harmful bacteria or other pathogens may also be present

# What is E. coli?
E. coli (Escherichia coli) is a species of fecal coliform bacteria. E. coli almost always comes from animal feces. E. coli is considered the best indicator of fecal water contamination. If E. coli is present, harmful bacteria or other pathogens may also be present. Not all E. coli make people sick. Some rare types of E. coli, such as O157:H7, can cause serious illness.

# What are Enterococci?
Enterococci are a type of bacteria mainly found in the gut and feces of animals. They are used as an indicator organism for groundwater because they closely link water quality with contamination by human feces. Some enterococci can cause disease in humans. Enterococci are not coliform bacteria.
For more information see or contact:
- Personal Preparation and Storage of Safe Water: CDC provides guidance on the amount of water needed for good health, as well as how to prepare and store safe water before and during an emergency.
- Hygiene and Handwashing: CDC provides guidance on alternative hygienic practices when water is not available or is contaminated.
- A Guide to Water Filters: CDC maintains a guide for filters that remove Cryptosporidium or Giardia.
- EPA Safe Drinking Water Hotline: 1-800-426-4791
- Consumer Information: EPA provides information and guidance about drinking water quality, emergencies, contaminants, public health issues, and treatment and storage. Frequently Asked Questions About Groundwater Rule Advisories, cont'd When I turn on the faucet, the water sputters. Why?
You have air in your lines. Turn on your tap slowly and run the water until the sputtering stops.

# The water is discolored. What should I do?
Flush water pipes by running the water until it is clear.
Do not wash clothes if the water is discolored. Wait until the water runs clear at the tap. Wash a load of dark clothes first.

# Why does my water have a strong smell?
The smell is probably chlorine. Often, water systems will increase chlorine levels to disinfect the pipes.

# What should I do if my water pressure is low?
Check the faucet screens for trapped particles. Remove the screens and clean out any particles. Put the screens back on the faucet.

# Do I need to clean out my faucets?
Yes. You should flush your faucets after the drinking water advisory.
- Turn on the main water valve.
- Turn on the cold water tap at all faucets and run the water until you feel a change in temperature (i.e. the water gets noticeably colder). This may take several minutes. Begin with the faucet that is highest up in your home or building and then open the other faucets one at a time moving from the highest floor to the lowest.

# Do I need to clean appliances?
Yes. Read the owner's manual for directions to clean appliances such as water softeners and filter units.

# Frequently Asked Questions About What to Do After a Drinking Water Advisory
My refrigerator has a water dispenser/ice maker. Do I need to clean them?
Yes. Water dispensers and ice makers are connected to your water line. You need to flush and clean them.
Follow the directions in the owner's manual or:
- Change the filter cartridges.
- Throw out ice.
- Flush the water dispenser for 3 to 5 minutes.
- Run the ice maker for 1 hour.
- Throw out all the ice.
- Wash and sanitize bin areas.

# Do I need to do something for the water softener?
Yes. You may need to run through a regeneration cycle. Follow the directions in the owner's manual.

# I have a water treatment unit for the house. Does it need special care?
Yes. Change the filter cartridges. Some units need disinfecting. Follow the directions in the unit's owner's manual.

# Frequently Asked Questions About What to Do After a Drinking Water Advisory, continued
Cuando abro una llave de agua, esta salpica, por que?
Hay aire en las tuberias de agua. Abra la llave de agua lentamente y deje correr el agua hasta que deje de salpicar.

# El agua esta turbia, que debo hacer?
Deje abiertas las llaves de agua hasta que el agua salga transparente.
No lave ropa si el agua esta turbia. Espere a que salga el agua transparente del grifo de agua. Primero lave una carga de ropa obscura.
Por que huele muy fuerte el agua que sale del grifo?
El olor es probablemente cloro. Con frecuencia los sistemas de agua aumentan los niveles de cloro para desinfectar las tuberias.

# Que debo hacer si la presion de agua es baja?
Revise si hay desperdicios atrapados en las mallas que estan en la salida de las llaves de agua. Saque estas mallas y limpielas bien. Vuelva a colocar las mallas en las llaves de agua.

# Debo limpiar mis llaves de agua?
Si; abra las llaves de agua que no haya usado durante la advertencia para hervir el agua potable.
- Abra la toma de agua principal.
- Abra la llave de agua fria en todos los grifos usados para obtener agua de beber en el hogar y deje correr el agua hasta que cambie de temperatura (por ejemplo que se sienta mas fria). Esto puede tardar varios minutos. Empiece con el grifo mas elevado de su casa o edificio y luego abra los otros grifos uno por uno en orden del piso mas alto al piso mas bajo.

# Preguntas frecuentes acerca de que hacer despues de una advertencia para hervir el agua
Mi refrigerador tiene surtidor de agua fria y fabricador automatico de cubitos de hielo, debo limpiarlos?
Si; los surtidores de agua fria y los fabricadores de cubitos de hielo estan conectados a su tuberia de agua. Debe desinfectarlos. Siga las instrucciones del manual del usuario o:
- Cambie los cartuchos de filtro.
- Tire el hielo.
- Deje correr el agua en el surtidor, de tres a cinco minutos.
- Deje funcionar el fabricador automatico de cubitos de hielo por una hora.
- Deseche los cubitos de hielo.
- Lave y desinfecte los recipientes de agua y hielo.
Debo hacer algo con el suavizador de agua?
Si; es posible que deba hacerlo funcionar durante todo un ciclo de regeneracion. Siga las instrucciones del manual del usuario.
Tengo un sistema de tratamiento de agua para el hogar. Necesito hacer algo en especial?
Si. Cambie los cartuchos de filtro. Algunas unidades deben ser desinfectadas. Siga las instrucciones del manual del usuario.

# Preguntas frecuentes acerca de que hacer despues de una advertencia para hervir el agua

# Point of Contact for Coordination During an Advisory

# PURPOSE
This form is designed to facilitate planning for exercises. The first section will help state objectives and desired outcomes from the planning session. The second section identifies participants and helps prepare them for discussion. The more preparation, the better the end product.

# DIRECTIONS
- Identify exercise leads and type of exercise (seminar, workshop, tabletop, game, drill, functional, full scale).
- Complete the purpose, scope, goal, and objectives. Invite staff and other organizations as appropriate.
- Include name and contact information for each participant.
- Identify and assign specific materials for participants to develop or provide.

# Section 2: During an Event-Issuing an Advisory
A drinking water advisory can occur at any time. Water systems must act quickly when an event is suspected or identified. The first action must be to assess the situation and follow standard operating procedures (SOPs) for issuing a drinking water advisory.

# Overview
Icon Key

# Initiating an Advisory
Identify the situation and collect facts.
Notify your drinking water primacy agency.
Decide to issue an advisory.
Identify the geographic boundaries.
Notify your internal staff and external partners.

# Preparing an Advisory
Develop, format, and translate the message.
Approve the advisory.
Identify the spokespersons.
Assign communication responsibilities.

# Distributing an Advisory
Brief elected and public officials.
Implement your communication platforms.
Use your communication network to expand distribution of the advisory.
Work with the media.

# Ending an Advisory
Issue End of Advisory notice.

# Checklist: During an Event

# Identify the Situation and Collect Facts
Drinking water advisories are issued for reasons identified in federal or state regulations or by decisions made by the water system. The situation and characteristics of the contaminant(s) of concern determine what type of advisory to distribute:
- Informational - Boil Water - Do Not Drink - Do Not Use
Use the Essential Information list to collect data and develop communication materials.

# Notify Your Drinking Water Primacy Agency
Each state that has primacy specifies particular mechanisms for state notification. Be familiar with your water system's protocols for notifying your primacy agency. See Appendix B: Online Resources, Primacy Agency.

# Decide to Issue an Advisory
Work with senior management and follow your communication SOP in making the decision to issue an advisory. Use your best professional judgment.

# Initiating an Advisory

# Essential Information

# Identify the Geographic Boundaries Boundaries
A key component of a drinking water advisory is to communicate clearly the area affected. Many customers do not know which water system provides their service and broadcast media usually reach a large audience beyond the affected area.
Clearly describe the boundaries of the affected area using street names, place names, and well known reference points.

# Maps
Maps help illustrate the affected area. Water systems can generate maps using internal or online mapping tools (e.g., geographic information system ). These maps can be posted on agency websites, or distributed electronically or as printed material. Update the map as the situation changes.

# Maps Help Define The Area Affected
When possible, use maps and brief descriptions of the boundaries of the area affected. Maintain and update maps of the water service area. Maps can be sent out as printed or electronic versions. Make sure the maps
- Are presented at a legible scale with legible fonts.
- Are uncluttered.
- Reflect commonplace names and reference points.
- Have crisp lines.
- Are easy to read.

# Descriptions
Clearly communicating the boundaries of affected areas also requires careful consideration of verbal descriptions so that spokespersons, radio, and other media can briefly but accurately depict the service area affected.

# Notify Your Internal Staff and External Partners
Activate your internal communication SOP. Use information collected to brief staff. Depending on the situation, also brief your partners:
- Wholesale, consecutive, and neighboring water systems.
- Public health department.
- Critical customers (see Critical Customer Checklist to assist in identifying at-risk populations served by a water system).
- Public officials.
- Emergency management.
- Community organizations.
- Businesses, childcare facilities, correctional facilities, food service, health care providers and facilities, and schools.
Provide Call Center Data Checklist to call center or customer service staff and partners. Unless a state requires specific templates, revise the order and content of these templates based on the local circumstances. Remember to include the 10 required elements from the Public Notification Rule.

# Notes
Understand the translation needs of your community. Use community partners or professional translation services to translate the message. Avoid using online dictionaries or other computer software.
Community partners are responsible for producing the message in formats that people they serve can read and understand, such as Braille, large font, or text messages.

# Required Elements of a Public Notice
All public notices must include a clear and readily understandable explanation of each violation containing the following 10 elements from EPA's Public Notification Rule (PNR) Quick Reference Guide.

# Description of the violation or situation, including contaminant(s) of
concern and the contaminant level(s). 2. When the violation or situation occurred. 3. Any potential adverse health effects from drinking the water and standard language regarding the violation or situation. 4. Population at risk, including subpopulations that may be particularly vulnerable if exposed to the contaminant in their drinking water. 5. Whether alternate water supplies should be used. 6. Actions consumers should take, including when they should seek medical help, if known. 7. What the water system is doing to correct the violation or situation. 8. When the water system expects to return to compliance or resolve the situation. 9. Name, business address, and phone number of the water system owner, operator, or designee who can provide additional information concerning the notice. 10. A statement encouraging the notice recipients to share the notice with other persons, where applicable.

# Preparing an Advisory

# Abbreviated Messages
Some channels of communication only allow for brief messages because of time or space constraints. Brief messages are appropriate for:
- On-screen scroll (local televised news, cable television, public service television channels, Emergency Broadcast System announcements).
- Text message systems (SMS).
- Social media (Facebook, Twitter).
- Reverse 911 phone message systems.
- Highway variable message signs and portable message boards.
See the Automated Messages tool.

# Abbreviated Message Template-Boil Water Advisory
The  is asking customers to boil tap water or use bottled water. For more information, go to 
-r call .

# Message Development
The information on which to base the advisory can be captured in the Information for Communication Planning tool. The Required Elements of a Public Notice (see page 86) outlines the questions and information the drinking water advisory must address in its materials. Key Questions for the Public Information Officer may help in preparation for working with the media.

# Approve the Advisory
Once the message has been developed and produced in appropriate formats, follow your communication SOP to have management approve the advisory.

# Identify the Spokespersons
The person to serve as a spokesperson during a drinking water advisory can come from water system management or from an outside partner agency, such as a public health department. The spokesperson should be someone in authority who is honest, credible, competent, accessible, and sensitive to public concerns.

# Tip
Abbreviated messages should include:
- Basic message of action to take
- Location
- Contact information
- Where to get more information Follow the communication protocols discussed in Section 1 and use essential information to prepare spokespersons for interacting with the public and media. See Basic Elements of a Spokesperson Statement.
If there is not a designated spokesperson, assess staff options and identify an individual to fill this role. See Spokesperson Assessment Tool.

# Assign Communication Responsibilities
Exchanging information and developing materials, such as news releases, among partners and water systems must be a coordinated effort. Liaisons should be designated staff who are the communication link for issuing an advisory and also for updating and lifting the advisory. Each organization or water system involved in an advisory should identify a liaison. Work with your partners to assign specific communication roles and responsibilities. Develop a list that identifies who (which partner) will be contacting whom (a specific audience) and when that contact will occur.

# Tip
When possible, the spokesperson should not be someone who is directly involved in operations.

# Brief Elected and Public Officials
Brief the appropriate public officials on the essential information before you notify the media. Media often will contact public officials rather than a water system for information and comments.

# Implement Your Communication Platforms
Determining the most appropriate strategies and tools for a particular situation is a reflection of the severity of the public health concern and the ability to define clearly the affected area. Effective communication will require distribution through multiple methods:
- News media outlets(are a primary means of distributing the advisory)
- Automated message systems (helps reach specific service areas quickly). See Automated Messages for more information.
- Door-to-door contact or door hangers (often used for small areas)
- Hand-delivered fliers

# Websites
- Social media (e.g., Facebook, Twitter)

# Distributing an Advisory

# Automated Messages
Broadcast notification systems use a variety of commercially available systems that include:
- Prerecorded or synthesized voices for brief messages,
- Text (SMS) for messages to cell phones, and
- E-mail for detailed messages to large groups.
For more information, see Automated Messages.

# Use Your Communication Network to Expand Distribution of the Advisory
As noted in the Collaborating with Partners (see pages 23-28) portion of Section 1: Before an Event, network partners can assist with translating, formatting, and distributing messages to specific audiences.
- Coordinate with local public health departments to help alert hospitals, health care providers, childcare providers, and food service and preparation facilities (See Appendix B: Online Resources, Additional Water and Health Resources and Appendix B: Online Resources, Disinfecting Water
- Coordinate with school districts and private schools, including colleges and universities.
- Use your communication network to reach diverse populations that may be outside mass media communication channels.

# Communication Network

# Work with the Media
The Public Notification Rule requires wide distribution and encourages the use of mass media. General circulation newspapers, radio, television, websites, and ethnic media are good channels for issuing advisories. After issuing a press release, call media outlets to verify they received the release. Ask for the duty editor or news director. Take time to explain the importance of this information to the public. This is especially important for lifting an advisory.
Monitoring the media, customer calls, and the status of the advisory will guide decisions about the need for media activities. Press conferences, additional calls to reporters, or expanding media work to partners are necessary in large-scale advisories.

# Media log
Use a log to track media contacts and reports. Logging media contacts gives a structure for follow up with updates or end-of-advisory notices. If the advisory includes multiple agencies or water systems, each organization should keep a log.

# Tip
To meet the intent of the Public Notification Rule , health effects and other details must be included in the press release.

# Include phone numbers and websites in the full advisory. See Required Elements of a Public Notice

# Did You Know?
Ethnic media reach 25 percent of the U.S. adult population. These adults are far more responsive to messages delivered by media from a similar culture or ethnic group. Forty-five percent of all African-American, American Indian, Hispanic, Asian-American, and Arab-American adults prefer ethnic television, radio, or newspapers to mainstream media channels. See Appendix B: Online Resources, Susceptible Populations.

# Media Evaluation
Look at media coverage during and after an advisory:
- Does media coverage reflect the scope and scale of the event?
- What is the tone of the coverage?
- What are the reactions in the community?
- Were updates covered by the media?
- How do the timing and placement of media stories link with the volume of customer service calls? (Look for the media's effect on customer questions.)

# Digital Media
Blogs and comments on websites DO NOT represent general public opinion. They DO give an idea of reactions and concerns.

# Working with the Media
- Get the facts straight. Who? What? When? Where? Why? How?
- Write the message to fit the circumstances.
- Keep all messages consistent.
- Edit, review, and get clearance for all media releases.
- Use standard press release format.
- Link to other information from relevant entities.
- Use e-mail, fax, and other methods to deliver the press release.
- Make follow-up calls to the media.
- Track contact with the media.
- Post the release and the advisory on the water system's website.
- Be honest with the media. If you do not know the answer to a question, say so, then offer to find the information.
- Discuss use of maps and visual aids with media outlets.
- Consider issuing a joint press release with the state and/or local health department.
- Send a release announcing the end of the advisory to media outlets and partners and post the announcement on your website.
- Make follow-up contact with media to encourage publicizing the end of the advisory.
- If the advisory is large or long-term, consider scheduling regular press conferences to keep the media up to date. These should be at a time that allows the media to meet press deadlines.

# Tier 1 PNR Compliant Press Releases
News editors will edit and reformat releases to fit their style and available space. Some of the required elements or language may be omitted. It is the water system's responsibility to post the official advisory in public places, apartments, schools, businesses, on websites, and other places as required by your state.
See the following tools and templates for guidance:
- How to Use Press Release Templates

# Press Conferences and Briefings
News conferences or briefings become necessary during some advisories. Press conferences and briefings create additional work and demand extra resources, but they can eliminate the need to answer large numbers of media inquiries individually. Preparation helps ensure a successful press event.

# Planning a Press Conference
The first step is to refer to the messages and essential information developed for the advisory. These messages and information are the basis for media kits, advisories, and statements. Messages should be consistent in all communication.
Media kits are simply a collection of information to provide to the media. Media kits should have:
- A copy of the official advisory distributed to customers When planning a press conference, coordination with partners is absolutely required.
- Work with partners to plan the press conference, develop materials for media kits, and ensure appropriate clearance is obtained from each agency.
- Designate one person or group to organize the press conference and one person to act as the emcee. Emcee responsibilities include introducing speakers, managing the question and answer period, and closing the press conference.
- Identify a spokesperson for each organization participating in the press conference See Spokesperson Assessment Tool.
- Use the essential information and messages to develop statements for each speaker. Brief the spokespersons prior to the event and review messages and materials. Speakers need to know the order of their appearance and roles. See Basic Elements of a Spokesperson Statement and Spokesperson Assessment Tool.
- Rehearse before the session and practice statements and possible questions and answers. It is important to prepare for difficult questions. Plan a strategy in case the situation becomes contentious. Include all spokespersons if other agencies are involved. Phone calls can work if spokespersons cannot meet inperson ahead of time.
- Plan logistics. This is central to a successful press conference. Study the location. The space should be accessible and have enough room, no echo, a central focus point, and a designated sign-in area. Media kits should be provided at the sign-in area. If possible, set aside a separate space for one-on-one interviews. On-site press conferences are more of a challenge. Use tape or cones to designate a specific safe area. Limit work noise and activity, if possible. Make it clear how long the press conference will last.
- Announce the press conference through media contacts. Develop a media alert and distribute it by e-mail, fax, or other methods. Follow up with calls to the media to make sure the right persons received the advisory. Select a time that will allow sound and video crews to set up equipment and all media to meet press deadlines. Use the Media Alert Template.

# Conducting a Press Conference
With the right planning in place, the press conference should go more smoothly. Make sure each media outlet signs in and has a media kit. Press conferences have a standard format:
- Entrance: Spokespeople enter the room or area in the order they are speaking.
- Introductions: The emcee gives a short summary of the reason for the press conference and introduces each spokesperson. One spokesperson may play this role if necessary.
- Statement: Spokespeople stand up, give their names and titles, and proceed with their statements.
- Questions: It is standard practice to have a question and answer session. The person doing the introductions should handle media questions and refer them to the best spokesperson for the topic.
- Close: Stick to the time allotted. The emcee thanks the media for their interest, states that the session is closed, and announces where to get more information and/or the time of the next update. Spokespersons leave the room.

# After the Press Conference
If appropriate, the media can conduct one-on-one interviews directly after the press conference. Make sure to get back to any member of the media that asked for more information.
A debriefing, either in person or by phone, will identify concerns that are not addressed, determine changes needed in messages, and prepare participants for the next update. Information from a press debriefing should be incorporated into the advisory protocol during the evaluation process.

# Notes

# Issue End of Advisory Notice
Federal regulations do not specify when to end an advisory. Water systems and drinking water primacy agencies consult with one another on the specific events around the advisory and use water quality criteria and protocols to make the decision to end or lift an advisory. State primacy agency criteria are typically based on laboratory testing (sampling) results.
When the water system and primacy agency end the advisory, communication moves to lifting the advisory. Develop and coordinate the end of the advisory messages with partners. The same communication methods, media partners, and outlets used to distribute the advisory should also be used to lift the advisory.
Be clear about the information used to end the advisory and the timing. Specifically, include the information on which you are basing your decision to end the advisory (e.g., the lab tested the water and it was negative for indicators).
Be sure to send the end of advisory notice to all partners in the communication network and the media. Post this information on websites clearly showing date and time. See the Ending an Advisory Press Release Template as an example.

# Ending an Advisory
Steps to Issue an End to the Advisory
- Update the media and partners.
- Update notifications in the affected area, including websites.
- Update affected customers electronically; for example, by automated messages or e-mail.
- Follow up earlier press releases with an end of advisory press release and phone calls. Calls abandoned (caller hung up without listening to recorded information).
Caller demographics (city, ZIP, county).
Caller contact information (phone number or e-mail) if needed to provide follow-up information.
Call topic (drinking water advisory, outage, discoloration, taste, illness).
Call reason (information request, report case, provide information).

# Key Questions for the Public Information Officer

# PURPOSE
This list provides a quick review of important points to consider for public communication during an advisory.

# DIRECTIONS
Compare available public communication materials available to this list. Provide this list to other water systems or organizations responding to an advisory. Use this list when working with the media. As a public information officer, consider the following before releasing information to the media:
1. Ability-Do you have the appropriate information on the subject?
2. Competency-Are you qualified to discuss the topic with the news media? If you are not the expert, find out who the expert is and arrange to have him or her brief the media.
3. Authority-Do you have jurisdiction over the issue? It's always advisable to stay in close contact with upper management to coordinate your response.
4. Security-Is the information classified? The security limitation is extremely important because of the need to safeguard classified and operationally sensitive information.
5. Accuracy-Is the information accurate? Public information officers have an obligation to provide accurate, factual information and to avoid speculation.
6. Propriety-Is the information appropriate to the situation? Ensure that information released displays sensitivity and dignity. For example, do not release photographs that could distress individuals or their family members.
7. Policy-Do the policies of your organization permit release of this information?

# Automated Messages

# PURPOSE
Automated messages take many forms. Developing the content for advisories requires careful planning. This information addresses automated messages specifically for drinking water advisories.

# DIRECTIONS
Review the information about automated messages. Be sure your communication plan addresses automated messages specific to the water system and community capabilities and tools. Automated broadcast notification is used to send messages quickly to large numbers of people. Broadcast notification systems, use a wide variety of commercially available systems that include the following:
- Voice: Delivering messages by prerecorded or synthesized voice is suited for brief messages. Automated systems like Reverse 911 can be programmed to leave messages on answering machines if there is no answer.
- Text (SMS): Short Messaging Service (SMS) delivers messages of up to 160 characters to cell phones.
- E-mail: E-mail is suitable for more detailed messages and can be sent to large groups relatively quickly. E-mail is delivered over the Internet, which is typically a reliable network unless there is a power outage.

# Note: SMS and e-mail systems cannot guarantee delivery to a contact.
Effective broadcast systems require:
- Accurate contact information.
- Delivery to a relevant contact point (e.g., reaching a cell phone versus a home landline).
- Simple, concise language.
- Coordination with other communication tools to provide access to more detailed information (e.g., website, customer call center).

# Coordinate with other tools
Automated messages are useful tools in combination with press releases, door hangers, call center information, website information, and other outreach tools. These brief messages are useful in building awareness but are inadequate to provide all the information customers need to receive.

# Accurate Contact Information
A notification system is only as good as the contact data. Uploading contact data is not ideal; data can be inaccurate (entry errors), false (purposefully wrong data), or invalid (phone number has changed or been disconnected). This is more likely when data are uploaded from customer records or purchased phone lists, or gathered from available databases. Even converting data from enhanced 911 systems to Reverse 911 programs will not assure accurate contact information. Automatically entering contact data into a system also has problems. Notification system vendors are wary of violating anti-spam laws and blacklisting.
Opt-in data collection can provide and validate content for notification. Individuals can be invited to join a list on a website, or indicate their interest when opening an account. This option can make it easier for subscribers to update their own contact information. This improves the results and reach of a broadcast. Opt-in processes for collecting data help protect the provider from unlawful use, because each recipient is giving the notification provider permission for future contact.

# Timing
Automated notification systems are quick, but not instantaneous. Time is required:
- To prepare the message
- To direct the message to appropriate audiences (e.g., customers in specific subsections of the distribution system)
- To distribute the advisory  Voice systems may only make 1,000 calls per hour  E-mail or text message distribution to similar numbers occurs in minutes, and
- For the recipient to listen to or read the message and take action.

# Automated Messages, continued Content
The purpose of an automated broadcast notification is to prompt people to seek information and take appropriate action. Messages for automated notification systems must be simple and concise. It is not practical to use language from standard public notification templates. Because these messages must be short, they cannot convey the detail required in EPA's Public Notification Rule.
- Key elements of abbreviated messages related to water quality concerns are:

# Working with the Media Template

# PURPOSE
These are sample statements to use if members of the media call before a press release is issued. Getting the facts correct is a priority. Do not give information to the media before confirming facts with field staff, the emergency operations center, and management. Changing information after it is released can lead to media confusion and loss of focus on the key messages.

# DIRECTIONS
Review these statements and adapt them with specific information about the water system. Incorporate the template into your standard operating procedures (SOPs) and emergency response plans (ERPs). Add specific information during an advisory. Rehearse the responses prior to speaking with media.

# Pre-scripted Immediate Responses to Media Inquiries
Use this template if the media is "at your door" and you need time to assemble the facts for the initial press release statement.
Getting the facts is a priority. It is important that your organization not give in to pressure to confirm or release information before you have confirmation (e.g., from your scientists and emergency operations center).

# Media Alert Template

# PURPOSE
Water systems can invite the media to attend press conferences and briefings or to tour facilities related to advisories. This type of activity provides the media with a better understanding of drinking water infrastructure and why advisories occur.

# DIRECTIONS
Use this template for media releases about press conferences, briefings, and facility tours. Replace information in brackets with specific water system and advisory information. Adapt the information as needed.

# Tier I Public Notification Rule Compliant Press Release Template

# PURPOSE
Use when a corresponding Tier 1 Public Notice boil water advisory is required and issued.

# DIRECTIONS:
Replace information in brackets with specific water system and advisory information. Adapt it as needed.  issues a boil water advisory for all customers in   advises all customers to boil their drinking water. The boil water advisory is in effect until further notice.

# Denotes required element of a public notice per EPA's Public Notification

# Customers should:
- Bring water to a rolling boil for 1 minute.
- Allow the water to cool before using.
- Store the cooled water in a clean container with a cover. . Customers should use boiled water that has cooled or bottled water for: 
These symptoms are caused by many illnesses other than drinking water. 
 Please share this information with all the other people who drink this water, especially those who may not have received this notice directly (for example, people in apartments, nursing homes, schools, and businesses).
For more information, go to   Customers should use boiled water that has cooled or bottled water for:
- Bring water to a rolling boil for 1 minute.
- Allow the water to cool before using.
- Store the cooled water in a clean container with a cover.
Customers should use boiled water that has cooled or bottled water for:
- Drinking.
- Brushing teeth. - Washing fruits and vegetables
- Preparing food and baby formula.
- Making ice.
- Giving to pets. Post-event activities are essential to improve, learn, and prepare for future events. They should reflect the scope and scale of the event.
The key is to understand what worked and what did not work during a drinking water advisory in order to improve the process in the future.

# Overview
Icon Key

# Tools and Templates

# Resources

# Assessing Expectations
Each advisory incident is an opportunity to compare planning to performance, and expectations to outcomes.

# Modifying Standard Operating Procedures (SOPs)
Incorporate changes into SOPs.

# Updating Public Outreach
Identify additional communication steps.
Follow up with the public.

# Notes

# Debrief and Conduct an After Action Review with Staff and Partners
Debriefing after an advisory helps organizations and communities understand what happened and why it happened during a drinking water advisory. A debriefing offers an opportunity to voice concerns and offer potential improvements. It often is informal and may be led by a neutral facilitator.
The format and size of the debriefing is based on the scope and scale of the drinking water advisory. In general, each division or organization that participated should be involved. Debriefings may benefit from having the perspective of an organization that was not involved but was affected by the drinking water advisory.
An After Action Review (AAR) is a structured form of debriefing that can compare planning with real activity. AARs can provide a clear understanding of what contributed to success and how to replicate it in the future. They also can provide a common understanding of where improvements canbe made and who will be responsible for following through on agreed action steps. AARs describe outcomes and planned actions.
The debriefing and AAR process and tools can be adapted for individual exercises and debriefings. See the Exercise Planning Template.
See the Debriefing Discussion Guide as an example.
The following are steps for conducting a debriefing.
1. Prepare: The Advisory Feedback Form can be used to plan a debriefing.
Conduct: Ground rules should be established. Consider using an outside neutral facilitator.
3. Report: Results of a debriefing can be incorporated into future planning efforts.

# Debriefing an Event

# Debriefing Ground Rules
To facilitate a debriefing:
- Respect colleagues. Refrain from personal remarks or assigning blame.
- Be honest and willing to share your knowledge and experience.
- Keep discussions about individual performance within the group.
- Read through the background information and consider the discussion questions.
- Accept the drinking water advisory as it happened.
- Avoid getting bogged down in small details.
- Think about the big picture.
- Provide paths forward and solutions where possible.
- Observe the time limits allotted for the debriefing.

# Perform an Evaluation
Evaluation is an ongoing assessment of a drinking water advisory protocol. It is the comparison of SOP criteria to performance. The collection and analysis of subjective experiences along with the analysis of objective forms of data or information provide the foundation for evaluation. Even the most basic evaluation provides insight and can improve future advisories and overall communication.
The scope of an advisory and a water system's resources and capacities guide the evaluation process. The time, resources, and expertise needed for an evaluation vary with the scope. Evaluations can be conducted over time and in different stages. Evaluations draw on many sources of information, including, operational reports, debriefings, surveys, and public comment. See the Debriefing Evaluation Form.

# Collect Data and Information Related to the Advisory
Different types of data are described below:
- Quantitative data, such as water quality data, Web analytics, and epidemiology statistics.
- Qualitative data, such as customer comments, media reports, staff memos, etc. See Appendix B: Online Resources, Data Management for links to information on qualitative data collection.

# See the Advisory Feedback Form
and Call Center Data Collection Framework for collecting information from partners.

# Conducting an Evaluation

# Evaluation Tips
- Make a list of evaluation questions.
- Identify the data sources.
- Link the sources.
- Proceed with the evaluation.  Participants of the advisory and debriefing need to know the results of the evaluation process. Reports should reflect the size and scope of the drinking water advisory and can range from a simple memo to a fullscale report. A report should summarize essential information for other post-event steps. See the Follow-Up Memo.
Routine updating of contact lists is an essential task. Use the debriefing process as an opportunity to improve this resource. Ensure routine updating by including it in regular protocols. Build reminders, such as online calendar prompts, into plans to update contact lists.

# Modifying Standard Operating Procedures (SOPs)

# Tip
Use the same approach for modifying SOPs after an exercise or an advisory. (See page 34).

# Call Center Data Collection Framework

# PURPOSE
This data framework provides an example of how to apply call center or customer service (CS) data to an evaluation.
The framework provides a more complete data set and includes measurements and goals. The framework approach can be used to evaluate other data from an advisory. This framework example uses specific goals and measurements for evaluation.

# DIRECTIONS
Adapt the framework to reflect water system data. The survey below will take about  minutes to complete. All information collected is confidential. We cannot identify who does or does not participate, or link answers to any one person.
We will use the results of this survey to .
For more information or if you have questions, please contact: Post-Advisory Community Survey 1. Which type of water do you prefer to drink? Please rank your preferences using a scale of 1-4, with 1 as the most preferred type and 4 as the least preferred.

# Debriefing Evaluation Form

# PURPOSE
This evaluation form can provide data to help evaluate an exercise, advisory, and debriefing. The information can be used to improve advisories, as well as to develop and evaluate future protocols and exercises.

# DIRECTIONS
Copy this form and give to the debriefing or exercise participants after the session. Ask them to complete the form before they leave. Collate the results and use them to evaluate the debriefing, advisory, or exercise. The form can also be used as an informal discussion guide for debriefings and exercises. Coliphage: A virus that infects bacteria is called a phage. Phages infect specific species of bacteria. Coliphages infect coliform bacteria. Coliphages do not infect humans or cause illness. A positive test for coliphages indicates the water may be contaminated with feces or E. coli.
Consecutive system: A water system that purchases its water supply from another water system.
Contaminant: An unwanted and/or undesirable chemical or microbe found in drinking water.
Corrective Action: The activities taken by a water system to fix an identified deficiency.

# Crisis communication:
A communication approach that relays the risks and benefits of different actions to agencies, consumers, and other stakeholders during an emergency or disaster.
Critical customer: Customers that receive priority notification during a drinking water advisory.
CS: Customer service.

# D
Drinking Water Advisory: Water systems and state or local agencies issue drinking water advisories when they believe water quality is or may be compromised. Advisories tell individuals, schools, hospitals, businesses, and others about the situation and how to take immediate action.
Debriefing: An informal, semi-structured discussion with stakeholders, partners, and other participants, after an advisory, exercise, or event, used to obtain useful information and improve or enhance operations.
Do Not Drink advisory: Communication to customers of a water system to avoid tap water and to use other sources of water for human consumption. A Do Not Drink advisory is used if boiling the water will not kill, inactivate, or remove the contaminant of concern, or if boiling would concentrate or release it into the air. Do Not Use advisory: Communication to customers of a water system not to use tap water for any purpose, including sanitation and fire protection.

# E Escherichia coli (E. coli):
A species of fecal coliform bacteria. E. coli almost always comes from animal feces. E. coli is considered the best indicator of fecal water contamination. If E. coli is present, harmful bacteria or other pathogens may also be present in the water. Some rare types of E. coli, such as O157:H7, can cause serious illness.
EPA: U.S. Environmental Protection Agency.