| #Q001 | administrative | operational | recommended | Establish Incident Response Team | drinking water | an incident response team should be established before an incident occurs, to enable a quick response to any drinking water-related event that has had or may have an effect on drinking water quality or public health. | Before an incident occurs | high |
| #Q002 | administrative | operational | recommended | Incident Response Team Composition | drinking water | Incident response team members should include professionals responsible for source water protection, treatment plant operation and water distribution, water quality monitoring, regulation of drinking water, and public health surveillance as well as communication specialists. | | high |
| #Q003 | administrative | operational | recommended | Criteria for Issuing Boil Water Advisory | drinking water | In making the decision to do so, the team should have established criteria in place to assess risks and determine whether a boil water advisory should be issued, taking into account site specific considerations and information. | | high |
| #Q004 | administrative | operational | recommended | Procedures for Corrective Actions and Rescission | drinking water | Similarly, the procedures concerning corrective actions and the criteria required in order to rescind an advisory should be established in advance. | | high |
| #Q005 | reporting | health | recommended | Detailed Instructions for Public and Target Groups | drinking water | It is important that detailed instructions be provided to the general public, as well as specific target groups. | During incident response communication | high |
| #Q006 | reporting | reporting | recommended | Communication Mechanisms | drinking water | When issuing and rescinding boil water advisories, it is important that messages reach all affected consumers. Thus, a variety of communications mechanisms should be used and may include social media sites, radio, newspapers, television and door- to-door canvassing, depending on the size and characteristics of the community. | When issuing and rescinding boil water advisories | high |
| #Q007 | reporting | reporting | recommended | Message Development and Clarity | drinking water | The procedures for developing messages should be established in advance in order to avoid delays. Messages should be clear and easily understood, identifying the reasons for the advisory, actions required of consumers during the advisory and where to seek additional or updated information. | | high |
| #Q008 | administrative | operational | recommended | Communication Management Strategy | drinking water | An increase in inquiries should be anticipated and a strategy for managing communications should be established. | | high |
| #Q009 | administrative | operational | recommended | Ongoing Review of Procedures | drinking water | The incident response team should also review their procedures on an ongoing basis and consult/inform stakeholders, as appropriate. | | high |
| #Q010 | operational | operational | recommended | Continuous Training for Response Team | drinking water | Incident response team members should have access to continuous training in order to ensure they are competent to fulfill their specific roles and responsibilities during a boil water advisory. | | high |
| #Q011 | operational | health | recommended | Emergency BWA for Confirmed E. coli | drinking water | Emergency boil water advisories should be issued in response to the confirmed detection of Escherichia coli (E. coli) in drinking water. | Confirmed detection of E. coli | high |
| #Q012 | operational | health | recommended | Immediate Issuance of Emergency BWA for E. coli | drinking water | If the presence of E. coli is confirmed in drinking water, an emergency boil water advisory should be issued immediately. | Confirmed detection of E. coli | high |
| #Q013 | operational | health | recommended | Emergency BWA for Treatment Failures | drinking water | Since treatment failures, such as a loss of primary disinfection, can result in the presence of pathogenic microorganisms in drinking water, they should also lead to the issuance of an emergency boil water advisory. | Treatment failures, such as loss of primary disinfection | high |
| #Q014 | operational | health | mandatory | Emergency BWA for Epidemiological Evidence | drinking water | Emergency boil water advisories are also required in situations where epidemiological evidence indicates that the drinking water is or may be responsible for an outbreak of illness. | Epidemiological evidence indicates water may be responsible for outbreak | high |
| #Q015 | operational | health | mandatory | Precautionary BWA Assessment | drinking water | These situations [precautionary boil water advisories] need to be assessed on a case-by-case basis, and require the incident response team to conduct an investigation and site-specific risk assessment. | When circumstances prompt consideration of a precautionary BWA | high |
| #Q016 | reporting | reporting | recommended | Contents of Boil Water Advisory Notice | drinking water | Advisory notices should be clear and understandable to the general public, and include the following elements (CDC, 2013):
* Description of the situation, the reason for the advisory, including contaminant(s) of concern and the contaminant level(s);
* When the situation occurred;
* Any potential adverse health effects from drinking the water (e.g., diarrhea);
* Population affected, including subpopulations that may be particularly vulnerable if exposed to the contaminant in their drinking water;
* Specific guidance on how to boil water, whether alternate water supplies should be used and, if so, recommended sources;
* Other actions consumers should take, including when they should seek medical help, if known;
* What the water system authority is doing to correct the situation;
* When the water system authority expects to resolve the situation;
* A central point of contact for additional information and where to seek updates as they become available; and
* A statement encouraging the notice recipients to share the notice with other persons, communicate with neighbours and check on isolated or vulnerable individuals, where applicable. | | high |
| #Q017 | operational | health | mandatory | Mandatory Boiling of Water | drinking water | All water used for drinking; preparing food, hot and cold beverages and ice cubes; washing fruits and vegetables; and dental hygiene must be boiled. | During a boil water advisory | high |
| #Q018 | corrective_action | health | recommended | Discarding Contaminated Items | drinking water | Any ice cubes, beverages or uncooked foods that have been prepared using possibly contaminated tap water should be thrown out. | During a boil water advisory | high |
| #Q019 | operational | health | recommended | Boiling Water for Infant Formulas | drinking water | Water should be boiled at all times when preparing infant formulas (Health Canada, 2012b). | During a boil water advisory | high |
| #Q020 | reporting | health | recommended | Advice for Immunocompromised Individuals | drinking water | Severely immunocompromised individuals should also be advised to discuss potential risks and remedial measures (such as always boiling tap water) with their physicians. | During a boil water advisory | high |
| #Q021 | operational | health | recommended | Cooling and Storing Boiled Water | drinking water | The water should then be cooled and poured into a clean container with a cover and refrigerated until needed. | After boiling water during an advisory | high |
| #Q022 | operational | health | recommended | Boiling Water at High Elevations | drinking water | At elevations over 2000 m, water boils at a slightly lower temperature; it should be boiled for at least 2 minutes to ensure that all disease-causing microorganisms are inactivated. | At elevations over 2000 m | high |
| #Q023 | operational | health | recommended | Bathing Cautions | drinking water | Adults, adolescents, and older children may shower, bathe, or wash using tap water, but should avoid swallowing the water. | During a boil water advisory | high |
| #Q024 | operational | health | recommended | Bathing Toddlers and Infants | drinking water | Toddlers and infants should be sponge bathed in order to reduce the chance of them swallowing the water. | During a boil water advisory | high |
| #Q025 | reporting | health | guidance | Sponge Bathing Advice During Sewage Contamination | drinking water | If the source of contamination is known to be human sewage, local health authorities may advise the public to sponge bathe. | If the source of contamination is known to be human sewage | high |
| #Q026 | operational | health | recommended | Hand Dishwashing Instructions | drinking water | If dishes are washed by hand, they should be (1) washed and rinsed in hot tap water, then (2) soaked in a dilute solution of unscented household bleach (20 mL of unscented bleach in 10 L of water) for 1 minute and (3) left to air dry for a minimum of 4 hours (Robertson et al., 1992). | During a waterborne outbreak advisory | high |
| #Q027 | operational | health | recommended | Providing Pets with Boiled Water | drinking water | As a precaution, it is advisable to provide pets with boiled water (that has been cooled) during an outbreak, as they can carry waterborne pathogens and transmit them to humans (CDC, 1997). | During an outbreak advisory | high |
| #Q028 | reporting | reporting | recommended | Frequent Reminders for Long-term Advisories | drinking water | In the case of long-term advisories, it is recommended that frequent reminders be issued to the public about the boil water advisory. | Long-term advisories | high |
| #Q029 | administrative | operational | recommended | Criteria for Rescinding BWA | drinking water | Criteria for rescinding a boil water advisory should include the resolution of the contamination event that prompted the issuing of the advisory. | | high |
| #Q030 | reporting | reporting | recommended | Communication Strategy for Rescission | drinking water | When an advisory is rescinded, it is important that the communication strategy described in Section A.1 be followed. Messages noting that the advisory has been rescinded should be conveyed through all the same communication channels used when the advisory was first issued, ensuring that all affected groups are reached. | When an advisory is rescinded | high |
| #Q031 | reporting | reporting | recommended | Notices Content for Rescission | drinking water | The notices should highlight any remaining actions required of consumers, as well as where to seek additional information. | When an advisory is rescinded | high |
| #Q032 | administrative | operational | recommended | Post-Incident Protocol Review | drinking water | After rescinding an advisory, the incident response team should review and evaluate their boil water advisory protocol, in order to better understand and improve the process in the future. | After rescinding an advisory | high |
| #Q033 | operational | health | recommended | Action for E. coli at Multiple Sites (Municipal) | drinking water | if E. coli is detected at multiple sites during routine sampling, the recommended action is to issue a boil water advisory in consultation with the responsible authorities. | Municipal systems routine sampling | high |
| #Q034 | monitoring | health | recommended | Action for E. coli at Single Site (Municipal) | drinking water | If only a single site is positive for E. coli, the recommended action is the positive site and adjacent sites should undergo a first re-sampling for E. coli and total coliforms. | Municipal systems routine sampling | high |
| #Q035 | operational | health | recommended | Action for E. coli in Re-sampled Site (Municipal) | drinking water | If any re-sampled site is positive for E. coli, the recommended action is to issue a boil water advisory in consultation with the responsible authorities. | Municipal systems re-sampling | high |
| #Q036 | monitoring | health | recommended | Action for Negative First Re-sample (Municipal) | drinking water | If the re-sampled site was negative for E. coli and total coliforms, the recommended action is to carryout a second re-sampling at the positive site and at the adjacent sites. | Municipal systems re-sampling | high |
| #Q037 | operational | health | recommended | Action for E. coli in Second Re-sample (Municipal) | drinking water | If any of the second re-sampled sites are positive for E. coli, the recommended action is to issue a boil water advisory in consultation with the responsible authorities. | Municipal systems second re-sampling | high |
| #Q038 | monitoring | health | recommended | Action for Total Coliforms without E. coli (Municipal) | drinking water | if total coliforms are detected during the first or second re-sampling for E. coli, or, if a routine sample is positive for total coliforms, in the absence of E. coli, the recommended action is to re-sample the positive site and adjacent sites for E. coli and total coliforms | Municipal systems | high |
| #Q039 | monitoring | health | recommended | Action for Negative Total Coliform First Re-sample (Municipal) | drinking water | If the re-sampled sites are negative for both total coliforms and E. coli, the recommended action is the positive sites and the adjacent sites should undergo a second re-sampling for E. coli and total coliforms. | Municipal systems | high |
| #Q040 | corrective_action | health | recommended | Action for Total Coliform in Re-sample without E. coli (Municipal) | drinking water | If total coliforms are detected in any of the re-sampled sites, in the absence of E. coli, the recommended action is to investigate the source of the contamination, implement corrective actions, and then return to the top of the decision tree, to the box recommending the first re-sampling of the positive sites and adjacent sites | Municipal systems | high |
| #Q041 | corrective_action | health | recommended | Post-BWA Corrective Actions (Municipal) | drinking water | After issuing the boil water advisory, the recommended actions are to investigate the source of the contamination, implement corrective actions and undergo a first re-sampling of the positive sites and adjacent sites. | After issuing a BWA for municipal systems | high |
| #Q042 | operational | health | recommended | Action for E. coli Detection (Residential) | drinking water | if E. coli is detected during routine sampling the recommended action is to issue a boil water advisory in consultation with the responsible authorities | Residential scale systems | high |
| #Q043 | monitoring | health | recommended | Action for Total Coliforms without E. coli (Residential) | drinking water | The right hand side of the decision tree should be followed if a total coliform sample is positive in the absence of E. coli. For this decision route, the recommended action is to undergo a first re-sampling of the positive sites and at adjacent sites for E. coli and total coliforms | Residential scale systems | high |
| #Q044 | monitoring | health | recommended | Action for Negative First Re-sample (Residential) | drinking water | If the first re-sampled sites are negative for both total coliforms and E. coli, the recommended action is the positive sites and the adjacent sites should undergo a second re-sampling for E. coli and total coliforms. | Residential scale systems | high |
| #Q045 | corrective_action | health | recommended | Action for Total Coliforms in Re-sample without E. coli (Residential) | drinking water | If total coliforms are detected in any of the re-sampled sites, in the absence of E. coli, the recommended action depends on the extent of the contamination, the history of the system, the jurisdictional requirements and if there is an outbreak in progress... The recommendation can be to either investigate the source of the contamination, implement corrective actions, and carryout a first re-sampling of the positive sites and adjacent sites, or to issue a boil water advisory in consultation with the responsible authority. | Residential scale systems | high |
| #Q046 | corrective_action | health | recommended | Post-BWA Corrective Actions (Residential) | drinking water | In all instances where the decision route leads to issuing a boil water advisory, the recommended action is to then investigate the source of the contamination, implement corrective actions and undergo a first re-sampling of the positive sites and adjacent sites. | After issuing a BWA for residential scale systems | high |
| #Q047 | administrative | operational | recommended | Pre-planning Personnel Logistics | drinking water | Roles, responsibilities, capacity and scheduling of personnel should also be pre-planned. | | high |
| #Q048 | administrative | operational | guidance | Regional Incident Response Coordination | drinking water | Where it is not practical to have a local incident response team, the responsible authority may wish to establish such a team on a regional or other appropriate scale. | Where local team is not practical | high |
| #Q049 | operational | health | guideline | Microwave Boiling Safety Precautions | drinking water | If water is boiled in a microwave oven, it is advisable to include a glass rod or wooden or plastic stir stick in the container to prevent the formation of superheated water (water heated above its boiling point, without the formation of steam). | When boiling water in microwave oven | high |
| #Q050 | operational | health | recommended | Hand Hygiene Disinfection during Outbreak | drinking water | The preferred method for disinfecting hands during a known outbreak is to continue to use proper handwashing technique (using tap water), followed by the use of an alcohol-based hand gel disinfectant containing more than 60% alcohol, or rub hands with a 65-95 % alcohol solution (Kampf and Kramer, 2004). Alcohol-based disinfectant should be rubbed into all areas of the hands until hands are dry. Hands should not be towel dried. | During a known waterborne outbreak | high |
| #Q051 | operational | health | guideline | Dishwasher Sanitization Alternative | drinking water | Alternatively, dishwashers that use hot water (final rinse temperature of at least 65°C) or have a sanitizing cycle will disinfect dishes. | During waterborne outbreak | high |
| #Q052 | reporting | health | recommended | Outbreak Precaution Advisories | drinking water | In the event of a waterborne outbreak, it may be necessary to advise the public to take additional precautions for bathing, showering, handwashing and washing dishes. | In the event of a waterborne outbreak | high |
| #Q053 | monitoring | operational | recommended | Bacteriological Rescission Sampling | drinking water | Boil water advisories are usually rescinded: if the advisory was issued on evidence of bacteriological water quality conditions: as soon as at least two consecutive sets of bacteriological samples, collected a minimum of 24 hours apart, produce negative results. | When rescinding BWA issued for bacteriological reasons | high |
| #Q054 | operational | operational | recommended | Operational Resolution for Rescission | drinking water | Boil water advisories are usually rescinded: if the advisory was issued on evidence of operational conditions: when the treatment, distribution, or operational malfunction has been corrected and any remaining corrective actions have been completed in order to eliminate any contaminated water. | When rescinding BWA issued for operational reasons | high |
| #Q055 | administrative | health | recommended | Outbreak Rescission Surveillance Criteria | drinking water | In the case of an outbreak, the responsible authority should consider rescinding the advisories after the above conditions have been met and when surveillance indicates that the incidence of the illness in the community has returned to background levels. | When rescinding BWA during an outbreak | high |
| #Q056 | administrative | operational | mandatory | Private System Owner Responsibility | drinking water | The owners of private systems (e.g., an individual well serving a rural home) are responsible for the microbiological quality of water in the system. | Private/Residential scale water supplies | high |
| #Q057 | administrative | operational | recommended | Health Authority Advisory Role | drinking water | Nevertheless, health authorities should be able to provide advice on remedial actions, when necessary. | Private/Residential systems | high |
| #Q058 | operational | health | guidance | Total Coliform BWA Discretion (Residential) | drinking water | A boil water advisory may be issued based on a single TC positive result, if deemed necessary by the responsible authority. | Residential scale systems single total coliform detection | high |
| #Q059 | operational | health | guidance | Total Coliform BWA Discretion (Municipal) | drinking water | A boil water advisory may be issued based upon a total coliform, in the absence of E.coli, if deemed necessary by the responsible authority. | Municipal scale systems | high |
| #Q060 | operational | health | guidance | Discretionary BWA for Single Site Contamination (Municipal) | drinking water | A boil water advisory may be issued on a single site contamination if deemed necessary by the responsible authority. | Municipal scale systems | high |
| #Q061 | administrative | operational | recommended | Addressing Long-term System Barriers | drinking water | In cases where drinking water systems require longer term upgrades which are unattainable in the short-term, there may be broader political, social or economic barriers which should be characterised and addressed through effective collaboration, innovation and community engagement. | Systems requiring unattainable short-term upgrades | high |
| #Q062 | operational | health | guideline | Handwashing Technique during BWA | drinking water | Hands can continue to be washed using tap water and a proper handwashing technique that includes rubbing all parts of the hands with soap and water for a minimum of 20 seconds. | During a boil water advisory | high |
| #Q063 | reporting | operational | mandatory | Provision of Alternative Disinfection Directions | drinking water | In the event that boiling is not practical, the local public health or other responsible authority will be able to give directions for the disinfection of water or the use of an alternative supply known to be safe. | When boiling is not practical | high |
| #Q064 | monitoring | operational | recommended | Total Coliform Resampling Pathway (Municipal) | drinking water | If a total coliform positive sample is detected during resampling for E.coli, the decision route for detection of a total coliform positive sample, in the absence of E.coli, should be followed (right-hand side of decision tree). | Total coliform detected during E. coli resampling in municipal systems | high |