| #Q001 | administrative | operational | recommended | Establish Incident Response Team | drinking water | Consequently, 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 | Decision Criteria for Advisories | 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 |
| #Q003 | administrative | operational | recommended | Corrective Action and Rescission Procedures | drinking water | Similarly, the procedures concerning corrective actions and the criteria required in order to rescind an advisory should be established in advance. | | high |
| #Q004 | administrative | reporting | recommended | Emergency Communications Lists | drinking water | The incident response team should prepare, and regularly update, contact lists, in order to ensure timely communication. | | high |
| #Q005 | reporting | reporting | recommended | Public Instruction Delivery | drinking water | It is important that detailed instructions be provided to the general public, as well as specific target groups, including those working with and/or in contact with vulnerable/immunocompromised individuals. | | high |
| #Q006 | reporting | reporting | recommended | Use Multiple Communications Mechanisms | drinking water | 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, and the urgency of the situation | | high |
| #Q007 | administrative | reporting | recommended | Preparation of Template Messages | drinking water | Template messages should be prepared in advance in order to avoid delays. Messages should be clear and easily understood, identifying the reasons for the advisory, precise and detailed actions required of consumers during the advisory and where to seek additional or updated information. | | high |
| #Q008 | reporting | reporting | mandatory | Localized Advisory Communications | drinking water | In the case where a large utility has a localized boilwater advisory, it is critical that residents of the affected area be identified and the precise location of the affected sector be clearly communicated. Messages should be formatted and translated for specific audiences (i.e., key languages in the area, visually impaired). | When a large utility has a localized boilwater advisory | high |
| #Q009 | administrative | reporting | recommended | Manage Public Inquiries | drinking water | An increase in inquiries from the public should be anticipated and a strategy for managing communications should be established. | | high |
| #Q010 | administrative | operational | recommended | Protocol Review and Stakeholder Consultation | drinking water | The incident response team should also review their procedures on an ongoing basis and consult/inform stakeholders, as appropriate. | | high |
| #Q011 | corrective_action | health | recommended | E. coli Emergency Advisory Issuance | 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 in drinking water | high |
| #Q012 | corrective_action | health | recommended | Treatment Failure Emergency Advisory | drinking water | Since significant treatment failures, such as a loss of primary disinfection or where treatment is overwhelmed by major changes in water quality, can result in the presence of pathogenic microorganisms in drinking water, they should also lead to the issuance of an emergency boil water advisory. | Significant treatment failures | high |
| #Q013 | monitoring | health | mandatory | Precautionary Advisory Risk Assessment | drinking water | These situations 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. | Situations that may prompt a precautionary boil water advisory | high |
| #Q014 | administrative | health | mandatory | Advisory Risk-Benefit Assessment | drinking water | The decision to issue an advisory will need to weigh the risks mitigated by the advisory with the potential negative impacts of the advisory. | | high |
| #Q015 | reporting | reporting | recommended | Elements of 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 faecal contaminant level(s); When the situation occurred; Any potential adverse health effects from drinking the water (e.g., diarrhea); Area(s) and population(s) 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, while indicating that the advisory is in place until the public is notified otherwise; 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 |
| #Q016 | operational | health | mandatory | Mandatory Boiling for Specific Uses | 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 |
| #Q017 | corrective_action | health | recommended | Disposal of Potentially Contaminated Prepared 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 |
| #Q018 | operational | health | recommended | Boiling 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 |
| #Q019 | reporting | health | recommended | Advice for Immunocompromised Individuals | drinking water | 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 |
| #Q020 | operational | treatment | recommended | High Elevation Boiling Protocol | 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 |
| #Q021 | operational | health | recommended | Sponge Bathing for Vulnerable Groups | drinking water | Adults, adolescents, and older children may shower, bathe, or wash using tap water, but should avoid swallowing the water. Infants, toddlers and immunocompromised individuals should be sponge bathed in order to reduce the chance of them swallowing the water. | During a boil water advisory | high |
| #Q022 | operational | health | recommended | Outbreak Handwashing Disinfection Method | drinking water | The preferred method for disinfecting hands during a known waterborne 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 |
| #Q023 | operational | health | recommended | Manual Dishwashing Disinfection Method | 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 situation | high |
| #Q024 | reporting | reporting | recommended | Long-Term Advisory Reminders | 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. | In the case of long-term advisories | high |
| #Q025 | administrative | operational | recommended | Criteria for Rescinding Advisory | 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 |
| #Q026 | reporting | reporting | recommended | Rescission Communication Reach | drinking water | 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 |
| #Q027 | reporting | reporting | recommended | Rescission Notice Highlights | 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 |
| #Q028 | administrative | operational | recommended | Post-Advisory 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 |
| #Q029 | corrective_action | health | recommended | Multiple Site E. coli Detection Advisory | 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 scale systems: E. coli detected at multiple sites during routine sampling | high |
| #Q030 | monitoring | health | recommended | Single Site E. coli Detection Re-sampling | 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 scale systems: Single site is positive for E. coli | high |
| #Q031 | corrective_action | health | recommended | Advisory on E. coli Positive Re-sample | 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 scale systems: Any re-sampled site is positive for E. coli | high |
| #Q032 | monitoring | health | recommended | Second Re-sampling on Negative First Re-sample | 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 scale systems: First re-sampled site was negative for E. coli and total coliforms | high |
| #Q033 | monitoring | health | recommended | Total Coliform Routine Re-sampling | drinking water | 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 scale systems: Routine sample positive for total coliforms, absence of E. coli | high |
| #Q034 | corrective_action | health | recommended | Corrective Action for Total Coliform Re-sample Positive | 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 scale systems: Total coliforms detected in re-sampled sites, absence of E. coli | high |
| #Q035 | corrective_action | health | recommended | Post-Advisory Investigation | 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. | Municipal scale systems: After issuing boil water advisory | high |
| #Q036 | administrative | health | recommended | Rescind Advisory After Negative Re-sampling | drinking water | If the second re-sampling is negative for E. coli, the water is considered safe and the recommended action is to rescind the boil water advisory in consultation with the responsible authorities, and to then continue with routine sampling. | Municipal scale systems: Second re-sampling is negative for E. coli | high |
| #Q037 | corrective_action | health | recommended | Residential E. coli Advisory | 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: E. coli detected during routine sampling | high |
| #Q038 | monitoring | health | recommended | Residential Total Coliform Re-sampling | drinking water | 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: Total coliform positive in absence of E. coli | high |
| #Q039 | corrective_action | health | recommended | Residential Total Coliform Re-sample Action | 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 a waterborne 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: Total coliforms detected in re-sampled sites, absence of E. coli | high |
| #Q040 | administrative | 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 |
| #Q041 | operational | health | guidance | Boiled Water for Pets During Outbreaks | drinking water | As a precaution, it is advisable to provide pets with boiled water (that has been cooled) during a waterborne outbreak, as they can carry waterborne pathogens and transmit them to humans (CDC, 1997). | During a waterborne outbreak | high |
| #Q042 | administrative | health | recommended | Rescinding Advisories for Waterborne Outbreaks | drinking water | if an advisory was issued on evidence of a waterborne outbreak : 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. | If an advisory was issued on evidence of a waterborne outbreak | high |
| #Q043 | reporting | reporting | guidance | Advisory Notices for Fountains and Schools | drinking water | In such instances [where boiling is not possible], 'do not use' or 'do not consume' notices may be used. | Where boiling water is not possible or practical, for example, in schools or at public drinking water fountains | high |
| #Q044 | 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 |
| #Q045 | administrative | operational | recommended | Personnel Pre-planning | drinking water | Roles, responsibilities, capacity and scheduling of personnel should also be pre-planned. | | high |
| #Q046 | operational | treatment | guidance | Microwave Boiling Stir Stick | 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) that may explode when bumped or otherwise disturbed. | If water is boiled in a microwave oven | high |
| #Q047 | operational | treatment | recommended | Boiled Water Cooling and Storage | drinking water | The water should then be cooled and poured into a clean container with a cover and refrigerated until needed. | After boiling water for consumption | high |
| #Q048 | operational | health | recommended | Outbreak Laundry Procedure | drinking water | Wash laundry with detergent in hot water at the maximum cycle length, and then machine (hot air) dry | During a waterborne outbreak situation | high |
| #Q049 | operational | health | recommended | Outbreak Automatic Dishwashing | drinking water | Use dishwasher that uses hot water (final rinse temperature of at least 65oC) or has a sanitizing cycle | During a waterborne outbreak situation | high |
| #Q050 | operational | health | recommended | Outbreak Bathing Restriction | drinking water | Sponge bathe only | During a waterborne outbreak situation | high |
| #Q051 | administrative | operational | recommended | Review of Precautionary Advisory Rationale | drinking water | Given that these two parameters [total coliforms and turbidity] are not, in themselves, indicative of an an increased human health risk, these boil water advisories are considered precautionary in nature; the rationale for their issuance should be subject to regular review, in order to determine whether they have served a public health purpose | When advisories are issued based on total coliforms or turbidity | high |
| #Q052 | administrative | operational | recommended | Addressing Barriers for Long-Term Upgrades | 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 long-term upgrades | high |
| #Q053 | monitoring | health | recommended | Bacteriological Rescission Testing | drinking water | as soon as at least two consecutive sets of bacteriological samples, collected a minimum of 24 hours apart, produce negative results. | If the advisory was issued on evidence of bacteriological water quality conditions | high |
| #Q054 | corrective_action | health | recommended | Operational Rescission Verification | drinking water | 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, and has been confirmed through bacteriological water quality testing. | If the advisory was issued on evidence of operational conditions | high |
| #Q055 | administrative | operational | mandatory | Private System Water Quality 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 systems | high |