About this form
Environmental health practitioners with experience working on individual wells can use this form to quickly assess damage and risk to the well and water infrastructure.
Practitioners can also use this form—along with water quality sampling information—to help homeowners or business owners take action to repair damage to the well and water system infrastructure and keep their water safe.
This is not a comprehensive well assessment form.
Learn about threats to well water after a wildfire and potential solutions to common problems.