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Cross Connection Questionnaire Form 

Please notify ELCO if any of the above conditions change on your property such as remodeling, changes or additions to your water piping system.
Confirm e-Signature
Read our Electronic Record and Signature Disclosure
Streamline Verify

Please answer all of the above questions and return the questionnaire within 30 days. This form will be kept on file at ELCO. If you have any questions please call us at 970-493-2044 ext. 316.

Please return survey report form to: Alex Ainsworth, ELCO, 232 S Link Ln Fort Collins, CO 80524

Per District policy, failure to comply with backflow questionnaires and/or on site surveys, can result in termination of water services.
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If Attachment 1 was neccesary for you to fill out, please email it to 

If you are having issues with the online form, please ensure you are answering all required questions.

If you are still having issues, or would like a paper copy, please download a copy of the Cross Connection Survey below to drop by our office at 232 S Link Ln Fort Collins, CO 80524, mail to PO BOX 2044 FORT COLLINS, CO 80522, or scan and email to

Download a copy of the Cross Connection Survey here.