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State of California—Health and Human Services Agency
California Department of Public Health

AFL 23-21
June 30, 2023

General Acute Care Hospitals

General Acute Care Hospital (GACH) Water Rationing Plan and Storage Requirements


​Al​l Facilities Letter (AFL) Summary

​This AFL announces GACH emergency water supply and planning requirements. GACHs must develop and submit a water rationing plan to the California Department of Health Care Access and Information’s (HCAI) Facilities Development Division (FDD) Seismic Compliance Unit (SCU) by January 1, 2024.


Pursuant to Title 24, Part 5 CPC section 615.4.1, GACHs are required to have on-site water supply sufficient to operate essential hospital utilities and equipment for 72-hours. GACHs water storage quantity is to be based on the water rationing plan, but must store no less than 50 gallons of water per licensed bed, per 24-hours (e.g., 150 gallons per bed for 72-hours) and must also have no less than a 5,000-gallon water storage tank. The emergency water tank must have fittings to allow for replenishment of the water supply from transportable water sources and a means to dispense water to portable containers if normal water supply becomes unavailable. The emergency water supply must be provided at adequate pressure.

GACHs are required to develop and submit a water rationing plan to HCAI. The water rationing plan will be used to compute a GACH's water storage capacity and is jointly approved by HCAI and the California Department of Public Health (CDPH).

Pursuant to Title 24 CPC section 727.1, GACHs are required to have on-site wastewater storage capacity sufficient for essential hospital utilities and equipment for 72 hours for water introduced into the sewer system. See the exception regarding hook-ups that allow for the use of transportable means of sewage and liquid waste disposal in lieu of on-site storage.

Water Rationing Plan Considerations

GACHs should review HCAI's A5 Advisory Guide for NPC-5 Water Rationing Plan (PDF) (guide) for guidance on what to include in their water rationing plan. The guide also provides water rationing plan submittal instructions and timeframe requirements. Although the guide does not provide a comprehensive list, it outlines commonly asked information by HCAI and CDPH. GACHs should consider including information on their facility's water usage, source of emergency water supply, and water quality in their water rationing plan.

Additionally, CDPH recommends GACHs consider existing requirements as it pertains to the use of water when developing a water rationing plan. Existing requirements include, but are not limited to:

  • Provisions for basic services such as medical, nursing, surgical, anesthesia, laboratory, radiology, pharmacy, and dietary services.
  • Provisions for supplemental services such as basic emergency services, intensive care, obstetrical, and hemodialysis
  • Infection control programs
  • Regulations for operating fixtures and equipment such as the following:
    • Air conditioning
    • Heaters/boilers
    • Autoclaves and sterilizers
    • Ventilation
    • Water heaters
    • Automatic fire suppression system
    • Toilets
    • Handwashing equipment/sinks
    • Bathing facilities
    • Medical gasses (water cooled)
    • Suction compressor (water cooled)

NOTE: Some hospital equipment such as medical gas equipment and suction compressors can be water cooled; however, not all suction compressors and medical gas equipment are water cooled. CDPH recommends GACHs indicate in their water rationing plan if specified equipment are water cooled or not. 

GACHs should also consider the following when developing their water rationing plans:

  • Cleaning of areas, fixtures, and articles
  • Testing the water supply at least every three months
  • Ensuring staff follow a hand hygiene program
  • Patient hygiene options such as bathing, showering, handwashing, and sponge bathing
  • Dietary service provides three meals daily
  • Adequate water is provided for patients
  • Ice is provided from sanitary source
  • Medications are available 24-hours per day, including IV bags and oral suspension medications

Water Rationing Plan Submission

Existing GACHs must submit water rationing plans as supplemental documentation along with an application (HCAI-FD-121) to HCAI's OSHPD Seismic Compliance Unit via email at by January 1, 2024. Instructions for submission can be found on the Application Process for the Seismic Compliance Unit webpage.

New hospital buildings must submit the plan electronically as part of the HCAI project application process through HCAI's eServices Portal. Additional instructions on the HCAI project application process can be found on the eServices Portal Information webpage.


CDPH recommends GACHs include a summary or table of contents as part of the water rationing plan. Additionally, CDPH recommends including the name of the GACH as it appears on the license, the HCAI facility number (1xxxx), address, and number of licensed beds as part of the water rationing plan.

In line with the Centers for Disease Control and Prevention's (CDC) Emergency Water Supply Planning Guide for Hospitals and Healthcare Facilities (PDF), CDPH also recommends GACHs conduct a water use audit as part of the water rationing plan. A water use audit will help GACHs determine their water use needs as part of emergency planning.

GACHs should consult with applicable staff and experts during the development of the water rationing plan. Staff and experts may include medical, nursing, surgical, pharmaceutical, dietetic, administrative, infection prevention, facilities, and operations staff. CDPH also recommends GACHs contact their local health department and county agencies regarding more stringent water quality and testing requirements. Emergency conditions does not preclude a GACH from continuing to comply with federal, state, and local laws and regulations.


If you have any questions about construction requirements, tank installation, or submitting your water rationing plan, please contact HCAI's SCU via email at

For questions regarding GACH regulatory requirements, please contact your local district office.



Original signed by Cassie Dunham

Cassie Dunham

Deputy Director



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