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Fifty-six drinking water systems on First Nations reserves in Alberta, Canada were evaluated for their ability to protect public health. A detailed survey form was used during each site visit to collect information necessary for the public health evaluation of the water supply system from source water to the end consumer, based on a variety of potential risk factors. For the 56 water systems evaluated, 50 of the water supply systems were ranked as high risk, 5 were ranked as medium risk, and there was 1 low risk site. The numerical scores ranged from a low of 7.5 to a high of 92.5 out of 100.0, with a higher score representing a water system better equipped to supply water meeting the Guidelines for Canadian Drinking Water Quality. In addition to the unique cultural, political, social, and economic environment on First Nations reserves a major factor that made it difficult to comprehensively assess the level of potential risk at these sites was the lack of source water characterization for pathogens (especially protozoan parasites). A major challenge in these small communities was providing meaningful training to First Nations public works personnel in the context of their cultural beliefs so that they develop a feeling of responsibility and ownership in helping protect their community's health. Additionally, there were prevalent inadequacies in the bacteriological monitoring and testing programs on the reserves. Addressing these issues would allow for a better assessment of potential health risks on First Nation reserves in Alberta and allow these communities to better manage the risks to their drinking water systems on a continual basis. [ABSTRACT FROM AUTHOR]