Access to safe drinking water is a global health issue that impacts populations worldwide and is of particular concern in the rural areas of under- and moderately-developed countries. A “health and drinking water” survey was piloted in a rural community of southeast Brazil where water quality issues and diarrheal and intestinal health problems are a primary concern. Partners in this community-based participatory research (CBPR) study included Brazilian public health officials and community volunteers in the local area of interest and a group of American health researchers and students who regularly work in this area. The survey instrument included questions commonly used by the World Health Organization and the World Bank to measure self-reported drinking water access and safety. A brief health history section created by the research team was also included in the instrument. Back translation and a pre-test for readability were used to develop the needed Portuguese-language version. The instrument was piloted by a Brazilian public health educator and four community volunteers who surveyed 42 heads of households (representing 174 residents) in the rural community of Emboacica, Espirito Santo, BRAZIL. Reported drinking water sources were predominantly private (52%) and public (38%) wells. Only 1 (2%) respondent indicated a “river, stream or lake” as the family's source for drinking water and the remaining respondents (8%) did not answer or were unsure. Despite uncertainty among local public health partners about drinking water safety in the area, 76% of respondents believed their drinking water was safe to use without treatment, 48% used a simple filter system known to be inadequate for full protection, and 40% reported using no treatment at all. Yet, in response to health history questions, 21% of these heads of households reported that at least one family member had experienced significant diarrhea or other intestinal problems within the previous year. In follow-up discussions, the CBPR partners highlighted the apparent confusion among respondents about drinking water sources and safety and made plans for future research to verify and test water sources and educate area residents about safe drinking water practices.Keyword(s): community-based programs, international issues, research