Following a radioactive fallout event, there are a number of possible intervention measures to reduce radioactive doses to the public via the surface water pathway. We have critically reviewed the options available to decision-makers in the event of radioactive contamination of surface waters. We believe that the most effective and viable measures to reduce radioactivity in drinking water are those which operate at the water treatment and distribution stage. Intervention measures to reduce concentrations of radioactivity in rivers and reservoirs are expected to be much less viable and efficient at reducing doses via the drinking water pathway. Bans on consumption of freshwater fish can be effective, but there are few viable measures to reduce radioactivity in fish prior to the preparation stage. Lake liming and biomanipulation have been found to be ineffective for radiocaesium, although the addition of potassium to lakewaters appears promising in some situations. Lake liming may be effective in reducing radiostrontium in fish, though this has not, to our knowledge, been tested. De-boning fish contaminated by strontium is probably the most effective food preparation measure, but salting and freezing can also reduce radiocaesium concentrations in fish. The provision of accurate information to the public is highlighted as a key element of countermeasure implementation.