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Print Form Brunswick Regional Water and Sewer CROSS CONNECTION CONTROL & BACKFLOW PREVENTION DEVICE TEST AND MAINTENANCE REPORT CUSTOMER: STREET ADDRESS: LOCATIONS OF ASSEMBLY: RP (DA) TYPE OF ASSEMBLY:

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How to fill out backflow test sheet

How to fill out a backflow test sheet:

01

Begin by filling in the date and time of the test at the top of the sheet. This will serve as a reference for future use.

02

Indicate the location of the backflow device for which the test is being conducted. This information helps to keep track of multiple devices in different locations.

03

Fill in the device make and model, as well as the serial number. This information is important for proper identification and maintenance purposes.

04

Provide the tester's name and contact information. This ensures that the responsible person for the test can be easily reached if any questions or issues arise.

05

Note the devices or components that were tested. This could include check valves, vacuum breakers, or pressure regulators, among others. Make sure to specify the specific make and model.

06

Include the results of the test, indicating whether the device passed or failed. If it failed, note any defects or issues that were identified during the test.

07

Sign and date the test sheet to certify its accuracy and completion.

08

Keep a copy of the filled-out test sheet for your records and provide a copy to the appropriate authorities or organizations, as required.

Who needs a backflow test sheet?

01

Property owners/managers: It is important for property owners or managers to have backflow test sheets as part of their regular maintenance records. These sheets provide evidence that the necessary testing has been conducted to ensure the safety of the water supply.

02

Plumbers or certified backflow testers: Plumbers or certified backflow testers are responsible for conducting the tests on backflow prevention devices. They need the test sheets to record the results and ensure that proper maintenance and repairs are done if necessary.

03

Regulatory agencies: Government or regulatory agencies that oversee water supply and safety may request copies of backflow test sheets to ensure compliance with backflow prevention regulations. These sheets provide a documented history of testing to ensure the protection of the water supply.

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What is backflow test sheet?

Backflow test sheet is a form used to record the testing and results of backflow prevention devices to ensure the safety of drinking water.

Who is required to file backflow test sheet?

Property owners, facility managers, and water utility providers are required to file backflow test sheets.

How to fill out backflow test sheet?

Backflow test sheets should be filled out by a certified backflow tester who will test the backflow prevention devices and record the results.

What is the purpose of backflow test sheet?

The purpose of backflow test sheets is to ensure that backflow prevention devices are functioning properly and protecting the drinking water supply from contamination.

What information must be reported on backflow test sheet?

The backflow test sheet should include details of the backflow prevention devices tested, test results, tester information, and date of testing.

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