Get the free Backflow Maintenance Report - Town of Madison

TOWN OF MADISON PUBLIC WORKS DEPARTMENT Maintenance Report Cross Connection Control Devices Name of Premise: Street Address: Location of Device: Type of Device: RP DC PUB Size: Manufacturer: Model

How to fill out backflow maintenance report

How to fill out a backflow maintenance report:

1. Begin by gathering all necessary information, such as the date of the backflow device inspection, the device number, and the location of the device.
2. Start the report by entering the contact information of the person responsible for the backflow device, including their name, address, and contact number.
3. Fill in the details of the inspection, such as the make and model of the backflow device, the serial number, and the type of backflow preventer used.
4. Provide a detailed description of the inspection process, including any testing or maintenance performed on the backflow device. This should include information on any repairs or replacements made, as well as the results of any pressure tests or flow tests conducted.
5. If any issues were discovered during the inspection, make sure to document them accurately and provide recommendations for necessary repairs or further testing.
6. Finally, sign and date the report, and ensure that it is submitted to the appropriate authorities or individuals who require it.

Who needs a backflow maintenance report:

1. Municipalities and water utility companies often require backflow maintenance reports to ensure that water systems are properly maintained and protected from potential contamination.
2. Property owners or managers may also require a backflow maintenance report as part of their routine maintenance and compliance with local codes and regulations.
3. Certified backflow testers and maintenance professionals are responsible for completing and submitting the backflow maintenance report after conducting the necessary inspections and repairs.

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What is backflow maintenance report?

Backflow maintenance report is a document that records the regular maintenance and testing of backflow prevention devices to ensure they are functioning properly.

Who is required to file backflow maintenance report?

Property owners or managers who have backflow prevention devices installed on their property are required to file backflow maintenance reports.

How to fill out backflow maintenance report?

To fill out a backflow maintenance report, one must record the date of maintenance/testing, results of the test, any repairs or adjustments made, and the signature of the certified tester.

What is the purpose of backflow maintenance report?

The purpose of the backflow maintenance report is to ensure that backflow prevention devices are being properly maintained and tested to protect the potable water supply from contamination.

What information must be reported on backflow maintenance report?

The backflow maintenance report must include the date of maintenance/testing, results of the test, any repairs or adjustments made, and the signature of the certified tester.