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CrossConnection and Backflow Prevention Inspection Report SECTION I (to be completed by Business×Property Owner): please print Business Name: Telephone: Mailing Address: Email: Owners Name: Telephone:
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Crossconnection and backflow prevention is a method to protect potable water supplies from contamination or pollution.
Businesses, industries, and facilities that have potential crossconnections are required to file crossconnection and backflow prevention plans.
Crossconnection and backflow prevention plans can be filled out by assessing potential crossconnections, installing backflow prevention devices, and providing documentation to the relevant authorities.
The purpose of crossconnection and backflow prevention is to ensure the safety of potable water supplies and prevent contamination or pollution.
Information such as potential crossconnections, backflow prevention devices, and maintenance schedules must be reported on crossconnection and backflow prevention plans.
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