
Canada Annual Backflow Preventer Test Report - City of Chilliwack 2012 free printable template
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ANNUAL BACKFLOW PREVENTER TEST REPORT Facility Name: Address: Assembly Location: Test Date: Line Pressure: psi DIVA PBA PDA CDA Orientation: SPRINKLER BOILER IRRIGATION DOMESTIC Assembly Type: PBA
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How to fill out Canada Annual Backflow Preventer Test Report
01
Obtain the Canada Annual Backflow Preventer Test Report form from the appropriate regulatory body or your local municipality.
02
Fill in the date of the test at the top of the form.
03
Provide the name and contact information of the tester, including their certification number.
04
Enter the location of the backflow preventer, including the address and any identifying information.
05
Record the type and model of the backflow preventer being tested.
06
Document the results of the test, including pressure readings and any issues found.
07
Indicate if any repairs or maintenance were required, and if so, describe the actions taken.
08
Sign and date the report at the bottom by the tester.
09
Submit the completed report to the relevant authority or keep it on file for future reference.
Who needs Canada Annual Backflow Preventer Test Report?
01
Property owners with plumbing systems that have backflow preventers installed.
02
Businesses that have specific water systems requiring certified backflow prevention.
03
Municipalities to ensure compliance with local water safety regulations.
04
Licensed plumbers or backflow testers who perform annual testing.
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What is Canada Annual Backflow Preventer Test Report?
The Canada Annual Backflow Preventer Test Report is a document that certifies the testing of backflow preventer devices to ensure they are functioning properly and preventing contaminated water from flowing back into the potable water supply.
Who is required to file Canada Annual Backflow Preventer Test Report?
Property owners or managers who have backflow preventer devices installed are required to file the Canada Annual Backflow Preventer Test Report, typically through a certified tester.
How to fill out Canada Annual Backflow Preventer Test Report?
To fill out the report, certified testers must complete sections detailing the device's information, test results, and any repairs or maintenance performed, ensuring all data is accurate and compliant with local regulations.
What is the purpose of Canada Annual Backflow Preventer Test Report?
The purpose of the report is to document the operational status of backflow preventers, to ensure public health and safety by preventing contamination of the drinking water supply.
What information must be reported on Canada Annual Backflow Preventer Test Report?
The report must include information such as the location and type of the backflow device, the date of the test, the name of the tester, results of the test, and any corrective actions taken if the device failed.
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