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CROSSCONNECTION/BACKFLOW PREVENTION QUESTIONNAIRE If you are not sure of how to answer any of these questions or if you have concerns regarding this form please contact CrossConnection Control Specialist
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Start by reading the instructions provided with the cross-connection/backflow prevention questionnaire.
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Gather all the necessary information and documents that will be needed to fill out the questionnaire, such as water usage details and plumbing diagrams.
03
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Who needs cross-connectionbackflow prevention questionnaire?

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Any individual, business, or organization that has a plumbing system connected to a public water supply needs to fill out a cross-connection/backflow prevention questionnaire. This helps ensure that potential hazards or contaminants do not flow back into the public water system, thereby protecting the overall water quality and preventing any health risks.
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The cross-connectionbackflow prevention questionnaire is a form used to assess and prevent the risk of backflow in water systems.
Anyone responsible for a water system, such as a property owner or manager, is required to file the cross-connectionbackflow prevention questionnaire.
You can fill out the cross-connectionbackflow prevention questionnaire by providing detailed information about your water system and potential cross-connections.
The purpose of the cross-connectionbackflow prevention questionnaire is to identify potential risks of backflow and ensure that proper prevention measures are in place.
Information such as the type of water system, potential cross-connections, and backflow prevention devices must be reported on the cross-connectionbackflow prevention questionnaire.
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