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License#Annual Test & Maintenance Report for Backflow Prevention AssembliesClermont County Public Health Prevent. Promote. Protect. Facility Name: Assembly InformationFacility Address: Model:Make:Size:Type:Water
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How to fill out backflow test and maintenance

01
Start by locating the backflow prevention assembly. It is usually installed near the main water supply line.
02
Shut off the water supply to the backflow prevention assembly. This can usually be done by turning a valve located upstream of the assembly.
03
Open all the test cocks on the assembly. These are usually small valves located on top of the assembly.
04
Connect a differential pressure gauge to the test cocks. This gauge measures the pressure difference across the assembly.
05
Open the downstream test cock slowly and observe the pressure on the gauge. It should read zero or close to zero.
06
Close the downstream test cock and open the upstream test cock. Again, observe the pressure on the gauge. It should read the same as the previous test.
07
If the pressure readings are not zero or if they differ significantly, there may be a problem with the assembly. Consult a certified backflow prevention specialist for further assistance.
08
Once the testing is complete, close all the test cocks and remove the gauge.
09
Turn on the water supply to the backflow prevention assembly and check for any leaks or abnormalities in the water flow.
10
Document the test results and any necessary repairs or maintenance in a backflow test report.
11
Repeat this testing and maintenance procedure annually or as required by local regulations.

Who needs backflow test and maintenance?

01
Anyone who has a backflow prevention assembly installed in their plumbing system needs backflow test and maintenance.
02
This includes residential properties, commercial buildings, and industrial facilities that have a higher risk of cross-contamination between potable water and non-potable water sources.
03
Backflow test and maintenance are crucial to ensure the proper functioning of the assembly and prevent the contamination of drinking water.
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Backflow test and maintenance is the process of testing and maintaining devices that prevent contaminated water from flowing back into the public water supply.
Owners of commercial properties and certain residential properties are required to file backflow test and maintenance.
Backflow test and maintenance forms can be filled out by a certified backflow tester and submitted to the appropriate water authority.
The purpose of backflow test and maintenance is to ensure the safety and quality of the public water supply by preventing contamination.
The information reported on backflow test and maintenance forms typically includes the location of the backflow device, the results of the test, and any necessary maintenance or repairs.
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