Canada Annual Backflow Preventer Test Report - City of Chilliwack 2023-2025 free printable template
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ANNUAL BACKFLOW PREVENTER TEST REPORT
Facility Name: ___
Address: ___
Assembly Location: ___
Line Pressure: ___ psiTest Date: ___ DCVA PVBA RPDA DCDA Orientation:
SPRINKLER
BOILER
IRRIGATION
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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 authority or website.
02
Enter the date of the test at the top of the report.
03
Fill in the name and contact information of the property owner.
04
Provide the address of the installation site.
05
Specify the type of backflow prevention device being tested.
06
Record the model and serial number of the device.
07
Document the results of the test, including any pressures indicated.
08
Note any repairs or maintenance performed on the device during the test.
09
Include the name and credentials of the certified tester completing the report.
10
Sign and date the report to validate the test results.
Who needs Canada Annual Backflow Preventer Test Report?
01
Property owners with backflow prevention devices installed.
02
Plumbers or certified testers conducting the backflow tests.
03
Local municipalities or regulatory bodies requiring compliance documentation.
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What is Canada Annual Backflow Preventer Test Report?
The Canada Annual Backflow Preventer Test Report is a document used to certify that backflow prevention devices installed in plumbing systems are functioning properly and have been tested according to regulations.
Who is required to file Canada Annual Backflow Preventer Test Report?
Property owners or managers who have backflow prevention devices installed are required to file the Canada Annual Backflow Preventer Test Report to ensure compliance with local regulations.
How to fill out Canada Annual Backflow Preventer Test Report?
To fill out the Canada Annual Backflow Preventer Test Report, the tester must provide information such as the property address, type of device, test results, technician's name, and signature, along with any additional notes as necessary.
What is the purpose of Canada Annual Backflow Preventer Test Report?
The purpose of the Canada Annual Backflow Preventer Test Report is to ensure that backflow prevention devices are functioning correctly, preventing contaminated water from entering the potable water supply, thereby protecting public health.
What information must be reported on Canada Annual Backflow Preventer Test Report?
The report must include details such as the type of backflow prevention device, test results (pass/fail), date of testing, technician's credentials, and information about any repairs or maintenance performed on the device.
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