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BACKFLOW ASSEMBLY TEST REPORTED EXISTING REPLACEMENTPREMISE OWNER: MAILING ADDRESS:PHONE:CITY: ASSEMBLY ADDRESS:STATEASSEMBLY TYPE:ASSEMBLY LOCATION:MAKE: WATER PURVEYOR:MODEL:SIZE: SERIAL NUMBER:REDUCED

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How to fill out backflow assembly test report

01

Gather necessary equipment: backflow assembly test kit, test gauges, and appropriate tools.

02

Turn off the water supply to the backflow assembly.

03

Attach the test gauges to the test cocks on the backflow assembly.

04

Open and close the test cocks in the appropriate sequence to perform the test.

05

Record the pressure readings at each test point on the backflow assembly test report form.

06

Compare the readings to the acceptable range specified by local regulations.

07

Fill out the backflow assembly test report form with the test results and any necessary information.

08

Submit the completed backflow assembly test report to the appropriate regulatory authority.

Who needs backflow assembly test report?

01

Plumbers

02

Building maintenance personnel

03

Water utility companies

04

Health departments

05

Regulatory authorities

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What is backflow assembly test report?

A backflow assembly test report is a document that verifies that a backflow prevention assembly has been tested to ensure it is functioning correctly and preventing backflow in a water distribution system.

Who is required to file backflow assembly test report?

Typically, certified testers or licensed professionals contracted by property owners or water utilities are required to file backflow assembly test reports.

How to fill out backflow assembly test report?

To fill out a backflow assembly test report, one must provide details such as the type of assembly, test results, date of testing, tester's name and certification, and any necessary remarks regarding the assembly's performance.

What is the purpose of backflow assembly test report?

The purpose of the backflow assembly test report is to ensure that backflow prevention devices are working properly to protect public drinking water supply from contamination.

What information must be reported on backflow assembly test report?

The report must include the type of backflow assembly, model and serial number, test results including any failures, the date of the test, name and certification number of the tester, and any corrective actions taken if necessary.

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