Get the free Backflow Test Form

This form is used to submit backflow test results, including detailed device information, location information, test results, and tester certification. It must be completed by a qualified tester with current MDNR certification within 30 days of the test results.

How to fill out backflow test form

How to fill out backflow test form

1. Obtain the backflow test form from your local water authority or testing service.
2. Fill in the date of the test at the top of the form.
3. Enter the address of the property where the backflow device is located.
4. Provide the name and contact information of the property owner.
5. Indicate the type of backflow prevention device being tested.
6. Enter the serial number of the backflow device.
7. Record the test results for each check performed, including the initial and final readings.
8. Include any additional notes or comments regarding the condition of the device.
9. Sign and date the form at the bottom to certify the accuracy of the information provided.
10. Submit the completed form to the relevant authority or keep it for your records as per local regulations.

Who needs backflow test form?

1. Property owners with water supply systems that include backflow prevention devices.
2. Businesses that have irrigation systems, pool fill lines, or any commercial water supply systems.
3. Plumbers and water quality professionals who install or maintain backflow prevention devices.
4. Local municipalities which require compliance with health and safety regulations.

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What is backflow test form?

A backflow test form is a document used to record the results of a backflow prevention device test, ensuring that drinking water supplies are protected from contamination.

Who is required to file backflow test form?

Property owners or managers of facilities that have backflow prevention devices installed are required to file backflow test forms.

How to fill out backflow test form?

To fill out a backflow test form, you need to provide details such as the property address, type of backflow preventer, test results, tester's name, and certification number.

What is the purpose of backflow test form?

The purpose of the backflow test form is to ensure compliance with local regulations and to verify that backflow prevention devices are functioning properly to protect public water supply.

What information must be reported on backflow test form?

Information that must be reported includes device identification, test results, the date of testing, tester's credentials, and any repairs made.