Get the free Backflow Assembly Test Report Form - City of Bellingham, WA - cob

NAME/COMPANY: SERVICEADDRESS: LOCATIONOFASSEMBLY: CROSSCONNECTIONFOR: ASSEMBLYINFORMATION: MAKE CityofBellingham 2221PacificSt BellinghamWA98229 Backflow cob.org MODEL INITIALTESTRESULTS New E

How to fill out backflow assembly test report

How to fill out backflow assembly test report:

1. Start by entering the date of the test at the top of the report.
2. Next, provide the location of the backflow assembly being tested. Include the address and any relevant details.
3. Identify the tester by including their name, contact information, and any relevant certifications or licenses.
4. Record the make, model, size, and serial number of the backflow assembly being tested.
5. Conduct the necessary tests on the assembly, such as the forward flow test, the backward flow test, and the differential pressure test. Record the results accurately.
6. Document any repairs or adjustments made to the assembly during the testing process.
7. If any violations or non-compliance issues are identified, note them and provide recommendations for corrective actions.
8. Sign and date the report to certify its accuracy and completion.
9. Submit the report to the appropriate regulatory authority or client.

Who needs backflow assembly test report:

1. Utility companies: Backflow assembly test reports are required by water utility companies to ensure the safety and reliability of the water supply.
2. Property owners: Building owners or managers may need backflow assembly test reports to comply with local regulations and maintain a safe environment for occupants.
3. Regulatory authorities: Government agencies, such as health departments or environmental agencies, may require backflow assembly test reports as part of their oversight and enforcement activities.

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What is backflow assembly test report?

A backflow assembly test report is a document that verifies a backflow prevention device is functioning correctly to protect the potable water supply from contamination.

Who is required to file backflow assembly test report?

Property owners or managers are typically required to file backflow assembly test reports with the appropriate regulatory agency.

How to fill out backflow assembly test report?

To fill out a backflow assembly test report, you must include information such as the location of the backflow prevention device, date of the test, test results, and the signature of the certified tester.

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 and protecting the public water supply from contamination.

What information must be reported on backflow assembly test report?

The backflow assembly test report must include the location of the device, date of the test, test results, make and model of the device, and the signature of the certified tester.