To complete a backflow preventer inspection form, gather the assembly details, your certification credentials, and the field test readings before you begin. Use FormsPal's free PDF editor to fill in, save, and download the form without any software installation.
Step 1: Enter tester and date information
Start with the inspection date, your full name, and your certification or license number. Include the name of your testing company and the calibration date of your test gauge. Most water authorities require this information to verify that your equipment meets current accuracy standards.
Step 2: Identify the assembly
Record the assembly type, manufacturer name, model number, serial number, and installation address. Common assembly types include reduced pressure zone (RPZ), double check valve (DCV), pressure vacuum breaker (PVB), and atmospheric vacuum breaker (AVB). Include the assembly size in inches and the installation position (horizontal, vertical, or normal-to-flow).
Step 3: Record field test readings
Enter the initial test results for each component of the assembly. If any component fails, document the failure reason and the repair or replacement action taken. Then enter the post-repair test readings to confirm the assembly passed before returning it to service.
Step 4: Sign and submit the report
Sign the completed backflow test report to certify the accuracy of all recorded results. Submit a copy to your local water utility within the required timeframe. Provide a copy to the property owner and keep one for your own records.
Related backflow preventer forms
If you need related documents, see the Backflow Assembly Test Report, the Backflow Test Report, the Backflow Tester Registration Form, and the NEWWA Backflow Test Sheet. For plumbing compliance documentation, see the Certificate of Plumbing Compliance.
Frequently asked questions
How often is backflow preventer testing required?
Most water utilities require annual testing of all backflow prevention assemblies. Some jurisdictions require more frequent testing for high-hazard connections. Contact your local water authority to confirm the testing schedule for your installation type.
Who can perform a backflow preventer inspection?
Backflow preventer tests must be performed by a state-certified backflow assembly tester. Certification typically requires completing an approved training course and passing a written and practical examination. Some states also require periodic recertification.
What happens if the assembly fails the test?
If the backflow preventer fails any part of the test, it must be repaired or replaced before it can be returned to service. The tester documents the failure, the repair action, and the post-repair test results on the same inspection form. The completed report is then submitted to the water authority.