Ensuring the safety and quality of public water supplies is a critical responsibility that involves regular testing and maintenance of backflow prevention devices. In New York State, this responsibility is underscored through the use of the DOH 1013 form, a comprehensive document mandated by the New York State Department of Health Bureau of Public Water Supply Protection. This form serves as a detailed report on the testing and maintenance activities carried out on backflow prevention devices, which are essential in preventing the reverse flow of water from potentially contaminating the public water supply. The form is structured into two main parts: Part A, which must be completed by a certified tester for both initial and annual tests, detailing the device's location, specifications, testing results before and after repairs, and final certification of the device's compliance. Part B is reserved for the design engineer, architect, or water supplier for initial tests, providing certification that the installation matches the approved plans. The document also includes sections for detailing deficiencies, making repairs, and certifying the accuracy of the provided information. By requiring the completion and submission of the DOH 1013 form, the New York State Department of Health ensures that each backflow prevention device is functioning correctly, protecting the community's health and safety by maintaining the purity of its water supply.
| Question | Answer |
|---|---|
| Form Name | Doh 1013 Form |
| Form Length | 2 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 30 sec |
| Other names | nys doh 1013 form, doh form 1013, doh 1013 test and maintenance form, doh 1013 pdf |