Get Form For Backflow Test Report - City Of Wooster

The Form For Backflow Test Report is essential for documenting the testing and maintenance of backflow prevention devices. This guide will provide clear, step-by-step instructions on how to complete the form online, ensuring that you provide all necessary information accurately.

Follow the steps to complete the form successfully.

1. Press the ‘Get Form’ button to access the form and open it in an online editor.
2. Begin by filling in the facility name, phone number, and address in the designated fields at the top of the form.
3. Enter the test date in the appropriate field.
4. Provide the backflow prevention assembly information, including the make, model, serial number, size, and type of assembly. Indicate whether it is a new installation or a replacement.
5. Specify the installation type (containment) and system type (domestic) as required.
6. Detail the location of the backflow prevention assembly (e.g., basement, first floor, outside) in the location field.
7. Record the test results by selecting whether the assembly passed or failed the test. Include line pressure and test status (before repair, isolation, etc.).
8. For failed tests, document any leaks found in the check valves or relief valves, along with their respective pressure drops.
9. Describe any repair materials used to rectify issues identified during the test.
10. The tester must sign the certification section, providing their Ohio certification number and company name as well as their phone number.
11. The facility owner or designated officer must also sign and print their name, title, and date to validate the information provided.
12. Once all sections are completed, review the form for accuracy, then save changes, download, print, or share the document as needed.

Complete your Form For Backflow Test Report online today to ensure compliance and maintain your backflow prevention systems.