Get Backflow Prevention Assembly Test Report Form - Town Of Medley

Filling out the Backflow Prevention Assembly Test Report Form accurately is essential for ensuring compliance with health and safety regulations. This guide will provide you with clear, step-by-step instructions to complete the form online, addressing each section in detail.

Follow the steps to successfully complete the report form online.

1. Press the ‘Get Form’ button to access the Backflow Prevention Assembly Test Report Form, which will open the document in your preferred editor.
2. Begin by filling out the 'Owner of Device' section with the full name of the person or entity that owns the backflow prevention assembly.
3. In the 'Owner Contact' field, provide the contact name corresponding to the owner, followed by their phone number.
4. Enter the complete address of the owner, including the street, city, and ZIP code.
5. Next, fill in the 'Name of Tester' section with the certified tester’s name and their certification number.
6. Include the business name and business address of the tester or testing company.
7. Record the model number and serial number of the assembly being tested.
8. Indicate the device's expiration date and ensure to provide the tester's contact number and ZIP code.
9. Complete the 'Date of Test' section by entering the actual date of testing.
10. In the 'Initial Test' and 'Annual Test' sections, provide details regarding the state of the shut-off valves, including whether they closed tight or leaked.
11. Document any failures or repairs by completing the remarks section if applicable, providing reasons for any failure.
12. Finally, certify the test results by having the certified tester sign and date the report.
13. Once all fields are filled in, you can save your changes, and download, print, or share the form according to your needs.

To ensure compliance and safety, complete your Backflow Prevention Assembly Test Report Form online today.