Get Backflow Test And Maintenance Form (pdf) - Clermont County

Completing the Backflow Test And Maintenance Form is essential for ensuring the proper functioning of backflow prevention assemblies. This guide provides clear instructions on how to accurately fill out the form online to facilitate a smooth filing process.

Follow the steps to fill out the form correctly.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Enter the facility name in the designated field. This should be the official name of the establishment where the backflow prevention assembly is installed.
3. Fill in the facility address accurately as it is crucial for the records and any follow-up communications.
4. Provide detailed information about the assembly, including model, make, size, type, water provider, and serial number. Each of these fields is important for identifying the specific equipment being tested.
5. Section for signature: The tester must print their name, provide their signature, phone number, company name, certification number, and date. This certifies that the information entered is accurate, and the backflow device is in working order.
6. Fill out the testing results for each assembly component, indicating whether each part has passed or failed the test. Be sure to document any pressure readings accordingly.
7. If any repairs were made, detail the repairs and materials used in the designated section, and note any re-tests conducted after repairs.
8. Once all sections are filled out, review the form for completeness and accuracy. Ensure all required fields are properly completed.
9. Save your changes, and proceed to download, print, or share the completed form as needed.

Ensure compliance and maintain safe water systems by filling out your document online today.