Get Annual Test & Maintenance Report For Backflow Prevention Assemblies

Completing the Annual Test & Maintenance Report for Backflow Prevention Assemblies is essential for ensuring compliance and safety in drinking water systems. This guide provides clear, step-by-step instructions on how to accurately fill out the form online.

Follow the steps to successfully complete your report.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Fill in the facility name and contact person’s name in the designated fields. Ensure that the address and phone number are also provided accurately.
3. In the Assembly Information section, input the make, model, size, and serial number of the backflow prevention assembly being tested.
4. Record the date of the initial test in the provided space.
5. Indicate the location details by selecting the correct options from the listed locations such as basement, penthouse, or mechanical room.
6. For the protection provided, select the applicable assembly type and record the results as pass or fail for the various components like the check valves and relief valve.
7. If any repairs were made, fill in the Repairs & Materials Used section and record the date of the re-test after repairs.
8. Re-check all fields for accuracy, ensuring that all data has been filled out completely as required.
9. Add the printed name, signature, and phone number of the tester, along with the company name and certification numbers.
10. Lastly, have the owner or officer certify the device's use and fill out their information similarly. Save changes, download, print, or share the completed form as needed.

Complete your Annual Test & Maintenance Report for Backflow Prevention Assemblies online today to ensure compliance and safety.