CITY OF LUBBOCK BACKFLOW PREVENTION ASSEMBLY. OSHA Injury and Illness FAQ 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by filling out the 'Backflow Assembly Information' section. Enter the Serial Number, Manufacturer, Model, and Size of the assembly. Indicate whether it is a commercial property by selecting 'Yes' or 'No'.
3. Provide the contact phone number and name of the business or customer associated with the assembly. Fill in the physical address where the backflow assembly is located.
4. Specify the assembly location on the property and select the type of device from options like DCVA, RPBA, PVBA, etc. If applicable, note any replacements for existing serial numbers.
5. Detail the reason for installation by describing any hazards present such as irrigation or chemicals. Confirm compliance with TCEQ and City requirements by selecting 'YES' or 'NO', providing reasons if necessary.
6. Complete the 'Customer Information' section if different from above, including Property Owner/Agent details and mailing address.
7. Fill out testing results for Reduced Pressure Assemblies and Double Check Assemblies, ensuring to document all pressure readings accurately.
8. Finally, certify that all information is true by entering your name, BPAT Certification Number, signature, test date and time, along with gauge calibration details.

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