Backflow test form pdf 2026

1. Click ‘Get Form’ to open the backflow test form in the editor.
2. Begin by entering the year of the test at the top of the form. Specify whether this is an initial or annual test.
3. Fill in the public water supply name, account number, and county. For New York City tests, include block and lot information.
4. Provide details about the facility, including its name, address, and specific location of the device.
5. Complete the device information section by entering manufacturer details, type (RPZ or DCV), model, size, and serial number.
6. In the 'Test Before Repair' section, indicate whether check valve #1 and #2 leaked or closed tight. Record line pressure and test date.
7. If repairs were made, describe them along with materials used and include the repairer's name and license number.
8. Complete the final test section if applicable, noting any deficiencies in the remarks area.
9. Certify that all data is correct by printing your name, signing, and providing your certification number and expiration date.

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