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Henry County Water Authority Backflow Test Report

Henry County Water Authority Backflow Test Report 2026

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The document is a maintenance report for backflow assembly testing conducted by the Henry County Water Authority. It includes sections for account information, test data, repairs, and certifications regarding the operation and maintenance of the backflow assembly. The report details various checks performed on valves, pressure readings, and any necessary repairs or replacements.

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Click ‘Get Form’ to open it in the editor.
Begin by entering the 'Account Contact Name and Number' at the top of the form. This ensures that all communications are directed to the right person.
Fill in the 'Account Name' and 'Mailing Address' fields accurately, as this information is crucial for record-keeping.
Provide your 'HCWA Account No' and 'Service Address'. These identifiers help streamline service requests.
Complete the sections for 'Manufacturer', 'Type of Assembly', and 'Installation Date'. This data is essential for maintenance tracking.
In the testing section, indicate the 'Test Date', select whether it's an Initial, Annual, or Other test, and fill in relevant details about check valves and repairs as needed.
Finally, ensure you sign off on the certification statement at the bottom of the form to validate your entries before submission.

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