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Cross Connection Control & Backflow Prevention Device Test and Maintenance Report 2026
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- Click ‘Get Form’ to open the Cross Connection Control & Backflow Prevention Device Test and Maintenance Report in the editor.
- Begin by entering the date at the top of the form. This is essential for record-keeping.
- Fill in the customer’s name and address, ensuring accuracy for future correspondence.
- Input the tester's name, company name, testing gauge serial number, model number, tester certification number, and calibration date in their respective fields.
- Indicate the type of backflow assembly by checking the appropriate box (RP or DC) and provide its serial number and water meter number.
- Select whether this is a new installation, existing device, or replacement by checking the corresponding box.
- Complete the initial test section by filling in details about check valves and shut-off valves as required.
- Document any repairs made during testing in the repairs section and add comments if necessary.
- Finally, sign at the bottom of the form to validate your report before submitting it to the designated address.
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What is backflow prevention device testing?
As far as fines go, it varies from county to county, but the first fine for a late backflow inspection typically starts at $100 and increases from there. If you dont complete your backflow inspection within 60 days, your county can shut off your water completely.
When should a backflow device be tested?
Testable backflow prevention devices at the property boundary (those installed on high or medium risk properties and fire services), legally require testing at commissioning, after any maintenance and every 12 months by an accredited tester qualified to test the devices.
What is a cross connection backflow preventer?
Backflow testing is a plumbing service that checks your backflow preventer device by assessing its pressure levels. When backflow is present, untreated or contaminated water can be back-siphoned into your clean water. For this reason, testing guarantees the water you use for drinking and showering is safe and sterile.
How often do backflow devices need to be tested?
A cross-connection control and backflow prevention program helps prevent contaminants from entering a drinking water distribution system.
How long is a backflow certification good for?
Upon successful completion of the examination, the certification is valid for a two year period. To qualify for the examination, an applicant must: Provide a copy of successfully passing a formal backflow prevention course. Be employed by a California State Licensed Contractor or possess a State Contractors License.
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People also ask
What is the life expectancy of a backflow preventer?
What is the Lifespan of a Backflow Preventer? The expected lifespan of a black flow preventer is typically 5 to 10 years, depending on the type of backflow preventer. Some common types of backflow preventers include: Double Check Valve Assemblies (DCVA)
How often do backflow preventers need to be tested?
Under Section 64764 of the regulations, backflow prevention devices must be tested annually by certified testers.
Related links
May 19, 2026 This report is used to document the results of testing a backflow prevention assembly for proper functioning.
The installation of backflow prevention devices does not eliminate a cross connection. The installation of backflow prevention devices is a protection solutionRead more