Cross Connection Control & Backflow Prevention Device Test and Maintenance Report 2026

1. Click ‘Get Form’ to open the Cross Connection Control & Backflow Prevention Device Test and Maintenance Report in the editor.
2. Begin by entering the date at the top of the form. This is essential for record-keeping.
3. Fill in the customer’s name and address, ensuring accuracy for future correspondence.
4. Input the tester's name, company name, testing gauge serial number, model number, tester certification number, and calibration date in their respective fields.
5. Indicate the type of backflow assembly by checking the appropriate box (RP or DC) and provide its serial number and water meter number.
6. Select whether this is a new installation, existing device, or replacement by checking the corresponding box.
7. Complete the initial test section by filling in details about check valves and shut-off valves as required.
8. Document any repairs made during testing in the repairs section and add comments if necessary.
9. Finally, sign at the bottom of the form to validate your report before submitting it to the designated address.

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