Backflow test form word 2026

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The document is a Backflow Device Certification Form for the City of Goose Creek, SC, used to certify the installation and testing of backflow prevention devices. It includes sections for certified testers to provide their information, details about the device being tested, test results before and after repairs, and certification by the tester. The form ensures compliance with the Safe Drinking Water Act and outlines procedures for reporting test results and contacting public works for device replacements.

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Click ‘Get Form’ to open the backflow test form in the editor.
Begin by entering your name as the Certified Tester, along with your Company Name, Address, and Phone Number. This information is crucial for identification.
Fill in the Customer details including Type, Size, Make, Model, Serial Number, Application, Water Meter Number, and Account Number. Ensure accuracy as this data is essential for record-keeping.
Provide the Service Address and Billing Address if different. This helps in proper documentation and communication.
In the Comments section, add any relevant notes regarding the testing process or device condition.
For each test conducted (before and after repairs), mark whether there were leaks or if it was closed tight. Record differential pressure readings accurately.
Complete the certification section by signing and providing your Certification Number and Expiration Date to validate the document.

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Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

What happens if you dont get your backflow tested?

If you dont have your backflow tested annually, as required by the Department of Health, your water purveyor will eventually take action to protect the health of their water system. Each water purveyor has different policies, but typically they impose fees once the test is severely delinquent.

How do you perform a backflow test?

First, the number 2 shut off valve on the backflow is turned off. A test kit is placed on the device. The test kit uses the water left in the backflow. Once the test is complete, the kit is removed, and the water is turned back on slowly, which prevents pressure surges from occurring.

What does a backflow tester do?

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.

What is the terminology of backflow?

The reversal of normal flow of water (potable or non-potable) or other substances into a drinking water system ( DWS ) that may be caused by back siphonage or back pressure in the presence of a cross connection. Back Siphonage.

What does a backflow technician do?

The Backflow Prevention Inspector is responsible for protecting the potable and non-potable water supply and on site plumbing of customers by inspecting the installation of backflow assemblies, performing cross connection control testing, conducting water use surveys, performing water constituent testing, and dye

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What does backflow certified mean?

About Certified Backflow Testers In order to protect our drinking water quality and prevent the spread of infectious disease and other contaminants, mechanical backflow prevention assemblies are utilized to prevent used, unclean or contaminated water or substances from entering the potable / domestic water system.

What is a certified backflow tester?

You must get at least 70% or above on the quiz. The quiz is open book and presentation, but please complete it yourself. 3. You will receive a training certificate by email once we receive and review your passing quiz.