BACKFLOW PREVENTION DEVICE TEST REPORT - Guelph 2026

1. Click ‘Get Form’ to open the BACKFLOW PREVENTION DEVICE TEST REPORT in the editor.
2. Begin by filling in the 'Address' and 'Facility ID' fields at the top of the form. Ensure that all information is accurate for proper identification.
3. Next, provide details for the 'Occupant' section, including the emergency contact person's name, telephone number, and email address.
4. In the 'Owner' section, enter the owner's name, telephone number, address, and email. This information is crucial for accountability.
5. Fill in the 'Name of Certified Tester', their certification number, business name, address, and email. This verifies that a qualified professional conducted the test.
6. Complete the device details such as make, model number, serial number, date of last calibration, and device location. Specify its purpose as well.
7. Indicate the test date and select whether it’s an initial or annual test. Mark if it passed or failed along with line pressure readings.
8. For each check valve and relief valve section under REDUCED PRESSURE BACKFLOW ASSEMBLY and DOUBLE CHECK VALVE ASSEMBLY, indicate if they leaked or closed tight and record pressure differentials.
9. If any assembly fails testing, complete the repairs section noting any existing device serial numbers if applicable.
10. Finally, ensure to sign and date at the bottom of the form before saving your changes.

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