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Backflow Test and Maintenance Form (pdf) - Clermont County, Ohio ... - clermonthealthdistrict

Backflow Test and Maintenance Form (pdf) - Clermont County, Ohio ... - clermonthealthdistrict 2025

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The document is an Annual Test & Maintenance Report for Backflow Prevention Assemblies issued by Clermont County Public Health. It includes sections for facility information, tester certification, test results for various backflow prevention devices, and a renewal fee payment instruction. The report ensures that backflow prevention devices are functioning correctly to protect public health.

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Click ‘Get Form’ to open it in the editor.
Begin by entering the Facility Name and Address at the top of the form. This information is crucial for identifying where the backflow prevention assembly is located.
Fill in the Assembly Information section, including Model, Make, Size, Type, Water Provider, and Serial Number. Accurate details ensure proper documentation.
In the Tester Certification area, print your name and provide your signature. Include your phone number and company name along with your Ohio Certification Number and date.
Complete the testing results for each valve listed under Initial Test. Indicate whether each component passed or failed by checking the appropriate box.
If repairs are needed, document them in the Repairs & Materials Used section and schedule a re-test after repairs are completed.

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Is backflow testing required in Ohio?

Required Annual Testing of Devices After a backflow device is installed, it must be maintained. A backflow device must be tested by a backflow-certified plumber (every 12 months) to ensure that the device is still in good working order.

What is a certified backflow tester?

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 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.

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.

How to do a backflow test?

State regulations and local municipalities typically require backflow preventer installations in commercial and industrial properties that contain chemicals, fertilizers, and other hazardous substances. Common industries with backflow preventers include: Restaurants. Healthcare facilities.

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

Backflow Test and Maintenance Form (pdf) - Clermont County, Ohio ... - clermonthealthdistrict 2025

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