TEST AND MAINTENANCE REPORT FORM RPZ Reduced Pressure Zone Assembly RPZ Company Name: Service Address: Contact Person: Manufacturer: Size: Model: Degree of Hazard: Location : Account No 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering the Company Name and Service Address in the designated fields. This information is crucial for identifying the service location.
3. Fill in the Contact Person's name, Manufacturer, Size, Model, Degree of Hazard, and Location. Ensure accuracy as this data is essential for compliance.
4. Input the Account No., Phone No., Device Type, Serial No., and Meter No. These details help track the device's history and maintenance.
5. For the INITIAL TEST OF DEVICE section, record results for Check Valve #1 and #2 along with Differential PRV. Use 'Y' or 'N' for YES or NO questions as instructed.
6. In the MAINTENANCE OF DEVICE section, indicate whether each valve was cleaned or repaired. This documentation is vital for future reference.
7. If a new device was installed, complete that section with relevant details including Date, Device Type, Manufacturer, Size, Model, and Serial No.
8. Finally, ensure all sections are filled out completely before signing off as a Certified Tester at the bottom of the form.

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