Sample Backflow Preventer Inspection and Field Test Report

The Waterworks Operator Certification Rule (effective January 4, 2014) includes a section on backflow preventer inspection and field test report content (WAC 246-292-036).

We've developed a sample test report to complement the rule. This report should help backflow assembly testers (BATs) and water systems comply with the minimum test report content requirements in the Operator Certification Rule.

This sample report includes several optional fields that commonly appear on other test reports used in Washington. You may change the optional content and the format of this report to meet your needs, however you must include the required content to comply with the Operator Certification Rule.

To help you properly complete the test report, we've numbered the fields on the sample test report and developed an instruction table. The instruction table describes each field on the test report by field number and name. Optional fields appear cream shaded in the report and table. To remove optional fields, highlight the cell and press the “delete” button. To change optional fields, delete cell content and type your information in the field.

Sample Test Report (Word) | (PDF)

Numbered Test Report with Instructions (PDF)

If you have questions or comments on the sample form or instructions, please contact us at: CCCprogram@DOH.WA.GOV