Backflow Prevention Test Report
Capture a backflow assembly test as you perform it: assembly type, make and serial, hazard served, tester certification and test-kit calibration, then check valve holds, relief-valve opening at differential, air inlet, leakage and the retest after any repair. Required differentials and test intervals are entered from your water purveyor's rule. Everything stays on your device.
Fill & print the form
Runs entirely in your browser — nothing is uploaded; your answers are saved only on this device.
Frequently asked
Can I submit this to my water purveyor?
Treat it as your working record, not the submission. It is not a certification or a regulatory filing — nearly every purveyor mandates its own official test report form, so transfer the results onto theirs and submit that.
Why are there no pass/fail numbers?
Required differentials, allowable leakage and kit-calibration periods are set by your purveyor and plumbing code and differ by assembly type. You record what you measured and compare it against the criteria your authority publishes.