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Backflow Test Report Template
Fill in the assembly, the readings and your certificate number, sign it, and download a PDF for the customer. Works for RP, DC, PVB and SVB assemblies.
Backflow test report
Saved in this browser only. Nothing is sent to us.
Pass values follow the common minimums in the USC Manual of Cross-Connection Control, 10th edition. Your water supplier's form and rules come first.
Doing this every week?
Book, test, report and bill in one place
Clevra runs the business side of a backflow testing company. It doesn't file with water suppliers, so you still file the way your supplier asks.
- Your test form as a Clevra checklist, with number fields, dropdowns, photos and a signature (Pro)
- The signed PDF in the customer's portal
- Booking confirmations and day-before reminders
- Repair estimates when an assembly fails
- The invoice from the job, paid by card or recorded as a cheque
Recurring visits don't repeat yearly yet, so book next year's test on its due date. See Clevra for backflow testing.
How to fill in the report
- 1
Assembly details
Type, make, model, serial and size, plus where it sits and what it protects.
- 2
Readings
Enter each reading in psid. The form flags anything below the common minimum and works out pass or fail.
- 3
Sign and download
Add your certificate number and test kit, sign on the screen and download the PDF.
Reference
Common passing values
These are the field test minimums in the USC Foundation's Manual of Cross-Connection Control, 10th edition. Your water supplier's form and rules come first.
| Assembly | Test | Minimum |
|---|---|---|
| RP | Relief valve opening point | 2.0 psid |
| RP | Check valve 1 | 5.0 psid, and above the relief valve reading |
| RP | Check valve 2 | Closes tight against backpressure |
| DC | Check valve 1 | 1.0 psid |
| DC | Check valve 2 | 1.0 psid |
| PVB and SVB | Air inlet | Opens at 1.0 psid and opens fully |
| PVB and SVB | Check valve | 1.0 psid |
What a complete report has
- The property, the assembly location and what it serves.
- Type, make, model, serial number and size.
- Initial readings, then repairs and retest readings if it failed.
- Your certificate number, the test kit and its calibration date.
- Pass or fail, the date and your signature.
Backflow test report FAQ
Will my water supplier accept this report?
Some will and some won't. Many suppliers want reports on their own form or filed in their own online system. Use this as the customer copy and your own record, and file with the supplier the way they ask.
What readings pass a backflow test?
Under the USC Manual of Cross-Connection Control, 10th edition: an RP relief valve opens at 2.0 psid or more, check valve 1 holds 5.0 psid or more and above the relief valve reading, and check valve 2 closes tight. Each check on a double check holds 1.0 psid or more. A PVB or SVB air inlet opens at 1.0 psid or more and opens fully, and the check holds 1.0 psid or more.
My supplier's form asks for a 3.0 psid buffer. Which is right?
Follow your supplier. Older criteria and some local forms still want check valve 1 to read at least 3.0 psid above the relief valve opening point. The 10th edition dropped that buffer, but the supplier sets the rules for its system.
Does it work for RPDA and DCDA assemblies?
Yes. Pick the detector type, record the main assembly readings, and put the bypass meter details in the comments.
Do you keep my reports or tester details?
No. Everything stays in your own browser, so your name and certificate number are filled in next time. Nothing is sent to Clevra.
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