A backflow test report is a public-health record
A backflow prevention assembly is the only thing standing between a building's plumbing — boiler chemicals, irrigation fertilizer, fire-line water that's been sitting for years — and the public water supply. That's why water purveyors require certified testers, calibrated test kits, annual retests and a written report for every assembly. The report is what the purveyor audits, what the owner's insurer asks for, and what protects the tester if something goes wrong downstream later.
The free template above gives backflow testers and plumbing service contractors a clean field test report for a single assembly and a register to keep an entire route or campus on schedule.
What's in the workbook
1. Backflow Test Report
Customer and purveyor details; the assembly — type (RP, DC, PVB, SVB, RPDA, DCDA), size, serial, make/model, a location specific enough to find it again, hazard, service and test type; an acceptance-criteria column you fill in from your program; initial and after-repair readings with a PASS / FAIL on every line and an overall result; a repairs and parts table; tester certification and expiration; test kit and calibration status; and the next test due date.
2. Assembly Register
Forty rows for every assembly at a site or on your route: ID, site, location, type, hazard, size, make, model, serial, service, last test date and result, tester, retest interval, next due, days to due and a STATUS column — CURRENT, DUE SOON, OVERDUE, or FAILED — REPAIR. A "sent to purveyor" column turns amber when a test was recorded but the report hasn't gone in.
Why you enter the acceptance criteria
Pass/fail minimums for check valves, relief valves and air inlets are set by the test procedure your program uses. The most common method in the US is the field test procedure in the USC FCCCHR Manual of Cross-Connection Control; some states and purveyors follow ABPA, AWWA M14 or their own procedure. Because the criteria belong to those programs — and can differ — this workbook doesn't reproduce them. Enter the minimums your program requires once, save the file as your company master, and every report you start from it grades itself.
How to fill out the test report
| Section | What to record |
|---|---|
| Assembly | Type, size and serial exactly as on the data plate. The serial number is how the purveyor matches your report to their record — a typo creates a "missing test" letter. |
| Location | Room, equipment, height, upstream/downstream reference. "Mech room" isn't enough on a campus with six mechanical rooms. |
| Hazard / Service | Health (high hazard) vs. non-health, and containment vs. isolation. It determines which assembly types are acceptable and sometimes the retest interval. |
| Readings | Only the lines that apply to the assembly type. Differentials in psid; closed-tight and opened lines as Yes / No. |
| Repairs | Parts cleaned or replaced for each component, then the after-repair readings. The assembly status uses the final result if there is one. |
| Tester & test kit | Cert number and expiration, test kit serial and calibration date. The sheet flags an expired cert or gauge on the test date. |
| Next test due | Calculated from the test date and the retest interval. |
Field notes from the test route
- Coordinate before you shut a fire line. Closing the shutoffs on a DCDA or RPDA takes the sprinkler system out of service. Notify the owner and the monitoring company and follow the fire impairment procedure first.
- Warn the occupants. Testing interrupts water. Hospitals, labs and restaurants need notice.
- Flush the test cocks. Debris in the test cocks throws off readings and damages the kit.
- A dripping relief valve is a symptom. Constant discharge on an RP usually points at the #1 check fouling or pressure fluctuation upstream. Note it even if the assembly passes.
- Winterize after testing. Irrigation PVBs tested in the fall freeze quickly if you leave them charged.
- Submit on time. Many purveyors require results within a set number of days. The register's amber "sent" flag catches the reports that are sitting in the truck.
When to move beyond Excel
A backflow testing business lives on recurring work: hundreds of assemblies, each due on its own date, each needing a report, a purveyor submittal and an invoice. Field PM's service and dispatch module schedules recurring tests, puts the report on the tech's phone with photos and signatures, and invoices the customer when the job closes. Start a free 30-day trial — no credit card required.
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- Browse all free construction templates
