Eaton, OH · Preble County
Backflow Preventer Test Report
This report records backflow preventer details, test results, and repairs for plumbing companies or testers submitting a completed report to Eaton Public Works.
What this form is
The report documents the backflow preventer’s customer and device information, test results, any repairs, and the tester’s certification details. It includes sections for reduced pressure backflow preventers, double check valve assemblies, and pressure type vacuum breakers. The completed report is returned to the email address listed on the form.
Who needs it
A plumbing company or tester completing and reporting a backflow preventer test for a device in Eaton needs this report.
How to submit it
Email the completed form to [email protected], as directed on the form.
About notarization
This report is signed and dated without a notary; the form asks for the tester’s initials and date, and lists no sworn or notarized attachment.
How to submit this form
- 1
Download The Report
Download the Backflow Preventer Test Report PDF.
- 2
Complete The Device Information
Enter the customer name, device address, and backflow preventer size, make, model, serial number, and location.
- 3
Record Test Results
Complete the applicable test section and record repairs, tester initials, date, plumbing company, and certification number.
- 4
Email The Completed Report
Send the completed form to [email protected], the email address listed on the report.
Frequently asked questions
- Who completes the Backflow Preventer Test Report?
- A tester or plumbing company completes the report with the customer and device information, test results, repairs, and tester certification details.
- How do I submit the Backflow Preventer Test Report?
- Email the completed form to [email protected]. The form identifies this email address for returning the completed report.
- Do I need a notary for the Backflow Preventer Test Report?
- No. The report asks for the tester’s initials and date, but does not require notarization or list a sworn or notarized attachment.
- What test information does the report collect?
- It includes test sections for reduced pressure backflow preventers, double check valve assemblies, and pressure type vacuum breakers, along with repair details.