Backflow Preventer Test Report Checklist
Annual backflow prevention device testing checklist covering double check valves, reduced pressure zones, and pressure vacuum breakers per NYC DEP requirements.
Device Identification
- CheckboxRecord device make, model, serial number, and size
- CheckboxVerify device type (DCVA, RPZA, PVB, DCDA)
- CheckboxRecord device location and service description
- CheckboxConfirm device is the correct type for the hazard level
- CheckboxCheck DEP registration number matches installed device
Visual Inspection
- CheckboxInspect device for physical damage or corrosion
- CheckboxCheck for leaks at all connections and test cocks
- CheckboxVerify shutoff valves upstream and downstream are operational
- CheckboxInspect relief valve discharge (RPZA) for continuous flow indicating failure
- CheckboxCheck that device is accessible for testing and maintenance
- CheckboxVerify test cocks are present and functional
Differential Pressure Testing
- CheckboxConnect calibrated differential pressure test kit
- CheckboxTest first check valve for proper closure and record differential pressure
- CheckboxTest second check valve for proper closure and record differential pressure
- CheckboxTest relief valve opening point (RPZA) and record differential pressure
- CheckboxVerify all readings meet minimum performance standards
- CheckboxRecord upstream supply pressure
Pass/Fail Determination
- CheckboxFirst check valve holds minimum 1.0 PSI differential (DCVA) or 5.0 PSI (RPZA)
- CheckboxSecond check valve holds minimum 1.0 PSI differential
- CheckboxRelief valve opens at minimum 2.0 PSI above second check closing point (RPZA)
- CheckboxAir inlet opens at 1.0 PSI above atmospheric (PVB)
- CheckboxCheck valve holds minimum 1.0 PSI above atmospheric (PVB)
- CheckboxMark device as PASS or FAIL based on all test results
Reporting and Compliance
- CheckboxComplete NYC DEP Backflow Test Report form
- CheckboxRecord all test gauge readings and serial numbers
- CheckboxSubmit test report to DEP within 30 days of test date
- CheckboxProvide copy of test report to building owner or manager
- CheckboxSchedule repair and retest if device failed
- CheckboxUpdate device testing records and next due date
Use This Checklist Digitally in KomplyOS
Complete inspections on your phone, capture photos, collect signatures, and generate professional reports automatically.
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