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Backflow Preventer Test Report

Certified backflow test report for RPZ, DCVA, and PVB assemblies. Record gauge readings, PSID values, pass/fail results, and tester certification — auto-emailed as PDF. Free to start.

27 fields across 3 pages ~10 min to complete Works offline

Use this template with your own crew

Start a free trial, open it in the builder, and send it to a technician today. No card required.

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30 days free · no card · cancel yourself any time. No seat minimum.

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What happens when it's submitted

Backflow Preventer Test Report, on a phone and as a PDF

On the technician's phone. All 3 screens, in order — tap to step through them. Photos, signatures and repeat rows are captured on the device, and it all works with no signal.
YOUR LOGOBackflow Preventer Test ReportService ReportJOB #1042DATE10 Aug 2026CUSTOMERNorthside Prop…TECHNICIAND. ReyesINSPECTION DETAILSCustomer / facilityNorthside Property Gr…Service addressUnit 4BTest location41.8781, -87.6298Assembly typeRPZ (reduced pressure…Make / model—REPAIR PARTS USEDPARTQTYUNITTOTALItem 112Item 1Item 1Item 224Item 2Item 2Item 336Item 3Item 3PHOTO — ASSEMBLY WITH SERIAL TAG…Photo 1Photo 2Photo 3SIGN-OFFTechnician signature10 Aug 2026DateYour Company · (555) 010-4477 · yourcompany.comPage 1 of 1
The PDF your customer receives. Your logo and your layout, with repeat sections tabulated and photos laid out — emailed the moment it's submitted.

Both panels are drawn from this template's actual fields, so they change when the form does. Sample values shown; branding and layout are yours to change in the PDF designer.

What's on the form

All of this is customizable to your process. Delete the fields you don't need, add the ones you do — and every lookup is powered by your customer list and your own data.

1

Assembly & tester

  • Customer / facilityRequiredcustomer lookup
  • Service addressaccount field
  • Test locationGPS stamp
  • Assembly typeRequireddropdown
  • Make / modelRequiredtext
  • Assembly serial numberRequiredtext
  • Assembly size (inches)Requireddropdown
  • Service / hazard protecteddropdown
  • Test gauge serial numberRequiredtext
  • Gauge last calibration dateRequireddate
2

Gauge readings

  • Line pressure (PSI)Requirednumber
  • Check valve #1 — closed tight at (PSID)Requirednumber
  • Check valve #1 resultRequireddropdown
  • Check valve #2 — closed tight at (PSID)number
  • Check valve #2 resultdropdown
  • Relief valve opened at (PSID)Conditionalnumber
  • Air inlet opened at (PSID)number
  • Shutoff valve #1 holds tightRequireddropdown
  • Shutoff valve #2 holds tightRequireddropdown
3

Result & certification

  • Overall test resultRequireddropdown
  • Repairs made (parts, seats, springs, discs)Conditionaltextarea
  • Repair parts usedparts picker
  • Photo — assembly with serial tag visibleRequiredphoto
  • Tester certification numberRequiredtext
  • Certification expiration dateRequireddate
  • Report to be filed with water purveyortoggle
  • Certified tester signatureRequiredsignature

Use this template with your own crew

Start a free trial, open it in the builder, and send it to a technician today. No card required.

Start free trial →

30 days free · no card · cancel yourself any time. No seat minimum.

Would rather ask a person first? Email us — a human answers.