Backflow Prevention Test Report Example
Example document for Backflow Prevention Test Report. Use this as a reference when creating your own.
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Document: Backflow Prevention Test Report
Example Document
Last updated 7/29/2026
Backflow Prevention Test Report
1. Property Details
- Property Owner/Company Name: Smith & Sons Pty Ltd
- Property Address: 123 Industrial Ave, Auburn, NSW, 2144
- Water Authority/Account Number: Sydney Water - 98765432
- Test Date: 15/03/2024
2. Device Details
- Device Location: Ground floor plant room, adjacent to main inlet
- Device ID/Serial Number: BF-45892-X
- Device Type: RPZD (Reduced Pressure Zone Device)
- Size (mm): 50mm
- Manufacturer: Watts
- Model: 009
- Year of Manufacture: 2019
3. Test Equipment Details
- Tester Name: John Doe
- Licence Number: NSW123456
- Test Gauge Serial Number: G-2021-88
- Gauge Calibration Due Date: 01/11/2024
4. Test Results (RPZD)
- Inlet Pressure (kPa): 520
- Zone Pressure (1st Check Closed) (kPa): 260
- Relief Valve Opening Pressure (kPa): 170
- Relief Valve Closing Pressure (kPa): 140
- Check 1 (Shut-off) Pressure (kPa): 505
- Check 2 (Shut-off) Pressure (kPa): 510
5. Test Results (DCV)
- N/A
6. Outcome
- Test Result: PASSED
- Reason for Failure (if applicable): N/A
- Repair Action Taken: N/A
7. Declaration I, the undersigned, certify that the above information is true and correct. I tested the device using a gauge that is currently calibrated. The test was conducted in accordance with AS/NZS 3500.1.
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Plumber Signature: J. Doe
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Date: 15/03/2024
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Property Owner Acceptance: B. Smith
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Date: 16/03/2024
Notes
This example shows a test for a 50mm RPZD at an industrial property. The Zone Pressure is roughly half the Inlet Pressure, which is expected. The Relief Valve opens at a suitable pressure difference. The Check valves hold pressure well. The gauge is within its calibration date. The result is a Pass.
About this Example
Part of the Backflow Prevention Test Report document collection
Document Type
Backflow Prevention Test Report
A record of inspection and testing results for a backflow prevention device to ensure it meets Australian Standards and local council requirements.