Richmond HillBuilding PermitsPlumbing & Drains
Backflow Preventer Test Report
Published by City of Richmond Hill
This is the City of Richmond Hill’s document, as published on its website on 19 October 2026. The municipality may have changed it since: check the current version at the source. Legal notice
- Type
- Form
- Published by
- City of Richmond Hill
- Date
- Dec 2014
- Also called
- Backflow Prevention Test Report
- Form reference
- Town of Richmond Hill By-Law 125-14
- For
- contractor
- Signed by
- qualified person · owner/tenant
- Building types
- All building types
- Pages
- 1
- Submit to
- Town of Richmond Hill
Overview
Richmond Hill's Backflow Preventer Test Report, the Maintenance & Operations Division form under Backflow Prevention By-law 125-14 for recording the test of a single backflow preventer. It captures the facility, owner, qualified person and test kit calibration, the device make, model, serial number, size, orientation and install date with its building permit number, the system and type of isolation, and initial or annual test readings for RP, DCVA and PVB devices. Repair and retest sections follow, then the qualified person's certification. It pairs with the Cross Connection Control Survey Report.
What it covers
- Backflow Preventer Test Report
- Facility Address
- Installed on What System
- Type of Isolation
- Type of Test
- Type of Device
- Test Result
- Retest Result
- For Office Use Only
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