| Backflow Testing

Backflow Testing

Please call if you need assistance completing this form. The cost to process each test is $25.00 per device.
Helpline: 513-946-7800, "option 2"

Manual Upload

Click Here for a blank printable version of this form.
If you'd like to print prepopulated forms, enter the device serial number or address here and click search.

Device Serial # or Address: Search

When you have typed out or filled out your form and saved it to your computer, please enter your email address, click choose file, and choose a .JPG or .PDF file to submit to our office.

Download Device Info

Click Here to download device information

Tester Information

Device Property Owner

Company Name: Contact Name: * Email: Pri Phone: * Address: * City: * State: * Zipcode: *

Device Location

Same as property owner's address? Address: * City: * State: * Zipcode: *

Provide a brief description of this location.

Device Details

This device is replacing the old device? New Device #: Manufacturer: *

*Other / Unknown:

Serial #: * Type: *

Waterline Size: *

Is this device part of an irrigation system? *

Is this device on a fire main? *

This device is used for: *

Device Test Results

Test Date: *

Outlet Valve: *

1st Check Valve: *

2nd Check Valve: *

Relief Valve Opening Point: *

Air Inlet Valve: *

Check Valve: *

Payment Options

Amount Due: $25.00 per device

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Pay With Escrow

By submitting this form you attest the information you have provided is true to the best of your knowledge.