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.


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

Enter your Backflow Certifcation # to autofill your information.

Device Information

Enter the Device Serial # to autofill the device information.

Device Property Owner

Device Location

Device Details

Device Test Results

Payment Options

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