Washington backflow test report (DOH field test form)

Updated October 7, 2026 · Stampario team

In Washington, the Department of Health publishes a sample Backflow Preventer Inspection and Field Test Report, and the minimum content is set by WAC 246-292-036. A water system may use the DOH form, its own version or another form with the same information, so a report that carries every DOH field is a legitimate format unless your water system asks for its own.

What the DOH report covers

Water system: PWS ID, name and file number
Premises: residential or not, address and contact
The preventer: hazard type, type (DCVA, RPBA, PVBA, SVBA, air gap), location, new / existing / replacement, confined space
Make, model, serial and size, whether the model is USC-approved, proper orientation and installation
Initial test readings for the assembly type, or the air gap inspection
Cleaning, repairs and parts, then the final test after repair
Line pressure, detector meter reading and whether service was restored
Test kit make, model, serial and verification date
The BAT’s certification, signature, certificate number and contact details

Can you use your own form?

DOH’s instructions treat the form as a sample: the title block can identify the water system or the testing company, and other formats with the same content are acceptable unless the water system requires its own. Ask your water system which it accepts and how it wants reports delivered.

The certification

The tester certifies that they personally inspected and field-tested the preventer with procedures and equipment that meet the DOH rules, and that the information is true, complete and accurate.

How Stampario fills it

Example Backflow Preventer Inspection and Field Test Report made in Stampario — Backflow test (Washington DOH layout)Example PDF

Washington companies get the DOH field test layout automatically: same sections and order, plus your logo.
Readings appear only for the assembly type you pick, and the final test only shows after a failed initial test.
The water system’s name, PWS ID and file number are saved per customer, so next year’s report starts filled in.

Common questions

Does my water system have to accept this report?

No. Each water system decides. Many accept any report with the DOH content; some require their own form or a portal. Ask yours.

Does it cover air gaps?

Yes. Picking "Air gap" swaps the test readings for the air gap inspection: approved or not, supply pipe diameter and separation.

Sources

Codes change by edition and the authority having jurisdiction (your fire marshal, water purveyor or state agency) decides which rules apply. This page is general information, not legal advice.