Backflow Test Report
Customers with a backflow-prevention assembly (commercial services, fire lines, and irrigation systems) are required to have it tested by a certified tester on a recurring basis. After completing the test, use this form to submit the results and attach the signed report. Questions? Call our office at 913-724-1800.
Find the assembly
Enter the customer's water account number (on their notice from us) and the serial number from the assembly's tag, and we'll fill in the customer and assembly details we have on file. Check them against what you see on site; you can change anything. No match? Fill in the form by hand.
Customer / facility
Backflow assembly
Test result
Certified tester
Attach the signed report *
Upload the completed, signed test report (PDF or a clear photo, up to 4 MB). This is the official record we keep on file.