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QLD Form 9 Backflow Test Report

Sections

Description of Land Owner/Occupier Contact Details Test Criteria Device Location, Mains Pressure and Time of Test Main Device By-Pass Device Pressure Type Vacuum Breakers Air Gap Test Kit Details Authorised Tester Details Authorised Tester's Results

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Contractor Licence Declaration

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Authorised Tester's Results

Pass or fail and comments on QLD Form 9

Confirm the device was tested in accordance with AS/NZS 2845.3:2020, tick Pass or Fail, and add comments if needed.

Authorised Tester Details

Licensed tester identity on QLD Form 9

Contractor Licence

Contractor details when not the responsible person on QLD Form 9