Property Backflow Assessment

• Document No.

• Property Address

• Property Backflow Assessment

• Conducted on

  Date

• For:

• HMM Inspection Services Pty Ltd 5B Robinlee Avenue BURWOOD EAST. VIC Ph: 9887 8414

• Personnel

Site

• Site photo

  Media

Meter Assembly

• Does meter assembly comply

  Yes

  No

  N/A

• Does back flow requirements comply

  Yes

  No

  N/A

Materials

• Has approved pipework coloured PURPLE been installed

  Yes

  No

  N/A

• Has approved marker tape been installed

  Yes

  No

  N/A

Installation

• Has approved clearances been provided

  Yes

  No

  N/A

• Has the appropriate pipe bedding material been installed

  Yes

  No

  N/A

• Has the approved cover been provided

  Yes

  No

  N/A

• Has the pipework been pressure tested

  Yes

  No

  N/A

• Satisfactory drinking water interconnection provided

  Yes

  No

  N/A

Water meter details

• What is the potable water meter No.

• What is the recycled water meter No.

• Additional Comments

Result

• Installation result

  PASSED

  FAILED

• Rectification a required

Photos

• Add photo of meter assembly and pipework

  Media