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Contractor record of installation

This form is intended for authorised contractors to provide information about installed backflow prevention devices. If this is not what you were looking for visit the backflow prevention homepage.

Please submit a separate form for each individual device installed.

Contractor information

Company name

Contact name

Contact email

Your work order/job reference number

This is your reference number, not the Council job number.

Name of technician installing device

Phone number of technician

Installation information

Address for installation

Property ID

This is located on the spreadsheet supplied by Council.

Was the device installed?

Yes, device was installedNo, device was not installed

Why wasn't the device installed?

Installation date

Testing and sign-off date

Any additional comments

Device information

Type of device

RPZTestable Dual CheckZone Protection

Make of device

WattsWilkinsOther

Specify the make of the device

Serial number of the device

Connection size of the device

15mm20mm25mm32mm40mm50mm100mm

Please provide the following photos

Location of the device relative to the business