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Division of  Environmental
Health

Backflow Prevention

Publications
Forms

Publications:

Permission for use from the University of Southern California does not allow web posting of the documents below. Limited distribution of hard copies is allowed only to regulated entities and consultants working in Washington State. However, you can order the publications through our on-line catalog links below.

• Backflow Prevention Assemblies Approved for Installation in Washington State

• Backflow Prevention Assembly Field Test Procedures Approved for Use in Washington State

Forms:

Backflow Incident Report Form #331-243 (188 KB Word) - Cross-Connection Control Program

Has your water system ever had a backflow incident? 

Backflow is when water flows in the opposite direction than intended.  Under backflow conditions, contaminants may enter the drinking water supply through unprotected cross-connections.  Sometimes the contaminant is confined to the customer’s plumbing system.  Other times the contaminant may enter the distribution system. 

Washington State Drinking Water rules [WAC 246-290-490(8)] require water purveyors to document details of backflow incidents using the above form. 

 To complete the backflow incident form, you can either:

• Fill out the form on your computer in Word, and then print it for your signature (preferred method).

• Print out the form and complete it manually.

Please send the signed, completed form to: 

Washington State Department of Health
Office of Drinking Water – CCC Program Manager
P O Box 47822
Olympia, WA 98504-7822

Cross Connection Control

Publications

More publications are available through our on-line publication catalog

External Links

Washington Certification Services Web Site

Backflow Assembly Tester (BAT) Information

BAT Public Listing
 

Foundation for Cross-Connection Control and Hydraulic Research

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Dept. of Health Office of Drinking Water 243 Israel Road S.E. 2nd floor Tumwater, WA 98501

Mail: P.O. Box 47822 Olympia, WA 98504-7822 (360) 236-3100

Send inquiries about DOH and its programs to the Health Consumer Assistance Office
Comments or questions regarding this Web site? Send mail to Judy J. Sides.

Last Update : 03/27/2008 10:18 AM