Report template · RP / RPZ
The RPZ test report form, field by field
A reduced pressure principle assembly report lives or dies on five things: the assembly identity, the line pressure, three measured values, the shutoff verification, and who measured them with which gauge. Here is what belongs on the sheet and how each reading is graded.
What an RP/RPZ test report must contain
A reduced pressure principle assembly (RP, commonly written RPZ) has two independent check valves and a differential relief valve between them. A report that only records "passed" proves nothing: the value of the document is the measured numbers, the identity of the assembly they came from, and the traceability of the person and gauge that produced them. Every complete report carries five blocks.
- Inspection and facility — customer or facility name, service address, contact and phone, the water purveyor receiving the report, meter or account number, assembly location notes, test date, and the reason for the test (annual, initial, post-repair, survey).
- Assembly identification — type, manufacturer, model, serial number, size, service type (domestic, irrigation, fire protection, boiler, process) and hazard classification. Serial number is what ties this year's test to last year's.
- Initial test readings — check #1 differential, relief valve opening point, check #2 tightness against backpressure, both shutoff valves, and static line pressure.
- Repairs and final retest — only when the initial test failed: what was done, and the complete second set of readings.
- Tester, gauge and signatures — certification number and expiration, company and license, differential gauge make, model, serial and calibration date, then the tester signature and, where required, the site representative's.
Field-by-field checklist you can work down
Print this or work down it on the screen. The order matches the order the generator asks for it, which is also the order that avoids walking back to the truck.
| Field | Why it is on the report | Common miss |
|---|---|---|
| Test date and test type | Why it is on the report:Establishes the compliance year and whether this is an annual, initial or post-repair test. | Common miss:Post-repair tests filed as annual, which hides the failure history. |
| Purveyor / meter number | Why it is on the report:Routes the report to the right authority and the right service connection. | Common miss:Meter number left blank on multi-meter sites. |
| Assembly serial number | Why it is on the report:The only durable identifier — model and size repeat across a property. | Common miss:Copied from last year instead of read off the tag after a replacement. |
| Size and hazard class | Why it is on the report:Drives inspection frequency and, in many programs, what is allowed on that service. | Common miss:Irrigation with chemical injection recorded as low hazard. |
| Static line pressure | Why it is on the report:Context for the readings; a very low supply pressure explains marginal results. | Common miss:Not recorded at all. |
| Check #1 differential | Why it is on the report:Primary measure of the first check's ability to hold. | Common miss:Recorded before the needle settles. |
| Relief valve opening point | Why it is on the report:Confirms the relief opens well below the first check's holding value. | Common miss:Read as the point of first drip rather than first discharge. |
| Buffer (calculated) | Why it is on the report:The margin between the two. Marginal assemblies are caught here. | Common miss:Never calculated, so a 0.4 PSID margin ships as a pass. |
| Check #2 against backpressure | Why it is on the report:Second line of defence; reported as tight or leaked. | Common miss:Skipped when no backpressure source is available on site. |
| Shutoff #1 and #2 | Why it is on the report:A leaking shutoff invalidates the readings taken through it. | Common miss:Assumed tight because the test was completed. |
| Gauge serial and calibration date | Why it is on the report:An out-of-calibration gauge makes every number on the sheet contestable. | Common miss:Calibration expired mid-season. |
| Tester certification and expiration | Why it is on the report:Proves the person who signed was qualified on the test date. | Common miss:Certification that lapsed before the test date. |
The order the readings happen in the field
Procedures are published by the certifying and regulating bodies and by the assembly manufacturer, and they differ in detail. What follows is the ordinary shape of a three-valve differential gauge test on an RP so you know which blank gets filled when — not a substitute for the procedure your certification and purveyor require.
Identify and inspect before you hook up
Read the tag: type, make, model, serial, size. Note the installation — orientation, clearance, relief port discharge, and anything you will have to describe in the location notes.
Record static line pressure and flush the test cocks
Note supply pressure, then flush each test cock so debris does not end up in the gauge or under a check.
Test check valve #1
Attach the gauge, bleed the hoses, then measure the differential across the first check. Baseline pass is 5.0 PSID or greater, and the reading must be stable, not falling.
Test the differential relief valve opening point
Measure the differential at which the relief valve begins to discharge. Baseline pass is 2.0 PSID or greater.
Calculate the buffer before you pack up
Check #1 minus relief opening. Below 3.0 PSID the assembly is marginal — it is far cheaper to service it now than to be called back. BackflowPass shows this number in large type as you type the two readings.
Verify check valve #2 against backpressure
Apply backpressure per your procedure and record tight or leaked. This is a condition, not a differential, so it is reported in words on the sheet.
Verify both shutoff valves and restore service
Record each as tight or leaked, close test cocks, restore the service, and confirm no relief discharge under normal operation.
Sign the report on site
Certification number, gauge serial and calibration date, signature, and the site representative where your program requires it. Signing on site is what makes a same-day submittal possible.
Baseline pass criteria used on this report
These are the thresholds BackflowPass ships with, read directly out of its rule engine. They reflect common field practice for reduced pressure principle assemblies. They are held in one configurable rule set, so a jurisdiction with different limits is a configuration change rather than a workaround.
| Reading | Baseline pass | Reported as |
|---|---|---|
| Check valve #1 differential | Baseline pass:≥ 5.0 PSID | Reported as:Pass / fail, with the measured value |
| Differential relief valve opening | Baseline pass:≥ 2.0 PSID | Reported as:Pass / fail, with the measured value |
| Buffer (check #1 − relief) | Baseline pass:≥ 3.0 PSID | Reported as:Calculated; failure or advisory depending on the configured rule |
| Check valve #2 under backpressure | Baseline pass:Held tight | Reported as:Tight / leaked |
| Shutoff valve #1 and #2 | Baseline pass:Held tight | Reported as:Tight / leaked |
A missing reading is reported as incomplete, never as a failure — an unrecorded number is not evidence of a defect. The overall result is always derived from the readings; there is no box to tick that declares an assembly passed.
Worked example: two RPs that both look fine
Buffer is the reading most often left off a paper form, and the one that most often explains a callback. Same two thresholds, two very different assemblies:
| Reading | Assembly A | Assembly B |
|---|---|---|
| Check #1 differential | Assembly A:8.2 PSID — pass | Assembly B:5.4 PSID — pass |
| Relief opening point | Assembly A:3.4 PSID — pass | Assembly B:5.1 PSID — pass |
| Buffer | Assembly A:4.8 PSID — 3.0 PSID minimum met | Assembly B:0.3 PSID — below the 3.0 PSID minimum |
| What it means | Assembly A:Healthy margin between the check holding and the relief opening. | Assembly B:The relief is opening almost as high as the first check holds. Small changes in supply pressure can push it into discharge. |
Both assemblies pass every individual threshold. Assembly B is the one you want to service on this visit. You can put your own numbers through the same math on the interactive pass/fail calculator.
When the initial test fails: what the report has to show
A failure is not the end of the report — it is the start of the second half of it. The document has to preserve what failed, what you did, and what the assembly measured afterwards.
Common RP failures and the usual cause
- Check #1 below minimum — debris or scale on the seat, damaged rubber, or a weak spring. Clean, then re-measure before replacing parts.
- Relief opening below minimum — fouled seat or a tired relief spring. Flush and service the relief; rebuild if it will not hold a stable opening point.
- Buffer too small — usually a relief opening creeping up rather than a check going soft. Service the relief first.
- Check #2 leaks under backpressure — debris or a nicked disc. This is the failure that most often follows upstream work on the system.
- Shutoff leaks — the readings taken through it are not defensible. Repair or replace the shutoff, then retest from the top.
What the retest block records
The repair actions performed (cleaned checks, replaced rubber or disc, replaced spring, serviced or rebuilt the relief, other with notes), then the full second reading set. A passing retest is reported as passed after repair — a distinct outcome from a first-pass result, and one the property owner and purveyor are both entitled to see. If any retest reading is missing, the record stays incomplete rather than quietly reporting a pass.
Using the blank template
There are two ways to work. Use the checklist above as your paper structure and transcribe later, or open the generator, pick RP, and let the form ask for exactly these fields in this order. The generator grades each differential as you type, calculates the buffer, opens the repair and retest section the moment something fails, takes both signatures on the screen and exports a one-page PDF — offline, with no account.
- The reading fields shown are only the ones an RP uses, so there is nothing irrelevant to scroll past in a vault.
- Your certification and gauge details are filled in from your profile, and can be overridden for a single test when you borrow a kit.
- The finished report fits one 8.5×11 portrait page — no spillover, no second sheet to lose.
- Next year, start the annual from last year's record: identity fields carry over, readings start blank, and the old report is preserved.
Questions testers actually ask
What readings go on an RPZ test report?
Check valve #1 differential in PSID, the differential relief valve opening point in PSID, whether check valve #2 held tight against backpressure, and whether both shutoff valves held tight. Line pressure, assembly identification and the tester's certification and gauge details go on the same sheet.
What is the buffer on an RPZ, and why does the report show it?
Buffer is check valve #1 differential minus the relief valve opening point. It is the margin between the check holding and the relief opening. Baseline practice treats 3.0 PSID as the minimum acceptable margin, so an assembly whose individual readings pass can still be reported as marginal or failed on buffer. BackflowPass calculates and displays it while the gauge is still connected.
Is an RPZ report the same as an RP report?
In common field usage RPZ and RP describe the same reduced pressure principle assembly, and the same reading set and report form apply. An RPDA (reduced pressure detector assembly) is tested using the same rule family and additionally documents the bypass meter and bypass assembly.
Does a failed RPZ still need a report?
Yes — document the failed readings, the specific reason, the repair performed and the final retest. BackflowPass keeps the failed initial readings on the record and on the PDF alongside the retest, so the report shows passed after repair rather than hiding the first result.
Will my water purveyor accept this form?
Some purveyors accept a complete standard test report; others require their own numbered form. Confirm with the authority that receives your submittals. Even where their form is mandatory, a complete report is useful as the tester's own record of what was measured, when and by whom.
Related field references
DCVA test sheet
Double check valve assembly test sheet: both check differentials, shutoff verification and how a DCDA fire line differs.
PVB inspection form
Pressure vacuum breaker test form: air inlet opening point, check holding, and the SVB differences worth knowing.
ASSE 5110 & pass/fail calculator
Tester qualification versus assembly product standards, plus an interactive calculator that runs the app's own rule engine.
USC cross-connection reference
What the USC Foundation publishes, how approved-assembly lists work, and where to find your own jurisdiction's rules.
Fill this out on the phone instead.
The generator asks for exactly these fields, grades every differential as you type, opens repair and retest fields when something fails, and hands you the finished one-page PDF. No account, no install, works with no signal.