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Last Visited: Backflow/Cross Connection Forms



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Backflow/Cross Connection Control Program Forms

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Blank Test Sheet |  Rain and Freeze Sensor Report | Tester Registration  

Blank Test Sheet
If you need to complete a backflow test, please print a blank Test Sheet, have a registered tester complete the sheet and mail the original to us at the address shown below. State law requires that we keep original copies of the test sheet on file. Please do not fax or email copies.

Rain and Freeze Sensor Report 
If you need to complete a Rain and Freeze Sensor test independent of regular backflow testing, then please print a blank Rain and Freeze Sensor Report  and have a registered tester who is authorized to test rain and freeze sensors complete the sheet and mail the original to us at the address listed below. State law requires that we keep original copies of all test sheets on file. Please do not fax or email copies. 

Tester Registration
If you're interested in becoming a Backflow or Rain & Freeze Sensor Registered Tester, please complete the Tester Registration form and return all required information below. There is currently no cost to register with the City of Fort Worth. 

Rain & Freeze Sensor Tester requirements:

***Applicant must provide current registration number issued by the Department of Planning and Development in order to register as a Rain/Freeze Sensor Tester. To contact the Department of Planning and Development call 817.392.2222.

Backflow Tester requirements:

  • Tester Registration form
  • T.C.E.Q. Backflow License
  • Confined Space Certificate
  • Driver's License
  • Gauge Calibration Certificate
  • Current Proof of Insurance ($500,000 minimum General Liability) Certificate holder must be the City of Fort Worth-Cross Connection Section, 920 Fournier St., Fort Worth, TX 76102
  • Fire line companies must provide copies and updates of current SCR and RME licenses.

  • Backflow Assembly Inspection Request Form
    (for Dedicated, Combination and Anti-Freeze Loop, Fire Line Backflow Assemblies)

Contract Meter Questionnaire
If you've contracted a meter through the Water/Customer Service division, you must complete a Contract Meter Questionnaire and return it with the test sheet and/or photograph within 10 days of contract date.

Mailing Address & Contact Information
If you have any questions or would like any additional information, please feel free to contact us. 

Backflow/Cross Connection Control Section
920 Fournier Street
Fort Worth, Texas 76102
817.392.8375
817.392.8834 Fax
backflow@fortworthtexas.gov
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