Plumbing · Canada

FLHA for backflow testing

By SiteSortedBuilt from provincial OHS law and CCOHS guidance · How we write and check theseUpdated November 9, 2026

Provincial OHS law requires hazards to be assessed and controlled before work starts. A field level hazard assessment (FLHA) for backflow testing is done on site at the start of the shift and again whenever conditions change.

It lists the tasks, hazards and controls, and every worker signs on before starting and signs off at the end of the shift. The main hazards are road traffic, falling through a floor opening or void, public entering the work area and bites and stings.

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FLHA example: backflow testing

This is a complete FLHA for backflow testing, with 5 job steps. Open it in the builder to add your site, crew and signatures, change anything, and download a PDF. Or download the free Word template below and fill it in by hand.

Field Level Hazard Assessment (FLHA)

Backflow prevention device testing · Plumbing · Example

Document FLHA-001 · Rev 1

Job steps, hazards and controls

#	Job step	Hazards	Risk before	Controls	Risk after
1	Find the device and set up cones if it is near a driveway or road	Road traffic Public entering the work area	Critical	Do the work at low-traffic times, or close the road or lane with approval. Elimination Put solid barriers between the work and traffic where speeds are high, not just cones. Engineering (guarding) Use a truck-mounted attenuator or buffer vehicle on high speed roads. Engineering Set up signs and cones to your provincial traffic control manual, with trained traffic control persons. Administrative Get a road occupancy permit from the municipality or road authority before you start. Administrative Park work vehicles to shield the work zone, with beacons on. Administrative Wear high-visibility clothing to CSA Z96. PPE Fence off the site with secure temporary fencing and lock the gates when you leave. Engineering (guarding) Give pedestrians a safe, marked path around the work, with ramps for strollers and wheelchairs. Engineering (guarding) Use hoarding, covered walkways or catch fans where work is above public areas. Engineering Put signs at each entry: site name, contact number and "No unauthorised entry". Administrative Make the site safe at the end of each day: cover holes, lower buckets and booms, remove ladders and lock tools away. Administrative Use a spotter when moving equipment or materials across public paths. Administrative	Medium
2	Open the pit or cage, checking for spiders, snakes and sharp edges	Bites and stings Cuts from sharp edges Falling through a floor opening or void	Critical	Check work areas before starting, and get pest control to remove nests. Elimination Look before you reach into dark spaces. Administrative Ask owners to keep pets away from the work area. Administrative Know who has allergies and keep their medication, such as an epinephrine auto-injector, close by. Administrative Wear gloves, long sleeves and boots. Use insect repellent outdoors. PPE Deburr or cover sharp edges, and fit edge protectors on exposed sheet metal. Engineering Use knives with retractable or self-retracting blades. Engineering Cut away from your body and keep your other hand clear. Administrative Put used blades in a blade bin or sharps container. Administrative Use two people to handle large sheets of metal or glass. Administrative Cover every hole and penetration with a fixed, secured cover marked "HOLE" or "DANGER". Engineering (guarding) Put guardrails with toe boards around stairwells, lift shafts, voids and open edges. Engineering (guarding) Install stairs early and fit temporary handrails as soon as they go in. Engineering Never remove a cover or guardrail without approval. Put it back straight away. Administrative Inspect covers and barriers daily and after other trades have been through. Administrative	Medium
3	Tell the site the water will be off, then isolate the device	Working in an occupied home or building Stored energy	Medium	Plan noisy, dusty or risky work for when the building is empty. Elimination Close off the work area with barriers, plastic sheeting or locked doors, and put up signs. Engineering (guarding) Keep fire exits and paths clear at all times. Administrative Tell occupants before you turn off power, water or gas, and before noisy or dusty work. Administrative Lock away tools, chemicals and materials each day, out of reach of children. Administrative Clean up dust and debris at the end of each day. Administrative Release or block all stored energy before work: release the pressure in pipes, tanks and hoses, bleed hydraulics, release springs, lower loads. Elimination Lock out and tag all energy sources with personal locks. Engineering (guarding) Put mechanical blocks or props under raised parts like buckets, tipper bodies and doors. Engineering Test that the system is dead and nothing can move before you start. Administrative Follow the maker's procedure, for example for garage door and roller door springs. Administrative Wear safety glasses and gloves. PPE	Low
4	Connect the test kit and run the test	Pressure testing High pressure water jetting	Medium	Test with water instead of air or gas where the system allows it. Never put water in refrigerant pipework, which is tested with dry nitrogen. Substitution Keep people out of the test area with signs and barriers. Engineering (guarding) Use a calibrated gauge and a relief valve set to protect the system. Engineering Test to the pressure the system calls for and hold it for the set time. Never go over. Administrative Release the pressure fully before tightening anything or fixing leaks. Administrative Wear safety glasses or a face shield. PPE Set an exclusion zone around the jetting area. Engineering (guarding) Use a dead man's trigger that stops the jet when released, and check hoses and fittings before use. Engineering Only trained operators use high pressure jetting gear. Administrative Never point the lance at anyone or put a hand in front of it. Administrative Treat any jetting injury as serious and go to hospital, even if it looks small. Administrative Wear a face shield, waterproof clothing, gloves, hearing protection and safety boots. PPE	Low
5	Restore supply, tag the device and lodge the report	Slips and trips Poor housekeeping and waste	Medium	Plan walkways and keep them clear of materials, hoses and leads. Elimination Run leads and hoses overhead on hooks or stands, or along walls, not across walkways. Engineering Fill or cover holes, and lay boards or mats on muddy access paths. Engineering Clean up offcuts, packaging and spills as you go, not at the end of the day. Administrative Keep work areas, stairs and access paths well lit. Administrative Wear safety boots with good grip, laced up. PPE Order materials to size and send packaging back where you can. Elimination Put waste bins and chutes close to the work. Engineering Clean as you go, and do a full clean up at the end of each day. Administrative Keep exits, stairs and walkways clear at all times. Administrative Stack materials neatly on level ground, away from edges. Administrative Wear gloves when handling waste. PPE	Low

PPE

CSA green triangle safety boots (CSA Z195)Work glovesSafety glasses (CSA Z94.3)High-visibility vest (CSA Z96)CoverallsCut-resistant glovesN95 respiratorFace shieldHearing protection

Plant and equipment

Electrical test meterHand tools

Permits and plans

Lockout permit

Emergency

Call 911. Add the nearest hospital, the muster point and the first aid attendant for your site.

Sign-off

Supervisor and every worker sign to confirm they have read and understood this FLHA, then sign off at the end of the shift.

Free FLHA template for backflow testing

Word (.docx) and PDF, Letter landscape, no email needed. Fill in your site details, then print or send it.

Word template (.docx)PDF template

Make yours in 2 minutes

Same document, filled in for your job. Answer a few yes or no questions, the crew signs on the phone, and you send the PDF.

Start this FLHA

Pre-start checklist for backflow testing

Tick these off before work starts. They come from the hazards, permits and equipment in this job.

FLHA read, explained and signed by everyone on the job
Openings, voids and penetrations covered and marked
Lockout, tagout and test before touch done before work starts
Exclusion zone and spotter set up for equipment and traffic
Exclusion zone below the work and public kept out
First aid attendant, first aid kit and emergency number (911) confirmed
PPE checked and worn: CSA green triangle safety boots (CSA Z195), work gloves, safety glasses (CSA Z94.3), high-visibility vest (CSA Z96)

The safe sequence of work

Find the device and set up cones if it is near a driveway or road
Open the pit or cage, checking for spiders, snakes and sharp edges
Tell the site the water will be off, then isolate the device
Connect the test kit and run the test
Restore supply, tag the device and lodge the report

Hazards to watch on backflow testing

The hazards most specific to this job, and the step where each one comes up.

Step 2Bites and stingsSpiders, wasps, ticks and dogs bite or sting workers in attics, crawl spaces and yards.

Step 4High pressure water jettingHigh pressure water cuts through skin and injects water and dirt into the body, or the hose whips.

Step 4Pressure testingA pipe, fitting or cap fails under test pressure and blows apart, hitting people nearby.

Step 1Road trafficPassing cars and trucks hit workers or plant working on or next to a road.

Step 3Stored energyEnergy left in springs, hydraulics, compressed gas, raised loads or capacitors releases suddenly and crushes or injures workers.

Step 3Working in an occupied home or buildingResidents, staff or children wander into the work area and get hurt, or the work blocks exits or cuts off power or water while people are inside.

Highest risk on backflow testing: Critical before controls (B), down to Medium after controls (A), on the Canada 5 by 5 risk matrix (possible and fatality becomes unlikely and lost time injury).

What changes on your site

This example covers the job itself. Your site may add more. Add controls for any of these that apply (the builder asks you these as yes or no questions):

Could anyone fall 3 metres or more, or fall any distance into machinery, water, a hazardous substance or through an opening?
Will anyone use a ladder or stepladder?
Will anyone work on a roof?
Is there a fragile roof, skylight or clear roof sheet?
Will you use a scaffold or mobile tower?

Why FLHAs get rejected

Prime contractors and COR auditors send documents back for these reasons. This example avoids them, but check yours too.

End of shift boxes already say "None" when the form was signed at the start of the shift.
One FLHA reused for days or weeks, or a "review by" date a month away, when the work and conditions change daily.
No time of assessment and no record of any revision, which Alberta s.7(3) requires.
Workers signed that they "read" it, but nothing shows they took part, which Alberta s.8(1) requires.
Work at height with no fall protection plan where the province requires one, or no written rescue procedure for workers using fall arrest.
Permits or locates required on site but no permit or ticket numbers recorded.
No re-assessment entry after an obvious change such as weather, a new task or a new crew member.

Rules by province for backflow testing

Province or territory	Key local rule	Regulator
Ontario	Fall protection (O. Reg. 213/91 s.26) applies at a fall of more than 3 m, more than 1.2 m where the work area is used as a path for a wheelbarrow or similar equipment, and at any height into operating machinery, water or other liquid, a hazardous substance, or through an opening.	Ontario Ministry of Labour, Immigration, Training and Skills Development
British Columbia	Fall protection is required where a fall of 3 m or more may occur (s.11.2). A written fall protection plan is required at 7.5 m or more where there are no permanent guardrails (s.11.3).	WorkSafeBC
Alberta	A hazard assessment must be done before work begins, and before a new work site is built (OHS Code s.7(1)). The results must be written down with the controls (s.7(2)).	Alberta Occupational Health and Safety
Quebec	Guardrails (Safety Code s.2.9.1, as amended by Decret 63-2025) are needed where a worker could fall into liquid or a hazardous substance, onto moving parts or dangerous equipment, 1.2 m or more when using a vehicle, 1.5 m or more when handling a load, and more than 3 m in all other cases.	CNESST (Commission des normes, de l'equite, de la sante et de la securite du travail)
Manitoba	A prime contractor is required whenever more than one employer or self employed person works on the site at the same time (Act s.7).	Manitoba Workplace Safety and Health Branch
Saskatchewan	An occupational health committee is required at 10 or more workers of one employer (Act s.3-22).	Saskatchewan Ministry of Labour Relations and Workplace Safety, OHS Division
Nova Scotia	Workers must be trained in fall protection before using it or working in, supervising or planning work in a fall protection area, with a refresher at least every 3 years (WHSR s.21.19).	Nova Scotia Department of Labour, Skills and Immigration, Safety Branch (OHS)
New Brunswick	Fall protection is needed from 3 m above water or the nearest permanent safe level (Reg 91-191 s.49(1)(a)(i)).	WorkSafeNB
Newfoundland and Labrador	Give written notice to the minister before starting a construction project that will last 30 days or more, with the site, location, type of work and number of workers (Regs s.8).	Government Services, Occupational Health and Safety Division
Prince Edward Island	Fall protection is needed from 3 m above the nearest safe surface or water (Fall Protection Regulations s.2(1)(a)).	Workers Compensation Board of PEI, OHS Division
Yukon	Every employer must do hazard assessments with the committee, representative or workers, and redo them after significant changes or incidents (Regs s.1.03.01).	Yukon Workers' Safety and Compensation Board
Northwest Territories	Fall protection is needed from 3 m, or lower if there is a risk of injury (s.119(1)). Guardrails are needed for falls of 1.2 m to 3 m at permanent work sites (s.119(2)).	Workers' Safety and Compensation Commission (WSCC)
Nunavut	No 911. To reach the RCMP in an emergency, dial your community's first three digits then 1111 (Iqaluit: 979-1111). Put the local fire, ambulance and RCMP numbers on every FLHA.	Workers' Safety and Compensation Commission (WSCC)

Questions

Do I need an FLHA for backflow testing?

Who signs the FLHA?

The supervisor and every worker take part in the assessment and sign on before work starts, then sign off at the end of the shift. Review it and re-sign whenever the task or conditions change.

How long do I keep it?

Keep completed hazard assessments for at least 3 years (COR auditors sample the last 12 months). Review this FLHA and re-sign whenever the task, crew or conditions change.

What PPE is needed for backflow testing?

Usually CSA green triangle safety boots (CSA Z195), Work gloves, Safety glasses (CSA Z94.3), High-visibility vest (CSA Z96), Coveralls, Cut-resistant gloves, N95 respirator, Face shield, Hearing protection. The site rules may add more, so check with the general contractor.

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Blank FLHA template: free FLHA templates. Also for other countries: Australia (SWMS) · United Kingdom (RAMS) · United States (JHA)