Title Page
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1st Class - Alcohol Compliance Check
2nd Class - Compliance Report
Licensee Information
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License Number:
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Date and Time of Check:
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Was Sale Completed?
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Minor was asked for identification?
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Name of Employee?
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Employee Date of Birth:
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Gender of Employee:
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Type and description of what was purchased:
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Cost of purchase?
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Money given to minor?
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Change returned?
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How was employee trained?
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Select date
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Select date
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Select date
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Trained By (name):
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As of this date I have not been trained to sell Alcohol or Tobacco
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Minors initials
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Gender of Minor:
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Minor was asked for identification?
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Name of Employee?
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Employee Date of Birth:
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Gender of Employee:
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How was employee trained?
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Select date
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Select date
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Select date
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Trained By (name):
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As of this date I have not been trained to sell Alcohol or Tobacco
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Minors initials
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Gender of Minor:
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Was designated driver sign posted?
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Reason check is incomplete:
