AOD Test Record

  • Site conducted

  • Conducted on

  • Prepared by

Subject Information

Subject Details

  • Subject name

  • Photo ID

  • Non-Photo ID

  • Position held

  • DOB

  • Breath sample required

  • Saliva sample required

Subject Certification/Consent/Declaration

  • I consent to the collection and testing of my specimen using on-site equipment/test devices or via a NATA-accredited laboratory if required for confirmatory testing purposes. I understand that the test is being performed as part of the Schlam Alcohol & Other Drugs Policy and Procedure. I authorise the release and recording of the test result to the nominated Company representative, I also certify that the information supplied on this form is True and Correct.

  • Subject signature

  • Date & time

Testing Technician to Complete

  • Testing Technician is to Complete the Remainder of this Form

Sample Collection

  • Has the test subject consumed Food, Drink, or Cigarettes within the last 20 minutes?

  • (SAMPLE CAN NOW BE COLLECTED)

  • Date & time

  • Testing Reason

  • Location

  • Subject ID type

  • Subject ID No.

  • Technicians Name

  • Technicians Signature

Results

  • Time of Result

  • Testing Device ID No

  • Consumable Order Code

  • Consumable Barcode No

  • Initial Test Result

  • In the event of a Non-Negative Result, insert comments in the Note section above

  • BAC - %

  • Evidentiary Test Result

  • BAC - %

  • AMP

  • BZO

  • COC

  • MET

  • OPI

  • THC

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.