AlcoTest – PSV Compliance and Training

Driver Alcohol Test Form

To be completed by the tester for all random or for-cause alcohol screenings.

Driver Consent and Declaration

I, the undersigned driver, hereby consent to the collection and processing of this information, including the results of my alcohol test.

I understand that this information will be processed by PSV Compliance and Training Ltd and may be shared with my employer and/or the owners of the vehicle I am driving.

This declaration is in accordance with UK GDPR requirements.

I confirm I have read and understood the declaration.

Check here if driver REFUSED to consent or provide a sample.

Checking this will lock the test sections and submit a refusal report.

Pre-Test Procedural Checklist

Tester must confirm all steps below have been completed *before* administering the test.

Confirmed the driver has not eaten, drunk, smoked, or used mouthwash in the last 20 minutes. (Note: Failure to wait may cause a false positive, requiring a re-test).

Opened a new, sterile mouthpiece in full view of the driver.

Shown the driver that the breathalyser is displaying zero (0.00) or ready state before use.

The driver is fit, able, and understands the requirement to provide a test sample.

Test Details

Date of Test

Time of Test

Location of Test

Reason for Test

Driver Shift Timing

Personnel Details

Driver's Full Name

Driver's Licence Number

Driver's Email (Optional)

For a copy of the completed form. May take up to 24 hours.

Company Driver is Working For

Name of Person Conducting Test

Test Result

Breathalyser Model

Test Result Reading

Photo of Test Result

Tap to add photo

Use device camera or upload file

Comments

Driver's Comments

Tester's Comments / Observations

Driver Signature Driver sign below to confirm test