Breathalyser Results Form

Breathalyser Results Form
Person Recording the Test:
Name*

First NameLast Name
Area*
Please specify*

End
Breathalyser Serial Number (can be found on reverse of breathalyser)*
Breathalyser Test Number (can be found on top right of screen)*
Date

DayMonthYear
Date
Time

Hour Minutes

Person Being Tested:
Name *

First NameLast Name
Company*
Test Results
Result (mg per 100ml)

Result Flowchart
Readings under 9mg per 100ml of breath = OK to work

Readings between 9mg - 15mg = Return for re-breathalysing in 2 hours – no site work to be carried out in this time.

If after 2 hours, the result being blown is still over 9mg, no work to be carried out that day and worker to be given 1 strike.

Readings of 16mg and over = No work for the day and worker to be given 1 strike.

Each strike is recorded in the log and the individual should report to their Manager of AO.
An accumulation of 3 strikes against one person will result in their dismissal.
Should be Empty: