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Jobsite Breathalyzer Test Form

Step 1: To Be Completed by Testing Administrator

Reason for Testing? Required

Step 2: To Be Completed by Employee

I                                                                  , certify that I am about to submit to alcohol testing and that

the identifying information provided on the form is true and correct.

Step 3: To Be Completed by Testing Administrator

I                                                                 , certify that I have conducted alcohol testing on the above-named employee, that I am trained and qualified to operate the testing device identified, and that the results are as recorded. 

Your Jobsite Breathalyzer Test Form has been submitted

Thank you!

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