DWI Monitoring Compliance Log
Complete this log to document daily monitoring and compliance activities for DWI program participants.
Participant Full Name
*
First Name
Last Name
Participant ID or Case Number
*
Date of Monitoring
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Time of Monitoring
*
Hour Minutes
AM
PM
AM/PM Option
Type of Monitoring
*
In-person
Remote (Video/Phone)
Ignition Interlock Device Check
Electronic Monitoring Device
Other
Type of Test Administered
*
Breathalyzer
Urine Test
Ignition Interlock Device Reading
Observation Only
Other
Test Result
*
Passed (No alcohol detected)
Failed (Alcohol detected)
Refused to Test
Were there any violations or incidents during this monitoring period?
*
No violations/incidents
Yes (please describe below)
If yes, provide details of any violations or incidents:
Additional Comments or Notes
Supervisor/Officer Name
*
First Name
Last Name
Supervisor/Officer Signature
*
Submit Log
Submit Log
Should be Empty: