Vehicle Breathalyzer Test Log Tracker
Record vehicle breathalyzer test details, results, and follow-up actions for operational tracking.
Driver and Vehicle Identification
Driver / Operator Name
*
First Name
Last Name
Employee or Internal Driver ID
Vehicle Unit or Fleet Number
*
Vehicle Make / Model
*
License Plate Number
*
Department / Route and Branch or Location
*
Breathalyzer Test Details
Test Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Test Time
*
Hour Minutes
AM
PM
AM/PM Option
Test Type / Purpose
*
Please Select
Pre-shift
Post-shift
Random check
Incident investigation
Return-to-duty
Other
Tester / Administrator Name
*
First Name
Middle Name
Last Name
Device Identifier / Serial Number
Calibration / Check Status
Please Select
Passed pre-use check
Calibration current
Due for calibration
Calibration overdue
Last calibration date recorded
Not checked
Other
Test Result and Safety Status
Breathalyzer Result Status
*
Passed
Failed
Inconclusive
Test Not Completed
Measured Reading
Retest Required
*
Yes
No
Vehicle Operating Status
*
Cleared to Operate
Hold Out of Service
Immediate Action Taken
Removed from Duty
Retest Scheduled
Supervisor Notified
Vehicle Locked Out
Other
Notes and Follow-Up
Incident or Observation Notes
Witness or Supervisor Name
First Name
Middle Name
Last Name
Follow-Up Action Required
Please Select
None
Supervisor Review
Driver Re-Training
Vehicle Inspection
Service Maintenance
Other
Next Review or Resolution Date
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Submit
Should be Empty: