ALCOHOL TEST RECORD (sample)






ALCOHOL TEST RECORD

Vessel: ………………….                                                              Month / Year: ……………...

No.
Rank
Person Name
Test Date
Result
Remarks
1





2





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5





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8





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20







Master: -

Ch. Officer / or Engineer: -

Witness: -
Name:

( in case of test of Master )
Name:

Name:
Signature:

Signature:

Signature:


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