UA / Breathalyzer Form

  • Home
  • UA / Breathalyzer Form

Details

Name Of Ambassador
Date
Done By
Witness Results
House Location
Time
Reason:
Baseline
Spontaneous
Suspicion
Job
Please circle the following Ambassador is positive for:
THC (Marijuana)
BZO (Benzodiazepines)
COC (Cocaine)
MET (Methamphetamine)
OXY (Oxycodone)
AMP (Amphetamine)
OPI (Opiates)
Other Negative Results
Does Ambassador have a prescription for drugs they were positive for:   Yes No

Breathalyzer Test Results

Ambassador Blew
These Drugs must be out of the Ambassador’s system within the following time frame:
THC (Marijuana) 30 days
BZO (Benzodiazepines) 5 days
COC (Cocaine) 72 Hours
MET (Methamphetamine) 72 hours
OXY (Oxycodone) 72 Hours
AMP (Amphetamine) 72 Hours
OPI (Opiates) 72 Hours
Breathalyzer TEST 24 hours
If Ambassador is positive for anything they must have a clean UA Drug/Breathalyzer test by the following date