6Within one hour of carrying out the analysis I signed and delivered to

6 Within one hour of carrying out the analysis I signed and delivered to the subject a statement as required by regulation 58(2). At the time of am/pm on the date of

Traffic Regulations 1999 71 FORM 2 CERTIFICATE ON REFUSAL OR FAILURE TO SUBMIT TO OR PROVIDE A SAMPLE OF BREATH SUFFICIENT FOR COMPLETION OF BREATH ANALYSIS I, (operator name) , a police officer who is authorised by the Commissioner to use a prescribed breath analysis instrument for the purposes of the Traffic Act 1987, certify that:

1. At the time of am/pm on the date of I prepared to perform an analysis on a sample of breath to be supplied by (full name and address of person) (the subject), whose occupation is and who is years of age.
2. I asked if the subject was suffering from any illness and the subject ".
3. I asked if the subject was suffering from any disability and the subject ".
4. I asked if the subject was suffering from any injuries and the subject ".
5. I asked if the subject was taking any tablets, drugs, insulin or medicine and the subject responded " ".
6. I satisfied myself that the subject had not consumed any alcohol within the immediately preceding 15 minutes.
7. I prepared the breath analysis instrument for use in the prescribed manner and satisfied myself that the instrument was in good working order.

Traffic Regulations 1999 72 8. I provided an unused mouthpiece for use by the subject in giving a sample of breath. 9. I said to the subject "This is a prescribed breath analysis instrument. I am authorised to use it for the purposes of the Traffic Act 1987. It is in good working order and ready for use. I require you to submit to a breath analysis.". 10. I then gave the subject directions as to how the subject was to provide a sample of breath sufficient for the performance of the breath analysis. 11. The subject then said " and the subject (describe the person's actions if relevant) At the time of on the date of

Traffic Regulations 1999 73 FORM 3 BLOOD TEST FOR FORENSIC ANALYSIS For completion by a medical practitioner, registered nurse, a member of staff of a hospital under direct supervision of a medical practitioner or registered nurse or, if at a health centre, a qualified person.

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Name of person liable to give sample of blood: ………………………………….. If identity of person unknown, enter Health Registration Number (HRN) ……………………… Person's address (if known): .……………………………………........................ ………………………………………………………………………………………….