ALCOHOL TEST RECORD
Vessel:
…………………. Month / Year: ……………...
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No.
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Rank
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Person Name
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Test Date
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Result
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Remarks
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1
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2
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3
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4
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5
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6
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7
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8
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9
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10
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11
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12
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13
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14
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Master: -
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Ch. Officer / or Engineer: -
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Witness: -
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Name:
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( in case of test of Master )
Name:
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Name:
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Signature:
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Signature:
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Signature:
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