Western Australian Consolidated Regulations Western Australian Consolidated RegulationsSerial No.
Western Australia
Regulation 6: Road Traffic (Blood Sampling and
Analysis) Regulations 1975
FORM A
I
..........................................................................................................................
of
........................................................................................,
Technologist, do hereby certify that the sampling equipment contained in
package Serial No. ................... comprises the items set forth in
regulation 5 of the Road Traffic (Blood Sampling and Analysis)
Regulations 1975 , and that those items were prepared by me and are
sterile and fit for the purpose of taking a blood sample for analysis if used
not later than ............................................
Dated at Perth this ............................. day of
........................ 20..............
..............................................
Signature.
(Reverse Side)
Note: This package should be opened by cutting along this fold.
Western Australia
Regulation 8: Road Traffic (Blood Sampling and
Analysis) Regulations 1975
FORM B
Part I
By Medical Practitioner or Registered Nurse:
I ............................................................ of
............................................................. duly qualified
medical practitioner or registered nurse hereby certify that:
1. At the hour of
....................................m. on the
........................................... day of
............................................................
20................ I took a sample of the blood of
.................................... of ............................. portion
of which sample is now contained in the enclosed container numbered
.............................................
2. The equipment used
for the purpose of taking that blood sample was contained in a package
serially numbered .................................... handed to me by
................................................. and that package was sealed
and intact prior to being opened by me.
3. In taking the blood
sample I complied with regulation 7 of the
Road Traffic (Blood Sampling and Analysis) Regulations 1975 .
.................................................
Signature, and Qualifications.
(Reverse Side)
Part II
By a member of the Police Force:
Name of subject
.....................................................................................................
Doctor or registered nurse
.....................................................................................
Time and date of taking blood sample
......................................................... m. on
................................................................................................................................
Time of occurrence of event giving rise to requirement of blood sample:
............................m. on the .....................................
Alleged time of last drink containing alcohol consumed by subject:
..................... m. on
................................................................................................
...................................................
Signature, Rank and Number.
Note: Open by cutting along this edge, leaving signatures intact.
Western Australia.
Regulation 10: Road Traffic (Blood Sampling and
Analysis) Regulations 1975
FORM C
I
.............................................................................................................................
of the Chemistry Centre (WA), Perth, an analyst within the meaning of
section 65 of the Road Traffic Act 1974 , hereby certify that:
1. On the
............................ day of ..................... 20......... the
Chemistry Centre (WA), Perth received a sealed package, comprising Form B of
the Road Traffic Blood Sampling and Analysis) Regulations 1975 then
intact from ......................... containing a sample of blood in a
container numbered .............................................
2. The certificate
(Form B) appearing on the cover of the package was endorsed (among other
things) as follows:
Name of subject
.............................................................................................
Doctor
.............................................................................................................
Time and date of taking blood sample
...........................................................
3. The sample was
analysed in accordance with the Road Traffic (Blood
Sampling and Analysis) Regulations 1975 and was found to contain
............................................. grams of alcohol per 100 mL of
blood.
...................................................
Analyst.
[Form C amended in Gazette 14 Mar 2008
p. 832; 9 Oct 2009 p. 3997-8.]
Western Australia
Regulation 12: Road Traffic (Blood Sampling and
Analysis) Regulations 1975
FORM D
To: (1)
...................................................................................................................
at (2)
...................................................................................................................
Acting pursuant to the provisions of section 66(5) or 66B(1) of the
Road Traffic Act 1974 , I, the undersigned member of the Police Force,
hereby request you the said
(1) ......................................................................
to take a sample of the blood of
(3) ......................................................................................................
presently at
(4) ..................................................................................................
in accordance with the abovementioned regulations.
Dated at
................................................ this
......................................... day
of........................................, 20..............
...................................................
Signature, Rank and
Number.
(1) Insert name of medical practitioner or
registered nurse or the words Medical Superintendent, Medical Officer in
Charge, Medical Registrar or Registered Nurse, as the case may require.
(2) Address or name of hospital, as the case may
require.
(3) Name of subject.
(4) Place where subject is then to be found.
[Form D amended in Gazette 11 Oct 2007
p. 5478.]
FORM E
Western Australia
Road Traffic (Blood Sampling and Analysis) Regulations 1975
I,
.............................................................................................................................
chief executive officer of the Chemistry Centre (WA), hereby certify that
.................................
................................................................................................................................
of
............................................................................................................................
* is an analyst/* was as at
................................................................... an
analyst.
.....................................................
chief executive officer,
Chemistry Centre (WA).
* Delete whichever is not applicable.
[Form E amended in Gazette 14 Mar 2008
p. 832.]
FORM F
Western Australia
Road Traffic (Blood Sampling and Analysis) Regulations 1975
I,
.............................................................................................................................
chief executive officer of the Chemistry Centre (WA), hereby certify that
.................................
................................................................................................................................
of
..........................................................................................................................
* is a drug analyst/ * was as at
..................................................... a drug analyst.
.....................................................
chief executive officer,
Chemistry Centre (WA).
* Delete whichever is not applicable.
[Form F amended in Gazette 14 Mar 2008
p. 832.]
[Schedule amended in Gazette 23 Jan 1976
p. 132; 10 Mar 1978 p. 688; 2 Feb 1982
p. 398; 25 Feb 1983 p. 650-1; 29 Jun 1984
p. 1795; 9 Aug 1991 p. 4232; 30 Jan 2001
p. 624-5; 11 Oct 2007 p. 5478; 14 Mar 2008
p. 832.]