Applications & Forms
This page has the links to all the forms you may need to renew your Type I, Type II or Type III permits in addition to the maintenance report forms and operational checklists for the particular instrument that you are using in your jurisdiction.
Permit Applications
Type 1 – fill-in form (form must be printed off and signed prior to submittal)
Type 1 permits are for laboratory persons who test for alcohol or drugs in blood, urine or saliva
Type 2 – fill-in form (form must be printed off and signed prior to submittal)
Type 2 permits are for persons authorized to supervise the breath analyzer, perform preventative monthly maintenance not to exceed 35-days, train Type 3 operators and perform breath tests on specified evidential breath analyzer
Type 3 – fill-in form (form must be printed off and signed prior to submittal)
Type 3 permits are for persons authorized to perform breath tests on an evidential breath analyzer
Note: If the application includes a request for the applicant’s Social Security number, it must be provided as required by RSMo 324.024. DHSS will not disclose any applicant’s Social Security number except as required under RSMo 610.035. Any failure or refusal to provide your Social Security number is grounds for denial of your application.
Maintenance Report Forms
Alco-Sensor IV/RBT IV – fill in form (form must be printed off and signed prior to submittal)
(Note: Maintenance Report Forms for the Intox DMT, Intoxilyzer 8000, and the Intox EC/IR II are not provided here because the official form for those instruments is the one within the software of the instrument)
Operational Checklists
(Note: Blood Alcohol Test Report and Operational Checklist forms for the Intox DMT, Intoxilyzer 8000, and the Intox EC/IR II are not provided here because the official form for those instruments is the one within the software of the instrument)