PROCES-VERBAL

privind constatarea faptei de conducere a

mijlocului
de transport n stare de ebrietate alcoolic

or._________________

____ ._____. 2015

(data ntocmirii)

nceput la ora ________

finisat la ora ________

IIP
al
Plut.
________________________________
Agent

constatator

Hincesti,Leova,Cimislia

(se indic funcia, numele, prenumele i

organul din care face parte agentul constatator)

Persoanele care asist la aciunea efectuat___________________________________________________________

(se indic persoanele care au participat la

_____________________________________________________________________________________________
efectuarea aciunii i adresele lor n caz de necesitate sau numrul de telefon)

_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
Temeiurile controlului:

Miros specific de alcool din cavitatea bucal

(miros de alcool din cavitatea bucal,

_____________________________________________________________________________________________
instabilitatea pozei, dereglarea mersului, tremurul accentuat al degetelor, pleoapelor, comportament neadecvat)

_____________________________________________________________________________________________
mutucul a fost desigilat n prezena cet._________________________________________________
(se face inclusiv meniunea c mutiucul a fost desigilat n prezena persoanei testate i i s-a explicat procedura testrii alcoolscopice)

_____________________________________
_________________________
(semntura persoanei testate)

_____________________________________________________________________________________________
numele prenumele, n/ i modelul mijlocului de transport condus de persoana supus testrii)

Cet.________________________________________________________________________________________
_____________________________________________________________________________________________
modelul m/t______________________________________________________________________________
Specialist _____________________________________________________________________________________
(se indic numele prenumele i instituia la care activeaz specialistul)

_____________________________________________________________________________________________
_____________________________________________________________________________________________
Persoana supus testrii ____________________________________________________a fost informat c refuzul,
(numele i prenumele)

mpotrivirea sau eschivarea conductorului mijlocului de transport de la testarea alcoolscopic, de la examenul

medical n vederea stabilirii strii de ebrietate i a naturii ei sau de la recoltarea probelor biologice n cadrul acestui
examen medical constituie infraciunea prevzut de art.2641 alin.(3) Cod penal.
Concomitent i s-a explicat c potrivit pct.13 i 14 din Regulamentul privind modul de testare alcoolscopic
i examinare medical pentru stabilirea strii de ebrietate i naturii ei, aprobat prin HG nr. 296 din 16.04.2009, n
cazul n care nu este de acord cu procedura testrii, funcionarea aparatului de testare, rezultatul testrii are dreptul
de a-l contesta prin examinarea medical cu recoltarea obligatorie a probelor biologice i c n acest caz urmeaz a fi
nsoit de lucrtorul de poliie la cea mai apropiat instituie medical abilitat, dar nu mai trziu de 2 ore dup
testarea alcoolscopic.
_______________________________
(semntura persoanei prentmpinate)

Mijloacele tehnice: Analizator a aerului expirat Alcotest Drager 6810, nr/seria:___________________

_____________________________________________________________________________________________
(se indic mijloacele tehnice utilizate, nr. i seria de identificare a aparatului electronic condiiile de utilizare, inclusiv audio sau video utilizate)

___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________

Despre faptul utilizrii

Alcotestului 6810 cu nr/seria:_______________________

s-acomunicat

persoanelor

(nr. i seria de identificare a aparatului electronic)

care particip la aciunea privind constatarea faptei de conducere a mijlocului de transport n stare de ebrietate, rezultatul
testrii alcoolscopice ___________mg/l_- adic grad______________n vaporii de aer expirat, a fost adus la cunotina
(se indic concentraia de alcool n aerul respirat)

persoanei supuse testrii contra semntur, iar extrasul semnat de persoana testat i agentul constatator se anexeaz la
procesul verbal.
___________________________
(semntura persoanei)

Numrul de nregistrare a informaiei n Registrul nr.2 de eviden a altor informaii despre infraciuni a
IP_________________ R-2, Nr.__________ n cazul n care concentraia vaporilor de alcool este de 0.15 mg/l i mai
mult n aerul expirat.
___________________________________________________________________________________________________
(se face meniuni despre refuzul de a semna extrasul cu privire la

___________________________________________________________________________________________________
rezultatul testrii i motivele invocate de persoana testat se indic)

___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
La procesul verbal au fost anexate _______________________________________________________________________
(fotografii, pelicule, nregistrri audio, video mpachetate i sigilate)

___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
Procesul verbal a fost dat citirii n prezena tuturor participanilor la aciune i li s-a explicat c au dreptul de a face
obiecii_____________________________________________________________________________________________
(obiecii i meniuni ale participanilor la aciune n caz dac sunt)

___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
(n cazul refuzului de a semna procesul verbal se face meniunea respectiv, indicndu-se inclusiv motivele indicate de persoana testat)

___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
Persoana testat ______________________
(semntura)
Persoane prezente ___________________
(semntura)
Agent constatator _____________________
(semntura)