At **(TIME)** hours on **(DAY)** **(DATE)**, I was on duty when I had occasion to undertake the station breath test procedure in the Intoximeter Room at **(STATION)** Police station. Also present were **(OFFICERS)**.

At the commencement of this I explained to the detained person, who gave their details to me as
**(NAME)**, **(DATE_OF_BIRTH)**, that the process was being documented for evidential purposes both in written form as well as with a visual and audio recording.

I inserted **(QUANTITY)** Digital Video discs into the PACEnet recorder which is installed near to the station Intoximeter and began the visual and audio recording of the breath test process.

I then commenced the breath test procedure. This entire procedure was being contemporaneously recorded in written form in national booklet MG DD A, together with form MGDD B, C, D, E or F*.

At **(TIME)** hours on **(DAY)** **(DATE)** I completed the breath test procedure and I stopped the PACEnet machine recording and subsequently withdrew the discs, one of which I sealed into a Plastic Jewel Case / Paper Wallet / Plastic Wallet and asked the detainee to sign the seal. The other can be used as a working copy. The unused portion of the discs is automatically erased by the machine to prevent any tampering.

The sealed master disc is stored within the Area Tape Library as Exhibit Number **(EXHIBIT)** and can be produced if necessary.

The working copy is attached, together with the form MG DD A, B, C, D, E or F*.

I am willing to attend Court if required.