S.I. No. 540/2011 - Road Traffic Act 2010 (Sections 15 and 17) (Prescribed Forms) Regulations 2011.

Notice of the making of this Statutory Instrument was published in

“Iris Oifigiúil” of 1st November, 2011.

I, LEO VARADKAR, Minister for Transport, Tourism and Sport, in exercise of the powers conferred on me by section 5 of the Road Traffic Act 1961 (No. 24 of 1961) and sections 15 and 17 of the Road Traffic Act 2010 (No. 25 of 2010) (as adapted by the Transport (Alteration of Name of Department and Title of Minister) Order 2011 ( S.I. No. 141 of 2011 )), hereby make the following regulations:

1. (1) These Regulations may be cited as the Road Traffic Act 2010 (Sections 15 and 17) (Prescribed Forms) Regulations 2011.

(2) These Regulations come into operation on 28th October, 2011.

2. In these Regulations “Act of 2010” means Road Traffic Act 2010 (No. 25 of 2010).

3. The form set out in Schedule 1 is prescribed for the purposes of section 15 of the Act of 2010.

4. The form set out in Part 1 of Schedule 2 is the prescribed form of certificate for the purposes of section 17 of the Act of 2010 to certify a concentration of alcohol.

5. The form set out in Part 2 of Schedule 2 is the prescribed form of certificate for the purposes of section 17 of the Act of 2010 to certify the presence of a drug or drugs.

SCHEDULE 1

Form to be completed by a designated doctor or designated nurse under section 15 of the Road Traffic Act, 2010 .

Foirm le comhlánú ag dochtúir ainmnithe nó d’altra ainmnithe faoi alt 15 den Acht um Thrácht ar Bhóithre, 2010.

1.	Name, address, date of birth and gender of the person from whom the specimen to which this form relates was taken, or who provided the specimen.Ainm, seoladh, dáta breithe agus inscne an duine ar tógadh an sampla lena mbaineann an fhoirm seo uaidh nó uaithi, nó a chuir an sampla ar fáil.	Name/Ainm..............Address/Seoladh..........................................Date of birth/Dáta breithe..............Gender/Inscne an duine..............
2.	Nature of specimen.(insert “blood” or “urine” asappropriate)An cineál sampla. (cuir isteach “fuil”nó “fual” de réir mar is cuí)	..............
3.	Place at which specimen was taken or provided. (delete whichever is not appropriate)An áit inar tógadh nó inar soláthraíodh an sampla.(scrios cibé ceann nach bhfuil cuí)	(a) ..............Garda Síochána Station/An Stáisiún Garda Síochána(b) ..............Hospital/Ospidéal
4.	Date on which specimen was taken or provided.An dáta ar ar tógadh nó ar ar soláthraíodh an sampla.	..............
5.	Time at which specimen was taken or provided.An t-am a tógadh nó a soláthraíodh an sampla.	..............
6.	Garda Síochána station from which the specimen will be forwarded to the Bureau.(to be completed in the case of a specimen taken or provided in a hospital)Stáisiún Garda Síochána óna gcuirfear an sampla ar aghaidh chuig an mBiúró.(le comhlánú sa chás gur tógadh sampla nó gur cuireadh sampla ar fáil in ospidéal)	..............

I, the undersigned designated doctor or designated nurse

Thóg mise, an dochtúir ainmnithe nó d’altra ainmnithe a bhfuil mo shíniú leis seo thíos

(a) took from the person named at 1 above the specimen of blood or (delete whichever is not appropriate)

ón duine ainmnithe ag 1 thuas an sampla fola nó (scrios amach cibé ceann nach bhfuil cuí)

(b) obtained from the person named at 1 above the specimen of urine

ón duine ainmnithe ag 1 thuas an sampla fuail

to which this form relates.

lena mbaineann an fhoirm seo.

I divided the specimen into two parts. I placed each part in a container, which I forthwith sealed.

Rinne mé dhá chuid den sampla. Chuir mé gach cuid ar leith i gcoimeádán agus shéalaigh mé láithreach é.

I labelled each container with the name of the person and date. I gave both containers to a member of the Garda Síochána.

Chuir mé lipéad ar gach coimeádán ar leith le hainm an duine agus an dáta. Thug mé an dá choimeádán do chomhalta de chuid an Gharda Síochána.

Signature of designated doctor or designated nurse

Síniú an dochtúra ainmnithe nó d’altra ainmnithe..............

SCHEDULE 2

Part 1

Certificate issued by the Medical Bureau of Road Safety under section 17 of the Road Traffic Act, 2010, certifying a concentration of alcohol.

Deimhniú arna eisiúint ag an Lia-Bhiúró um Shábháilteacht ar Bhóithre faoi alt 17 den Acht um Thrácht ar Bhóithre, 2010, ina ndeimhnítear cion alcóil.

Particulars relating to specimen received for analysis, as shown on the form completed by designated doctor or designated nurse:—

Sonraí a bhaineann le sampla arna fháil lena anailísiú, mar a thaispeántar ar an bhfoirm arna comhlánú ag an dochtúir ainmnithe nó d’altra ainmnithe:—

1.	Name, address, date of birth and gender of the person from whom the specimen was taken or who provided the specimen.Ainm, seoladh, dáta breithe agus inscne an duine ónar tógadh an sampla nó a sholáthair an sampla.	NameAinm..............AddressSeoladh........................................................Date of birth/Dáta breithe..............Gender/Inscne an duine..............
2.	Nature of specimen.(insert “blood” or “urine” asappropriate)An cineál sampla. (cuir isteach “fuil”nó “fual” de réir mar is cuí)	..............
3.	Place at which specimen was taken or provided. (delete whichever is not appropriate)An áit inar tógadh nó inar soláthraíodh an sampla.(scrios cibé ceann nach bhfuil cuí)	a) ..............Garda Síochána Station/An Stáisiún Garda Síochánab) ..............Hospital/Ospidéal
4.	Date on which specimen was taken or provided.An dáta ar ar tógadh nó ar ar soláthraíodh an sampla.	..............
5.	Time at which specimen was taken or provided.An t-am a tógadh nó a soláthraíodh an sampla.	..............
6.	Garda Síochána station from which the specimen analysed was forwarded.(to be completed in the case of a specimen taken or provided in a hospital)An Stáisiún Garda Síochána ónar cuireadh an sampla ar aghaidh. (le comhlánú i gcás sampla a tógadh nó a soláthraíodh in ospidéal)	..............
The Medical Bureau of Road Safety certifies that on analysis by the Bureau the specimen to which the above particulars relate contained a concentration of (delete whichever is not appropriate) Deimhníonn an Lia-Bhiúró um Shábháilteacht ar Bhóithre, tar éis don Bhiúró anailís a dhéanamh, go raibh, sa sampla lena mbaineann na sonraí thuas, cion(scrios cibé ceann nach bhfuil cuí)		..............milligrammes of alcohol per 100 millilitres of blood or urine.m(h) illeagram alcóil in aghaidh an 100 millilítear fola nó fuail.

Signature of person who carried out the analysis/Síniú an duine a rinne an anailís ..............

Date/Dáta ..............

This certificate is issued under section 17 of the Road Traffic Act, 2010.

Eisítear an deimhniú seo faoi alt 17 den Acht um Thrácht ar Bhóithre, 2010.

The Seal of the Medical Bureau of Road Safety was affixed hereto this

Greamaíodh Séala an Lia-Bhiúró um Shábháilteacht ar Bhóithre de seo ar an

............................................. day of/lá seo de .............................. in the presence of/i láthair ..............

(Chairman or Director or Deputy Director of the Bureau or member of the Bureau duly authorised by the Bureau to act in that behalf).

(Cathaoirleach nó Stiúrthóir nó Leas-Stiúrthóir an Bhiúró nó comhalta den Bhiúró arna údarú nó arna húdarú go cuí ag an mBiúró chun gníomhú chuige sin).

Part 2

Certificate issued by the Medical Bureau of Road Safety under section 17 of the Road Traffic Act, 2010, certifying the presence of a drug or drugs.

Deimhniú arna eisiúint ag an Lia-Bhiúró um Shábháilteacht ar Bhóithre faoi alt 17 den Acht um Thrácht ar Bhóithre, 2010, á dheimhniú go bhfuil druga nó drugaí ann.

Particulars relating to specimen received for analysis, as shown on the form completed by designated doctor or designated nurse:—

Sonraí a bhaineann le sampla arna fháil lena anailísiú, mar a thaispeántar ar an bhfoirm arna comhlánú ag an dochtúir ainmnithe nó d’altra ainmnithe:—

1.	Name, address, date of birth and gender of the person from whom the specimen was taken or who provided the specimen.Ainm, seoladh, dáta breithe agus inscne an duine ónar tógadh an sampla nó a sholáthair an sampla.	NameAinm..............AddressSeoladh..........................................Date of birth/Dáta breithe..............Gender/Inscne an duine..............
2.	Nature of specimen.(insert “blood” or “urine” asappropriate) An cineál sampla. (cuir isteach “fuil”nó “fual” de réir mar is cuí)	..............
3.	Place at which specimen was taken or provided. (delete whichever is not appropriate)An áit inar tógadh nó inar soláthraíodh an sampla.(scrios cibé ceann nach bhfuil cuí)	a) ..............Garda Síochána Station/An Stáisiún Garda Síochánab) ..............Hospital/Ospidéal
4.	Date on which specimen was taken or provided.An dáta ar ar tógadh nó ar ar soláthraíodh an sampla.	..............
5.	Time at which specimen was taken or provided.An t-am a tógadh nó a soláthraíodh an sampla.	..............
6.	Garda Síochána station from which the specimen analysed was forwarded. (to be completed in the case of a specimen taken or provided in a hospital)An Stáisiún Garda Síochána ónar cuireadh an sampla ar aghaidh. (le comhlánú i gcás sampla a tógadh nó a soláthraíodh in ospidéal)	..............
The Medical Bureau of Road Safety certifies that on analysis by the Bureau the specimen to which the above particulars relate contained the presence of the following drug or drugs.(delete whichever is not appropriate) Deimhníonn an Lia-Bhiúró um Shábháilteacht ar Bhóithre, tar éis don Bhiúró anailís a dhéanamh, go raibh an druga nó na drugaí seo a leanas sa sampla lena mbaineann na sonraí thuas.(scrios cibé ceann nach bhfuil cuí)		..........................................

Signature of analyst/Síniú an anailísí..............

Date/Dáta..............

This certificate is issued under section 17 of the Road Traffic Act, 2010.

Eisítear an deimhniú seo faoi alt 17 den Acht um Thrácht ar Bhóithre, 2010.

The Seal of the Medical Bureau of Road Safety was affixed hereto this

Greamaíodh Séala an Lia-Bhiúró um Shábháilteacht ar Bhóithre de seo ar an

........................................ day of/lá seo de...................................in the presence of/i láthair..............

(Chairman or Director or Deputy Director of the Bureau or member of the Bureau duly authorised by the Bureau to act in that behalf).

(Cathaoirleach nó Stiúrthóir nó Leas-Stiúrthóir an Bhiúró nó comhalta den Bhiúró arna údarú nó arna húdarú go cuí ag an mBiúró chun gníomhú chuige sin).

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GIVEN under my Official Seal,

27 October 2011.

LEO VARADKAR,

Minister for Transport, Tourism and Sport.

EXPLANATORY NOTE

(This note is not part of the Instrument and does not purport to be a legal interpretation)

These Regulations prescribe the form, both in English and Irish, to be completed by a designated doctor or designated nurse under section 15 of the Road Traffic Act, 2010 and the certificate, both in English and Irish, to be issued by the Medical Bureau of Road Safety under section 17 of the Road Traffic Act, 2010 .