AMAS

Peer Report


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Date of Report Request:

Name of Individual Being Monitored:
 

Date of Birth of Individual Being Monitored:
 

Employee ID (if applicable):

Base Meeting or Peer Appointment ABSENCES:
(for 'None' enter '0')

I have been in contact with this airman on the following dates since the last report:

Airman Sobriety Date:

Airman has a 12-Step Sponsor:

Airman is working step:

Further comments are appreciated to assist with oversight and monitoring by IMS and Psychiatrist:
(Consider asking questions such as: How has your recovery improved over past 6 months? -or- Describe what is different about you today because you are sober? Ask for specifics.)

 

To the best of my knowledge this airman has remained totally abstinent. I have no concerns. I agree to notify the IMS of any changes.

Today's Date:

Position or Job Title:  

Leave this empty:

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Signature Certificate
Document name: Peer Report
lock iconUnique Document ID: b58d96652f20bf6777666350328d7b831a9c1989
Timestamp Audit
March 4, 2022 1:59 pm MDTPeer Report Uploaded by IMS Records - imsrecords@aviationmedicine.com IP 180.195.115.70
March 17, 2022 12:50 pm MDTIMS Records - imsrecords@aviationmedicine.com added by Caitlin Bruton - cbruton@aviationmedicine.com as a CC'd Recipient Ip: 69.129.92.41
April 13, 2022 2:00 pm MDTIMS Records - imsrecords@aviationmedicine.com added by Caitlin Bruton - cbruton@aviationmedicine.com as a CC'd Recipient Ip: 69.129.92.41
June 16, 2023 1:21 pm MDT Document owner cbruton@aviationmedicine.com has handed over this document to imsrecords@aviationmedicine.com 2023-06-16 13:21:20 - 70.176.10.239
June 16, 2023 1:21 pm MDTIMS Records - imsrecords@aviationmedicine.com added by IMS Records - imsrecords@aviationmedicine.com as a CC'd Recipient Ip: 70.176.10.239
December 7, 2023 9:57 am MDTIMS Records - imsrecords@aviationmedicine.com added by IMS Records - imsrecords@aviationmedicine.com as a CC'd Recipient Ip: 180.195.200.90
December 7, 2023 10:25 am MDTIMS Records - imsrecords@aviationmedicine.com added by IMS Records - imsrecords@aviationmedicine.com as a CC'd Recipient Ip: 180.195.200.90
January 16, 2024 1:58 pm MDTIMS Records - imsrecords@aviationmedicine.com added by IMS Records - imsrecords@aviationmedicine.com as a CC'd Recipient Ip: 180.195.115.70