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 Caitlin Bruton - IP
March 17, 2022 12:50 pm MDTIMS Records - added by Caitlin Bruton - as a CC'd Recipient Ip:
April 13, 2022 2:00 pm MDTIMS Records - added by Caitlin Bruton - as a CC'd Recipient Ip:
June 16, 2023 1:21 pm MDT Document owner has handed over this document to 2023-06-16 13:21:20 -
June 16, 2023 1:21 pm MDTIMS Records - added by IMS Records - as a CC'd Recipient Ip: