IN Code § 36-8-24-5 (2021)
2021 Indiana Code|Title 36. Local Government|Article 8. Public Safety|Chapter 24. Vehicular Carbon Monoxide Testing|36-8-24-5. Required Forms

Sec. 5. (a) A test administrator shall generate a written form for each vehicular carbon monoxide test conducted on behalf of the test administrator's fire department.(b) Each form described in subsection (a) must contain entries for the following identifiers:(1) Name of the motor vehicle owner.(2) Address of the motor vehicle owner.(3) Telephone number of the motor vehicle owner.(4) Vehicle year.(5) Vehicle make.(6) Vehicle model.(7) License plate number.(8) State in which the motor vehicle is registered.(9) Name of the fire department responsible for the administration of the vehicular carbon monoxide test.(10) Serial number of the direct read instrument.(11) Unit model number of the direct read instrument.(12) Carbon monoxide reading for the motor vehicle after five (5) minutes.(13) Carbon monoxide reading for the motor vehicle after ten (10) minutes.(14) Date of the vehicular carbon monoxide test.(15) Time of the vehicular carbon monoxide test.(16) Name of the motor vehicle owner (printed).(17) Name of the motor vehicle owner (signature).(18) Name of the test administrator (printed).(19) Name of the test administrator (signature).(20) Any other information required by the standard record keeping practices of the fire department responsible for the administration of the vehicular carbon monoxide test.(c) In addition to the information required under subsection (b), each form shall contain the following language:"The motor vehicle owner receiving carbon monoxide test results for a motor vehicle recognizes and agrees that the carbon monoxide test results provided are the result of a vehicular carbon monoxide test conducted by the device listed on the date and time indicated and under the conditions present at that date and time. The readings obtained by the vehicular carbon monoxide test do not constitute a warranty that the tested motor vehicle has a carbon monoxide issue or that the vehicle is free from any carbon monoxide issue.In consideration for receiving the vehicular carbon monoxide test from (insert the name of the fire department) at no charge to the recipient, the recipient agrees to discharge and hold harmless (insert the name of the fire department), and its agents, employees, and officers from any and all actions, claims, causes of action, demands, damages, including punitive damages, and expenses arising from or relating to the results of the vehicular carbon monoxide test. This release specifically applies to any claims made or implied based upon the readings derived from the vehicular carbon monoxide test. This release from liability is binding regardless of whether a claim or expense is caused, or alleged to have been caused, by the sole, joint, several, or comparative negligence of the (insert the name of the fire department) or by any other alleged breach of duty or warranty, express or implied, by the (insert the name of the fire department).The recipient of the vehicular carbon monoxide test represents that he/she will, upon disclosure of the test readings and test administrator recommendations, assume all responsibility for all automotive diagnostics and repair. It is the responsibility of the recipient of the vehicular carbon monoxide test to schedule any recommended diagnostic services or repairs.This agreement constitutes a waiver that covers the entire period from the date the results of the vehicular carbon monoxide test are presented to the owner of the motor vehicle through and after the date the owner submits the motor vehicle to an automotive specialist for any desired or recommended repair, maintenance, or service.".(d) All completed and original forms shall be permanently stored:(1) by the fire department responsible for the administration of the vehicular carbon monoxide test; and(2) in a manner consistent with the current record keeping practices of the fire department responsible for the administration of the vehicular carbon monoxide test.As added by P.L.8-2018, SEC.2.