The DA Form 2801 is the official U.S. Army form used to document consent for a polygraph examination. It is governed by Army Regulation AR 195-6, with the Provost Marshal General (PMG) as the proponent. The form must be completed before any polygraph session can proceed.
This consent form spells out key rights for the examinee. Participation is voluntary, and declining will not trigger adverse action based on that choice alone. The examinee may consult a lawyer before, during, or after the session. The form also discloses whether audio or video surveillance may be used, defines the scope of questions, and explains how results may appear in administrative, military, or judicial proceedings.
Three signature blocks appear at the bottom: one for the examinee, one for the examiner, and space for witnesses. These signatures confirm that rights were explained and that consent was freely given. The completed DA Form 2801 is retained as part of the official Army record.
For related documents, you can review the Army Certificate DA Form 87 or the Maryland Polygraph Police form for law enforcement comparison.
| Question | Answer |
|---|---|
| Form Name | Da Form 2801 |
| Form Length | 1 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 15 sec |
| Other names | polygraph report sample, online lie detector test, polygraph consent form template, passed lie detector test results template |