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MTL100-05_C-RH-RH-D-18-002-002

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Held by: Ville de Montréal. Section des archives via Archives de Montréal (Ville de Montréal)
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In the picture: Document Form Government Montreal Printed Public HealthTagged automatically by a vision model; may contain mistakes.
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Format: Document
What the image shows: This is a blank printed form titled "Annexe A - Grille de signes et symptômes objectifs d'intoxication" with the Montréal city logo at the top right. It is laid out in four numbered sections with checkbox lists under headings for behaviour, physical symptoms, elocution, and balance, plus blank fields for the employee's name, date and place of observation, and witnesses' and supervisor's details. The text is in French and the page is black and white, with a few blank lines for writing.Described automatically by a vision model; may contain mistakes.
Text in the image: MontréalAnnexe A – Grille de signes et symptômes objectifs d'intoxicationSection 1 – Identification de l'employéNom de l'employé :Date, heure et lieu de l'observation :Description de l'incident :Section 2 – Observations de facultés affaibliesComportementSymptôme physiqueÉlocutionÉquilibreSection 3 – Effets sur le travail observables depuis le(date de début des observations)Section 4 – Informations complémentairesTémoin(s) :Intervention(s) du superviseur :Signature :Date :NervositéPolitesse exagéréeConfusionExcitationSomnolenceIrritabilitéNon-coopératifTrop bavardPleursPertes de mémoireProblème d'attentionAutre (veuillez préciser)Sudation excessiveRéactions lentesAgitationMaux de têteTremblementsDétérioration de l'hygièneEcchymoses inexpliquéesNausées ou vomissementsPupilles dilatéesYeux rouges ou vitreuxOdeur de cannabisOdeur d'alcoolBouche sècheEmpâtéLenteConfuseDifficileIncohérenteTendueChuteChancelantIncertainBesoin d'appuiTitubanteInstableAutres (veuillez préciser)Détérioration du rendement de l'employéNon-respect des politiques de l'organisationRead automatically; may contain mistakes.
Harvested: 2026-10-16T15:48:21Z · source datestamp n/a · ead

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