AUDIT-C Alcohol Screening

Use it when a clinician, occupational health nurse, or trained intake staff needs to screen for risky alcohol use and document the result. It is appropriate for workplace health programs, employee assistance referrals, and clinical intake workflows where a brief validated screen is needed. It is not a substitute for a full diagnostic assessment when symptoms or safety concerns require deeper review.

It captures the participant context, the three AUDIT-C questions, the calculated total score, the scoring basis used for interpretation, and the documented next step. It also includes fields for consent, clinical notes, a follow-up date, referral resources, and clinician signature. That makes it useful as both a screening form and a record of what happened after the screen.

Use it at intake, during periodic health screenings, or whenever a policy calls for alcohol-use screening. The right cadence depends on the program purpose and the level of risk identified in prior screenings. If the score is elevated or the participant reports change in use, repeat screening should follow the organization’s clinical protocol.

Yes, if you are collecting PII or using the result for clinical or workplace follow-up, the participant should see a clear consent or acknowledgment field. The form should also explain what happens after submission, including who reviews the result and whether the information enters a health record or case file. Keep the disclosure limited to what you actually use, consistent with data minimization.

Common mistakes include leaving the scoring basis unclear, using free text where a structured field is needed, and skipping the follow-up plan after an elevated score. Another frequent issue is collecting more personal information than necessary, which creates privacy risk without improving the screen. The template helps prevent these problems by separating the questions, score, risk zone, and next action.

Keep the three question fields intact so the validated instrument remains recognizable, then tailor the surrounding context fields to your workflow. You can rename the screening context, add a program-specific referral resource, or route the next step to a clinician review queue. Avoid changing the question wording or score logic unless your clinical governance process approves it.

Yes, it can be connected to EHR, HR case management, or secure intake workflows through form automation or integrations. Common handoffs include sending the score to a clinician review task, creating a follow-up reminder, or attaching the completed form to an audit trail. Keep access controls tight because the form may contain sensitive health-related information.

An ad-hoc questionnaire often lacks consistent scoring, clear interpretation, and a documented next step. This template standardizes the three AUDIT-C items, captures the score in a structured way, and records the risk zone and follow-up action. That makes it easier to review, audit, and use consistently across staff or locations.