DA Form 2801: Polygraph Consent Form (Download PDF) – DA Form 2801, titled Polygraph Examination Statement of Consent, is an official Department of the Army form. It documents that an individual understands their rights and voluntarily agrees to undergo a polygraph examination.
The form is prescribed under AR 195-6, Department of the Army Polygraph Activities. It pairs with DA Form 3881 (Rights Warning Procedure/Waiver Certificate), which details legal rights.
Key Details:
- Proponent: U.S. Army Criminal Investigation Division (CID) or Provost Marshal General (PMG).
- Current Version: June 2011 (previous editions obsolete).
- Official Download: DA Form 2801 PDF.
Purpose of the Polygraph Examination Statement of Consent
The form protects the rights of the examinee while allowing the Army to conduct polygraph exams for:
- Criminal investigations.
- Counterintelligence and security clearance matters.
- Suitability assessments for agents, sources, or operatives.
It confirms the examinee:
- Has been informed of their rights.
- Understands the exam procedures.
- Consents voluntarily without coercion.
- Knows they can withdraw consent at any time.
No adverse action can be taken solely for refusing the exam.
When Is DA Form 2801 Required?
Commanders, CID investigators, or authorized officials use it in situations where polygraph testing helps resolve investigations or verify credibility. This includes:
- Serious criminal offenses under the Uniform Code of Military Justice (UCMJ).
- Espionage, sabotage, or unauthorized disclosure of classified information.
- Resolving derogatory information affecting security clearances.
Only certified Army polygraph examiners conduct exams, following strict protocols in AR 195-6. Exams require prior approval via related forms like DA Form 2805.
Key Provisions and Rights Explained on DA Form 2801
Before signing, the polygraph examiner must explain several critical points to the examinee in the presence of witness(es):
- Rights per DA Form 3881 have been explained.
- Refusal to take the polygraph cannot result in adverse action based solely on refusal.
- Right to consult a lawyer before, during, and after the exam.
- The examination area may have a two-way mirror or observation device.
- The session may be monitored or recorded.
- Questioning can occur before, during, and after the instrument portion.
- Statements made during the exam can be used in administrative, military, or judicial proceedings.
- Consent is voluntary and can be withdrawn at any time.
The form includes a statement confirming no threats, coercion, or promises were made.
How to Fill Out DA Form 2801 (Step-by-Step)?
- Header Information: Enter File Number, Location, Time, Date, Name (Last, First, MI), Grade/Status, and Organization/Address.
- Statement of Consent: Review the detailed rights and procedures explained by the examiner.
- Signatures: The examinee signs to confirm understanding and voluntary consent. Witnesses and the examiner also sign.
Important: Read the entire form carefully. Consult a legal advisor (JAG) if needed before signing. Only sign if you fully understand and agree.
Who Needs to Sign DA Form 2801?
- Examinee — The person undergoing the polygraph.
- Witness(es) — Present during rights explanation.
- Polygraph Examiner — Certified U.S. Army examiner who conducts the test.
Related Army Forms and Regulations
- DA Form 3881: Rights Warning.
- DA Form 2805: Polygraph Examination Authorization.
- AR 195-6: Governs all Army polygraph policies and procedures (updated as of 2016).
Polygraph records are handled securely and stored according to Army regulations for quality control and privacy.
Download DA Form 2801 Official PDF
U.S. Army personnel and authorized users can download the latest fillable version here:
Download DA Form 2801 PDF
Always use the official source from armypubs.army.mil for the most current version.
Frequently Asked Questions (FAQs)
Is the polygraph exam mandatory?
No. Consent is voluntary, and refusal alone cannot lead to adverse action.
Can I withdraw consent during the exam?
Yes. The examination must stop immediately if you withdraw consent.
Who can access the results?
Results are used for official investigative or administrative purposes and protected under privacy regulations.
Where can I get help with DA Form 2801?
Contact your unit’s legal advisor, CID, or refer to AR 195-6 for guidance.
Note for Service Members: Polygraph examinations follow strict ethical and legal standards to ensure fairness and reliability.
For the most accurate and up-to-date information, consult official Army publications, your chain of command, or a qualified military legal professional. Regulations and forms can be updated, so verify through armypubs.army.mil.