Polygraph Consent Template

In plain language: Names the subject, the examiner, and the requesting party, and assigns a unique examination reference to tie the consent to a specific test event.

Common mistake: Listing only the examiner without naming the requesting party. This omission obscures who receives the results and who is obligated to protect them, creating disclosure liability.

In plain language: States explicitly that the subject is participating of their own free will, that no promise or threat has been made, and that refusal carries no specified penalty.

Common mistake: Omitting the 'no adverse consequence for refusal' language. Without it, the consent may be challenged as coerced, rendering results inadmissible and exposing the requesting party to EPPA or equivalent liability.

In plain language: Defines the specific subject matter the examination will cover — a particular incident, date range, or issue — and prohibits the examiner from asking questions outside that scope.

Common mistake: Defining the scope so broadly that it covers unrelated conduct or general character. Overly broad scope clauses are the leading cause of EPPA violations and may expose the employer to civil penalties of up to $10,000 per violation.

In plain language: Informs the subject of their rights under applicable law — in the US, the specific EPPA disclosures required at least 48 hours before the examination.

Common mistake: Providing the statutory disclosure at the time of examination rather than at least 48 hours in advance, as required by the EPPA. This procedural defect voids the examination for EPPA purposes regardless of whether the content is accurate.

In plain language: Confirms that the subject has reviewed all questions that will be asked before the examination begins and agrees that no surprise or undisclosed questions will be introduced.

Common mistake: Attaching a Schedule A that lists only broad topic areas rather than the exact questions. Courts and regulators require the actual questions to have been disclosed — topic headings do not satisfy the requirement.

In plain language: Limits who may receive the examination results and under what conditions — typically the requesting party, law enforcement under court order, or third parties with the subject's written authorization.

Common mistake: Omitting a confidentiality clause entirely. Without it, the examiner or requesting party may share results broadly — including with future employers — exposing the subject and increasing liability for the requesting party.

In plain language: Grants the examiner express authorization to attach instrumentation, conduct the test, and record physiological data for the duration of the examination.

Common mistake: Using past-tense authorization language ('Subject authorized...') drafted as a post-examination acknowledgment. Consent must be obtained before the examination begins — backdating or post-hoc documentation is legally invalid.

In plain language: Reminds the subject of their right to stop the examination at any time, describes how to exercise that right, and confirms there is no penalty for doing so mid-test.

Common mistake: Failing to address what happens to partial results if the subject stops mid-examination. Without this clause, partial data could be disclosed as inconclusive or deceptive, causing reputational harm without any legal basis for use.

In plain language: Records the subject's dated signature confirming they have read the document, had an opportunity to ask questions, and are signing voluntarily.

Common mistake: No witness line on the signature block. A third-party witness signature substantially strengthens the voluntariness of consent if the agreement is later challenged.

A polygraph consent form is a legal document an individual signs before undergoing a lie detector examination. It confirms that participation is voluntary, discloses the scope of questions that will be asked, and informs the subject of their legal rights — including the right to stop at any time. In the United States, most private employers are prohibited from requiring polygraphs, so a valid consent form is also evidence that the examination was genuinely voluntary and legally permissible.

Under the US Employee Polygraph Protection Act (EPPA), most private employers cannot require, request, suggest, or cause an employee or applicant to take a polygraph. The law provides narrow exemptions for employers in certain industries — federal defense contractors, certain security firms, and pharmaceutical distributors — and for specific incident investigations involving a reasonable suspicion of economic loss. Government employers are not covered by the EPPA and may use polygraphs more broadly. Always confirm the applicable exemption in writing before scheduling an examination.

Yes — no polygraph examination should proceed without a signed written consent form. For EPPA-exempt private employers, a signed consent is a regulatory requirement with mandatory content. Even in non-EPPA contexts, such as law enforcement voluntary examinations, a signed consent is essential to establish voluntariness, which governs the admissibility and usability of results. Proceeding without documented consent exposes every party to serious legal liability.

Under the EPPA, the pre-examination notice must tell the subject: (1) the nature of the examination and the specific incident under investigation; (2) that they may refuse to take the examination; (3) that they may terminate the examination at any time; (4) that they may not be required to take the examination as a condition of employment (with limited exceptions); (5) the consequences, if any, of refusing; and (6) their right to consult a lawyer. This notice must be delivered in writing at least 48 hours before the examination — oral disclosure does not satisfy the requirement.

In the United States, polygraph results are generally inadmissible in federal court and in most state courts as evidence of guilt or innocence, because courts have not accepted polygraphs as scientifically reliable enough to meet evidence standards. However, results may be used in limited contexts — administrative proceedings, employment termination decisions in exempt industries, or by agreement of both parties in some state courts. Admissibility rules vary significantly by jurisdiction, so legal counsel should assess whether results can be used for the intended purpose before the examination is administered.

In most US private-sector contexts, no — the EPPA prohibits disciplining, discharging, or discriminating against an employee or applicant solely because they refused to take a polygraph examination. The narrow exception applies in specific incident investigations where the employer has met all EPPA procedural requirements and the refusal is one factor — not the sole factor — in an adverse action. Government employers and employers in certain exempt industries operate under different rules. Outside the US, rules vary substantially by country.

Under the EPPA, the written pre-examination notice must be delivered to the subject at least 48 hours before the examination is scheduled — not counting weekends or holidays. Delivery on the day of the examination, or even the evening before, does not satisfy this requirement and constitutes a per se violation. Use a delivery method that creates a timestamp — email with read receipt, personal delivery with a signed acknowledgment, or tracked mail — to document compliance.

Yes — the subject may withdraw consent and stop the examination at any point before or during the test. A well-drafted consent form includes an explicit withdrawal clause that describes how to exercise this right (typically a verbal statement to the examiner) and confirms that partial results will not be used or disclosed. Once the examination is fully completed, consent to the test itself cannot be retroactively revoked, but the subject retains rights regarding how results are disclosed.

Notarization is not a legal requirement for a polygraph consent form in any major jurisdiction. The voluntariness of consent is typically established through the content of the form itself, the 48-hour advance delivery, and a third-party witness signature at execution. If the examination results are expected to be used in a high-stakes proceeding — such as a criminal investigation or major civil litigation — legal counsel may recommend additional steps, but notarization is not among them.