You are here

403.10E6 Drug and Alcohol Reasonable Suspicion Observation

Code No. 4O3.10E6

DRUG AND ALCOHOL REASONABLE SUSPICION OBSERVATION

Employee's Name:  ____________________________________

Date of Observation: _________________

Time of Observation:  From __________ a.m./p.m. to __________ a.m./p.m.

Location: _____________________________________________________________________________

Observed personal behavior: (check all appropriate items)

Speech: Normal_____ Incoherent_____ Confused_____ Slurred _____ Whispering_____ Silent_____

Balance: Normal_____ Swaying_____ Staggering_____ Falling_____

Walking and Turning: Normal_____ Stumbling_____ Swaying_____

Falling_____ Arms raised for balance_____ Reaching for support_____

Awareness: Normal_____ Confused_____ Paranoid_____ Sleepy Stupor_____ Lack of coordination_____

Odor: ________Normal ________Alcohol ________Burned rope ________

Other observed behavior/odor:________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

Reasonable suspicion of current use or impaired by: alcohol_____ drugs_____.

Above behavior witnessed by:

_____________________________________________________________________________

_____________________________________________________________________________

Signed: _______________________________________  Date: ______________________

Signed (optional)______________________________ Date: ______________________

This form must be completed by each trained employee observing the driver suspected of drug use and/or alcohol misuse by behavior, speech and/or odor while on duty, the earlier of within 24 hours or the determination of reasonable suspicion or prior to receiving tile test results. The observations must be specific, contemporaneous and articulable concerning the appearance, behavior, speech and body odor of the driver.

 

Revised  7-17-23