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 Loud
Slurred Whispering Silent Disruptive
Balance: Normal Swaying Staggering Falling
Walking Normal Stumbling Swaying Falling
And Turning: Arms raised for balance
Awareness: Normal Confused Paranoid
Sleepy or Stupor Lack of Coordination
Odor: Normal Alcohol Burned Rope
Appearance: Red Eyes Vomiting Half closed eyes
Comments:
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 twenty-four hours of the determination of reasonable suspicion or prior to receiving the test results. The observations must be specific, contemporaneous and articulable concerning the appearance, behavior, speech and body odor of the driver.
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