PERSONNEL
403.6E06 - 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 and Turning:
Normal
Stumbling
Swaying
Falling
Arms raised for balance
Reaching for support
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.