403.7E5 – Drivers’ Drug & Alcohol Reasonable Suspicion Observation Form

Observed Personal Behavior (check all appropriate items)
Employee’s Name		Date of Observation
Time of Observation	From			To
Location
Speech	_____Normal	_____Incoherent	_____Confused	_____Loud
Speech	_____Slurred	_____Whispering	_____Silent	_____Disruptive
Balance	_____Normal	_____Swaying	_____Staggering	_____Falling
Walking and Turning	_____Arms Raised for Balance		_____Reaching for Support
Walking and Turning	_____Normal	_____Stumbling	_____Swaying	_____Falling
Awareness	_____Normal	_____Confused	_____Paranoid	_____Sleepy or Stupor
Awareness	_____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

Signature	__________________________________________	Date	________________________________
Signature (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.