403.7E5 - Drug and Alcohol Reasonable Suspicion Observation Form

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 the test results.   The observations must be specific, contemporaneous and articulable concerning the appearance, behavior, speech and body odor of the driver.

An example of an appropriate observation statement is, “The driver entered the bus barn slowly and held onto the bus until the driver reached the bus door,” rather than, “The driver came to work stoned and could not walk without holding onto the bus for support.”

Employees must notify the director of transportation about the situation.  The director of transportation will notify the superintendent and they will contact law enforcement to assist with the investigation.

 

 

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                           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

                                                                        ___Arms raised for balance         ___Reaching for support

 

Awareness:                                                                  ___Normal       ___Confused      ___Paranoid

                                                                            ___Sleepy or stupor   ___Lack of coordination

 

Odor:                                                                                  ___Normal       ___Alcohol        ___Burned rope

Other observed behavior/odor:

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Reasonable suspicion of current use or impaired by:       ___Alcohol      ___Drugs

 

Above behavior witnessed by:

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