Reasonable Suspicion

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	REASONABLE SUSPICION DOCUMENTATION

NOTE: Prepare this form every time a driver is suspected of drug and/or alcohol use by physical, behavioral, speech, or performance indicators that constitute a major change in the driver’s appearance, behavior, and/or performance of his/her job-related duties, which is the basis for performing a “reasonable suspicion” drug and/or alcohol test.

Drivers Name:
Date of Observation:	month, day, year
Start of Observation:
End of Observation:
Location:

Observed Behavior: (Check all that apply)

Physical Indicators		Behavioral Indicators
Dilated Pupils	Chronic Redness of Eyes	Depression	Anxiety
Constricted Pupils	Chronic Nasal Problems	Moodiness	Irritability
Drowsiness	Odor of Marijuana	Alienation	Agitation
Cold Sweats	Odor of Alcoholic Beverage	Combativeness	Restlessness
Tremors	Noticeable Weight Loss	Panic Reactions	Euphoria
Excessive Yawning	Loss of Appetite	Neglect of Personal Hygiene
Rapid Breathing	Ravenous Appetite
Dizziness	Unsteady Walk/Stumbling

Speech Indicators		Performance Indicators
Thick	Rapid	Unable to Concentrate
Slurred	Incoherent	Errors in Judgement
Excessively Talkative		Impaired Reasoning


Other abnormal behavior observed:

Max 500; characters remaining:

To the best of my knowledge and belief, this report represents the physical, behavioral, speech, or performance indicators of the above-named driver, observed by me and upon which I base my decision to require said driver to submit to a reasonable suspicion:
Choose from one of the following:

The above behavior has been witnessed by:

X_________________________		X_________________________
Signature of Supervisor or Company Official		Signature of Supervisor or Company Official

__________/___________/_________		__________/___________/_________
Date		Date

| 15.05.2006 |