Drug and Alcohol Reasonable Suspicion Observation Form

A supervisor form for documenting observable signs that may indicate drug or alcohol impairment in the workplace and initiating appropriate next steps.

Report Details

• Date of Observation
• Time of Observation
• Supervisor Name
• Employee Name
• Employee ID
  Optional if needed for internal audit trail. Do not collect more PII than necessary.

Observation Summary

• Location of Observation
• Reason for Concern
• Other Observable Details
  Describe specific behaviors, statements, or conditions observed. Include objective facts and approximate timing.
• Were any other witnesses present?

Alcohol Indicators

• Speech appeared impaired?
• Balance or coordination appeared impaired?
• Strength of alcohol odor

Drug Indicators

• Pupils appeared abnormal?
• Coordination or motor skills appeared impaired?
• Noticeable change in behavior or mood?
• Describe any suspected substance or paraphernalia observed
  Include only what was directly observed.

Immediate Actions Taken

• Was the employee removed from duty?
• Was safe transportation arranged?
• Next Steps Taken
• Follow-Up Notes
  Record any additional actions, instructions, or observations relevant to the audit trail.

Acknowledgment

• I certify that this report is based on my direct observations and is accurate to the best of my knowledge.
• Supervisor Signature
• Date Signed