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Run: Drug and Alcohol Reasonable Suspicion Observation Form

Document observable signs of possible drug or alcohol impairment, record immediate actions, and create a clear supervisor audit trail for next steps.

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Report Details

Date of Observation (required)

Time of Observation (required)

Supervisor Name (required)

Employee Name (required)

Employee ID

Optional if needed for internal audit trail. Do not collect more PII than necessary.

Observation Summary

Location of Observation (required)

Reason for Concern (required)

Other Observable Details

Describe specific behaviors, statements, or conditions observed. Include objective facts and approximate timing.

Were any other witnesses present? (required)

Alcohol Indicators

Speech appeared impaired? (required)

Balance or coordination appeared impaired? (required)

Strength of alcohol odor

Drug Indicators

Pupils appeared abnormal? (required)

Coordination or motor skills appeared impaired? (required)

Noticeable change in behavior or mood? (required)

Describe any suspected substance or paraphernalia observed

Include only what was directly observed.

Immediate Actions Taken

Was the employee removed from duty? (required)

Was safe transportation arranged? (required)

Next Steps Taken (required)

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. (required)

Yes No N/A

Supervisor Signature (required)

Date Signed (required)

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Email (required)

Your name (optional)

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