DOT Reasonable Suspicion Testing Checklist
Document observed indicators, supervisor verification, and testing referral details for a DOT reasonable suspicion situation.
Employee and Observation Details
Employee name or identifier
*
Department or location
*
Date and time observation began
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Location where observation occurred
*
Reasonable Suspicion Checklist
Observed indicators
*
Appearance
Behavior
Speech
Coordination
Odor
Other observable facts
Brief notes
Verification and Action Taken
Second trained supervisor confirmed the observation?
*
Yes
No
Testing action initiated
*
Please Select
Immediate drug test
Immediate alcohol test
Immediate drug and alcohol test
Referral only
Supervisor completing checklist
*
First Name
Middle Name
Last Name
Immediate follow-up or transport instructions
Submit Checklist
Should be Empty: