Fit for Duty Observation Report

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Fit for Duty Observation Report

This Fit for Duty observation report is to be used for documenting the basis for all “reasonable suspicion” Alcohol and Drug tests to be conducted by SASR. This report should be filled out by the employee’s supervisor or Human Resources.

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Instructions		Reasonable Suspicion Form

Instructions

Please ensure prior to filling out this form you have read the entire process on the Knowledge Base.
I acknowledge that I have read the entire process in the Knowledge Base prior to filling out this form *
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Part 1
Observed Employee Name and EID
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Required Employee Name Required EID
Observation Date & Time *
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dd-MMM-yyyy HH:MM AM/PM
Location of Observation
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Required
Street Address Required City Required State/Region/Province
Observed Behaviors or Causes for doubting the employee is Fit for Duty
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Please state what was observed to come to this conclusion.
Appearance *
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Check all that apply
Description if Other
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Speech *
N/A

Check all that apply
Description if Other
N/A
Motor Skills *
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Check all that apply
Description if Other
N/A
Behavior *
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Check all that apply
Description if Other
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Did the observed Employee refuse to submit to a "Reasonable Suspicion" test? *
N/A
Please record the statement of what happened below *
N/A

(Description of the Event)
Did the observed Employee refuse to be accompanied off the worksite? *
N/A

Observed associate would need to take an Uber back to the hotel with 2 associates, or be driven by 2 associates. DO NOT ALLOW THEM TO DRIVE.
Please record the statement of what happened below *
N/A

(Description of the Event)
Third Party/Witness Report

Please have witness fill this section.
Name of Third Party/Witness
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Required First Name Required Last Name
Name of individual completing the form
N/A

Required First Name Required Last Name
Phone Number *
N/A
Nature of Contact with Employee *
N/A
Witness Signature
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E-Signature Field
Clear
Supervisor/Lead Signature *
N/A

E-Signature Field
Clear

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