DUI QUESTIONNAIRE

1. Where were you, where were you located, three hours before being stopped by the Arresting Officer?

2. Where had you just been, or from where had you just left, before being stopped by the Arresting Officer?

3. Had you consumed any alcoholic beverages within the 3-hour period just before being stopped by the Arresting Officer? If so, what and how much?

4. Did the Arresting Officer see you driving?

YesNo

5. What was the first thing the Arresting Officer said to you after pulling you over?

6. Did the Arresting Officer have a valid and legal reason for stopping you or making contact with you in or near the vehicle?

7. Did the Arresting Officer tell you that you had committed a traffic violation? If so, what?

8. Did you admit to drinking or doing drugs? If yes, what and how much?

9. Did you take any field sobriety tests (balance and coordination exercises) before arrest and handcuffing? (i.e. standing on one foot, walking a straight line heel-to-toe, etc.)

YesNo

10. Did the Arresting Officer demonstrate the field sobriety tests before administering the tests?

YesNo

11. Did you fail to satisfactorily perform the field sobriety tests (balance and coordination tests) as demonstrated to you by the Arresting Officer?

YesNo

12. Did the Arresting Officer administer a hand-held breathalyzer at the scene of the stop before arrest and handcuffing? If so, what was the result of the hand held breathalyzer test?

13. Did the Arresting Officer tell you that you could refuse to take the hand-held breath test?

YesNo

14. Did you take a blood, breath or urine test at the Police Department or a hospital within 1-1/2 hours after finishing your last drink of alcohol?

YesNo

15. Did you choose to take the blood, breath or urine test?

YesNo

16. Were your test results greater than .08%?

YesNo

17. If your driver’s license was suspended because you refused to take a blood, breath or urine test, did you refuse to take a test after being told that your driver’s license would be suspended if you refused to submit to a test?

YesNo

18. Did you voluntarily take a blood test?

YesNo

19. Did the Arresting Officer or breath test machine operator watch you closely for at least 20 minutes before you provided a breath sample into the breath machine at the Police Department?

YesNo

20. Did the Arresting Officer or breath test machine operator check to make sure you didn’t burp, belch, vomit, or have anything in your mouth prior to the breath test at the Police Department?

YesNo

21. How many times did you blow into the breath test machine at the Police Department?

22. If you provided a breath sample more than once at the Police Department, what happened during or after the first breath sample?

23. After completing the breath test at the Police Department, did the Arresting Officer or breath test machine operator tell you that the breath test machine destroys your breath sample and therefore, you had the additional right to take a blood or urine test, free of charge?

YesNo

24. If you took a urine test, did you completely empty your bladder the first time you urinated?

YesNo

25. Did the Arresting Officer collect your urine twice?

YesNo

26. Was the Arresting Officer present with you when you provided the urine sample(s)?

YesNo

27. Did you drink any alcoholic beverages, or take any drugs, within 5-10 hours of being stopped by the Arresting Officer?

YesNo

28. Did the Arresting Officer treat you fairly and professionally?

YesNo

29. Are there any other facts about your arrest that you would like to share?