Deputy Name EID# Date NCIC Code District/Grid. Subject s Name (Last, First, Middle) DOB: DL# DL State

Transcription

1 El Paso County Sheriff s Office Colorado Springs, Colorado D.U.I. INVESTIGATION CASE SUMMARY Case Number Deputy Name EID# Date NCIC Code District/Grid Subject s Name (Last, First, Middle) DOB: DL# DL State Vehicle License Number State Year Make Model Style VIN Attachments: [ ] Summons & Complaint # [ ] Notice of Revocation or Denial # [ ] Chemical Test results printout [ ] Impound # [ ] Evidence [ ] Other(s) Phase I. VEHICLE IN MOTION Deputy Initiating Contact: EID# Date/Approximate Time First Observed: Day of Week: Subject s Location/Direction of Travel: Road/Surface Condition: Weather: Traffic: Reasons Leading to Stop/Contact: Reaction to Emergency Equipment: Normal Slow Erratic Other/Describe: _ Approximate Time of Stop: Final Location of Stop: Comments/Unusual Actions Observed: _ Phase II. PERSONAL CONTACT: Defendant s location in vehicle upon contact: Engine running? YES NO Keys in Ignition? YES NO Open Alcoholic Containers? YES NO Describe: DEFENDANT S APPEARANCE Breath Odor of alcoholic beverage None Faint Moderate Strong Other: Face Apparently Normal Flushed Pale Other: Eyes Apparently Normal Watery Bloodshot Other: Clothing Orderly Mussed Soiled Disorderly Other: Speech Apparently Normal Slurred Stuttering Confused Incoherent Attitude Polite Cooperative Reserved Excited Antagonistic Sarcastic Hilarious Silent Profane Talkative Combative Sleepy Exiting Vehicle Normal Unsteady Staggers Needs Help/Support Other: Walk to Roadside Normal Unsteady Staggers Needs Help/Support Other: Standing Normal Unsteady Staggers Needs Help/Support Other Cocky Insulting Other: Signs or complaint of injury? Is subject on any medications? YES NO If so, describe:

2 Advised of right to refuse roadside testing? YES NO If roadside testing was refused, How? Other Comments: Passengers in vehicle? (Must list on the back of the Summons and Complaint or on an Involved Other sheet) 1. Name: DOB: Location in Vehicle: 2. Name: DOB: Location in Vehicle: D.U.I. INVESTIGATION CASE SUMMARY PAGE 2 Phase III. PRE ARREST SCREENING Deputy conducting tests: EID#_ 1. Horizontal Gaze Nystagmus Left Eye Right Eye Wearing Glasses? (Yes) (No) Lack of smooth pursuit (Yes) (No) (Yes) (No) Wearing Contacts? (Yes) (No) Distinct and Sustained Nystagmus at maximum deviation (Yes) (No) (Yes) (No) Eye Problems? (Yes) (No) Onset of Nystagmus prior to 45 degrees (Yes) (No) (Yes) (No) Equal Pupil Size? (Yes) (No) Equal Tracking? (Yes) (No) Vertical Nystagmus? (Yes) (No) Resting Nystagmus? (Yes) (No) Other: Total Clues: (Out of a possible 6) Comments: 2. Walk and Turn Cannot Keep Balance During Instruction Stage: _ Starts Too Soon: Stops Walking Misses Heel-Toe Steps Off Line Raises Arms Actual Steps Taken Turn 1 st Nine Steps 2 nd Nine Steps Total Clues (Out of a possible 8) Type of Footwear: Comments: 3. One Leg Stand (CIRCLE WHICH FOOT IS RAISED) Sways While Balancing Uses Arms to Balance Hopping LEFT FOOT RIGHT FOOT Puts Foot Down Total Clues: (Out of a possible 4) Comments:

3 ALCOHOL RELATED You are required to take, complete or cooperate in completing an eventual chemical test to determine the alcoholic content of your blood or breath. The chemical test you choose is the chemical test you will be taking. You cannot choose a different test later. If you choose a blood test, two tubes of blood will be drawn. One tube belongs to you and you may have it tested at a Health Department Certified Independent Laboratory of your choice. If you choose a breath test, two breath samples will be analyzed by a certified evidential breath alcohol testing device following an approved standard operating procedure. You will not receive a sample to have independently tested by a certified laboratory. ANSWER:. DRUG RELATED You have been arrested for driving under the influence of drugs. By the act of driving Colorado, you have already agreed to take a (Officer chooses between Blood or Urine) test. Do you wish to take a test? ANSWER:. UPON AN ORAL OR PHYSICAL REFUSAL, READ THIS: If you refuse to take, complete or cooperate in completing an evidential chemical test to determine the alcoholic content of your blood or breath your driving privilege may be revoked. Now, do you still wish to refuse or will you now take a test? ANSWER:. D.U.I. INVESTIGATION CASE SUMMARY PAGE 3 CHEMICAL TESTING: (Circle test) BREATH TEST BLOOD TEST OTHER: Was the person who administered the breath or blood test certified to do so under Colorado Department of Health Rules? YES NO Did the subject consume any alcoholic beverage from the time stopped until the time the chemical test was administered? YES NO Test by: Location: Time: _ Result: % BrAC / BAC If BLOOD TEST, which arm was blood taken from? RIGHT LEFT Drawn by: # Did you personally witness the Phlebotomist draw the blood and did they properly label and seal the blood samples? YES NO Did you initial the labels on the blood samples and the seals the blood samples were packaged in? YES NO (Initials ) COLORADO DEPARTMENT OF HEALTH AND ENVIRONMENT LABORATORY SERVICES DIVISION BREATH ALCOHOL TESTING PROGRAM. APPROVED CHECKLIST FOR EVIDENTIAL BREATH ALCOHOL TEST(S) AFTER UPGRADE TO INTOXILYZER 5000EN SOFTWARE REVISION 1358.XX, IN COMPLIANCE WITH THE COLORADO BOARD OF HEALTH RULES AND REGULATIONS CONCERNING TESTING FOR ALCOHOL AND OTHER DRUGS, 5-CCR , AS AMENDED. SUBJECT: DATE: Certified operator or instructor conducting the EBAT must initial inside the parentheses to the left of each step and sign in the space provided at the bottom. ( ) 1. Turn power switch on and/or observe that the power switch has been activated. If the EBAT device is in STANDBY mode, press the START TEST switch. ( ) 2. The subject must remove foreign objects from the nose and mouth including dentures. The subject must be closely and continuously observed for 20 minutes prior to testing to assure no belching, regurgitation or intake of any foreign material by nose or mouth has occurred. If such occurs, another 20 minutes of close and continuous observation must elapse under the same conditions.

4 Start Time: Stop Time: ( ) 3. Verify that the external breath tube and simulator vapor tube are both warm. ( ) 4. Observe that the simulator temperature is between 33.8 degrees Centigrade and 34.2 degrees Centigrade. ( ) 5. Press the Start Test switch. ( ) 6. Follow the instructions and sequence of events as they appear on the EBAT device display. ( ) 7. Retain all printouts generated by the EBAT device with the DUI packet. (i.e. Error message printouts) THIS EVIDENTIAL BREATH ALCOHOL TEST WAS CONDUCTED IN ACCORDANCE WITH THE COLORADO BOARD OF HEALTH RULES AND REGULATIONS, 5-CCR Certified Operator or Instructor Conducting Test D.U.I. INVESTIGATION CASE SUMMARY PAGE 4 Was Notice of Revocation or Denial issued? (YES) (NO) ROADSIDE AUTHORIZATION: I authorize and accept responsibility Number: for the above captioned vehicle contained within this report to remain where now parked, and I understand that this vehicle must be moved within 24 hours. Was the subject s vehicle impounded? (YES) (NO) Impound Number: Operator: _ Witness: ADDITIONAL COMMENTS: Case Status:

5 STATE OF COLORADO} } AFFIDAVIT COUNTY OF EL PASO } Probable Cause Affidavit for arrest; DUI, DUI PER SE, DUID and DWAI. The undersigned, a Peace Officer and hereafter referred to as the affiant, first being sworn upon oath, deposes and says that the affiant has personal and true knowledge of the facts contained in the foregoing report, from which there exists probable cause to believe that the herein described offense/s, was/were committed by the Defendant on or about the day of, 20, at approximately (AM) (PM), in the County of El Paso, State of Colorado. Defendant charged with: 1. CRS# 2. CRS# 3. CRS# 4. CRS# Affiant Signature Subscribed and sworn to before me this day of, 20. My commission expires:. NOTARY SEAL Notary D.U.I. INVESTIGATION CASE SUMMARY SUBJECT S ADVISEMENT OF RIGHTS AND SUBJECT INTERVIEW ADVISEMENT OF RIGHTS: 1. You have the right to remain silent. 2. Anything you say can and will be used against you in a court of law. 3. You have the right to talk to an attorney and have one present during any questioning. Signature of Subject: 4. If you cannot afford to hire a lawyer, one will be appointed to represent you before and during any questioning, if you wish one. 5. Do you understand each of these rights I have explained to you? (YES) (NO) 6. Having these rights in mind, do you wish to talk to us now? (YES) (NO) Date: Time: SUBJECT INTERVIEW: 1. Were you driving a vehicle? (YES) (NO) Where were you going? Where are you now? 2. Have you been drinking? (YES) (NO) 4. Are you ill or injured? (YES) (NO) If so, explain : 5. Are you taking medicine? (YES) (NO) What kind? (Get sample)

6 What were you drinking? How much did you drink? When did you start drinking? What time did you stop? What time is it now? 3. Were you in an accident? (YES) (NO) Deputy conducting interview: EID # What time was your last dose? 6. Do you have any physical defects/handicaps? (YES) (NO) If so, what? 7. Do you have epilepsy or diabetes? (YES) (NO) 8. How much sleep have you had in the last 24 hours? Last time you slept? How long did you sleep? Date: Time: