Day of Arrest

Vehicle and driving conditions

Are you the primary driver in your household?
Weather and Road Conditions (check all that apply):

The Offense

Do you speak English fluently?
Do you believe that your language or accent caused any problems in the officer being able to understand you?
At any time did you ask to speak with an attorney?
Did you tell the officer you had been drinking?
Were there any passengers in the vehicle?
Were you told you had the right to remain silent, that anything you said could be held against you, that you had the right to an attorney, etc.?
Were you wearing any article of clothing that may have been considered "binding" or restrictive enough to interfere with your ability to perform any of the field sobriety tests?
Do you recall any law enforcement officer making any inappropriate sexual remark or gesture?

Route driven

Traffic control lights?
Working Properly?


(Complete this section ONLY IF an accident of some type has occured in connection with your DUI arrest.)
Were you involved in an accident?
Were in you inside your vehicle when the officer first arrived on the scene?
Did the police officer take your driver's license from you?
After the accident, did you exit the vehicle or leave the immediate area (for any purpose, such as to call a tow truck, call police, etc.)?
Injuries or death to any other person(s)?
Do you recall the circumstances leading up to the accident?
Prior to this case, had you EVER been the driver of a vehicle in which another person (passenger, person(s) in other car, pedestrians(s) were killed?
Did you hit your head, or break the windshield?
Did you call anyone on a cellular phone after the accident?
Did the officer direct you to drive the car after the accident?
Did the officer ask you if you had anything to drink since the time of the accident?
Did you have conversation with the other driver, or with witnesses to the accident?

Roadblocks (Complete this section ONLY if you were arrested at or near a DUI checkpoint)

Was the arrest at a roadblock or license checkpoint?
Were you given any advance notice of the roadblock (was the roadblock well marked and visible)?
Was there a sign advising of a roadblock?
Lighted sign?
Orange "traffic control" cones?
Did they have their blue lights on?
Any traffic cones or flares used at "stop" location or place where you were tested?
Did you turn away from the roadbock before reaching it?
Did the officer charge you with an additional traffic violation when you turned to avoid the roadblock?

Evidence Seized

Was your vehicle towed?
Was your vehicle return to you?
Was your vehicle searched?
Was your vehicle searched?
If so, was anything taken from you and not returned?
Did you know it was there?

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