SCENE:

Traffic stop was conducted at [location].

INVESTIGATION:

While working a DUI saturation patrol, I was traveling [location], when I observed a [color of vehicle]
[make/model of vehicle] [list violation]. I activated my emergency lights and sirens on my agency issued
vehicle and conducted a traffic stop at [location of stop].

[list how you made contact with driver]. I made contact with the [male / female] driver, [last name], and
identified them by the Florida driver license. While at the driver's door, I observed [last name] [clothing
disarrayed]. I identified myself and the reason I was present. I informed [last name] the reason for the
traffic stop was [reason]. I asked [last name], where was [he / she] going, with a [type] speech, [he / she]
stated, "[comment]." I asked [last name] where was [he / she] coming from, and stated, "[comment]."
While talking, I [could / could not] smell the strong odor of an alcoholic beverage emitting from [his / her]
breath, as well as both eyes [description]. I asked [last name] if [he / she] had anything to drink, and stated,
"[comment]." I advised [last name] to exit the vehicle. As [he / she] exited they vehicle, [he / she] [status].

REASONABLE SUSPICION

- Slurred/mumbled speech
- Bloodshot/ glassy eyes
- Staggering
- Swaying
- Strong odor of an alcoholic beverage emitting from breath
- Admission of drinking

I conducted the three (3) standardized field sobriety exercises in the standardized manner, as follows:

While speaking to [last name] was also observed to have:

- Bloodshot eyes
- Slurred speech
- Trouble finding his license
- Trouble finding his registration
- Gum, Mints or Candy in his mouth in an apparent attempt to mask the odor of the alcoholic
beverage
- Trouble exiting his vehicle
- Slow and lethargic movements
- Disarranged clothing
- Soiled his clothing
- The need for support to maintain his balance

When asked, [last name] agreed to submit to a series of field sobriety tasks.

HORIZONTAL GASE NYSTAGMUS TASK

Prior to beginning the task it was determined [last name] was not wearing contacts. [last name] eyes were
checked and his eyes displayed equal tracking and his pupils were equal sizes. [last name] was instructed to
following the stimulus with [his / her] eyes only, keeping [his / her] head still. After stating [he / she]
understood the instructions [last name] attempted this task.

The results of this task displayed 3 of the 6 possible clues.

- A lack of Smooth Pursuit in [his / her] left eye.

 - A distinct and sustained nystagmus in the left eye at maximum deviation.
- An onset of nystagmus in the left eye prior to 45 degrees.
- The task further revealed the presence of vertical nystagmus. Vertical nystagmus is an indicator of
high doses of alcohol, other central nervous system (CNS) depressants or inhalants, and the
consumption of the drug phencyclidine (PCP).

While performing the Horizontal Gaze Nystagmus task, it was observed that [last name]:

- Had difficulty following and responding to instructions.

- Moved [his / her] head from side to side during the task.
- Swayed while standing.
- The instructions for the task had to be repeated before [last name] would respond

WALK AND TURN TASK

Prior to attempting this task, [last name] indicated he did not have any medical problems that would have
prevented [him / her] from performing the task. [last name] was instructed to put [his / her] left foot on the
line and [his / her] right foot in front of it with [his / her] right heel touching the toe of [his / her] left foot.
[He / She] was instructed to stand in this manner with [his / her] hands to [his / her] sides until the task
instructions were completed and the task demonstrated. [last name] was instructed not to begin the task
until told to start. [He / She] was instructed to take nine steps along the line in a heel-to-toe manner. After
the ninth step [he / she] was to stop and turn around keeping [his / her] lead foot on the ground, taking
several small steps with the other foot to turn around. After turning around [he / she] was to take nine steps
in a heel-to-toe manner back along the line, in the direction [he /she] had come from. [last name] was
further instructed to watch [his / her] feet at all times while walking, keep [his / her] arms down to [his /
her] side, and to count [his / her] steps out loud. After the task was demonstrated [last name] stated [he /
she] understood the instructions and was instructed to begin the task.

- After attempting the Walk and Turn Task [last name] displayed 2 of 8 possible clues.

Walk and Turn task observations:

- On the first set of steps [last name] failed to walk in a heel-to-toe manner on 1 step, failing to walk
heel-to-toe on step 6. [last name] then stepped off the line on 2 steps, stepping off the line on steps
1, and 6.
- On the second set of steps [last name] failed to walk in a heel-to-toe manner on 4 steps, failing to
walk heel-to-toe on steps 1, 3, 6, and 9. [last name] then stepped off the line on 3 steps, stepping off
the line on steps 1, 3, and 7.

ONE LEG STAND TASK

Prior to attempting this task, [last name] indicated [he / she] did not have any medical problems that would
have prevented [him / her] from performing the task. [last name] was instructed to stand with [his / her]
heels together and hands down to [his / her] sides while the instructions were given and during the task.
[last name] was instructed not to begin the task until [he / she] was instructed to start, and after the task had
been demonstrated. When instructed to start, [he / she] was to raise the foot of [his / her] choice off the
ground approximately 6 inches. While [his / her] leg was raised [he / she] was to keep [his / her] leg
straight, watch [his / her] raised foot, and to count out loud by thousands (one thousand one, one thousand
two, one thousand three...) and to continue the task until told to stop (30 seconds). After this task was
demonstrated and indicating [he / she] understood the instructions [last name] attempted this task.

When [last name] attempted this task [he / she] raised his right foot.

The result of this test displayed 4 of the 4 possible clues. During this task [last name]:

- Swayed during the task.

 - Used arms for balance.
- Hopped during the task.
- Put [his / her] foot down (2 time(s) during the task).

Additionally, during the One Leg Stand Task, [last name] was observed to:

- Started the task before [he / she] was instructed to start.

- End the task before [he / she] was told to put [his / her] foot down. ([He / She] was to keep [his /
her] leg raised for 30 seconds). Ending the task at the count of 55.
- Fail to watch [his / her] raised foot during the task as instructed.
- Fail to keep [his / her] raised leg straight.
- Fail to count out loud by thousands as instructed.

I asked [last name] would [he / she] consent to a breath test, [he / she] stated, "[comment]." I read [him /
her] implied consent, from a pre printed card. I again asked [him / her] if [he / she] would consent to a
breath test, [he / she] stated, "[comment]." I transported [last name] to the Putnam County Jail, to conduct a
breath test, which would be administered by [BAC Operator].

[BAC Operator] conducted the breath test and the results are as follows:

Test 1: [result]
Test 2: [result]

CONCLUSION:

[Last Name] was booked for the above listed charges. [Last Name]'s vehicle was inventoried and towed by
[tow company] which is located at [address of tow company]. [Last Name] was issued a probable cause
citation [citation #:] for the offense of [reason] DUI as well. [Last Name] was issued a DUI citation
[citation #:] for DUI as well. No further actions by this deputy.

Phase I (Vehicle in Motion)

[ ] TURNING WITH WIDE RADIUS

[ ] DRIFTING
[ ] STRADDLING CENTER LANE OR MARKER
[ ] TIRES ON CENTER/ LANE MARKER
[ ] APPEARING TO BE DRUNK
[ ] BRAKING ERRATICALLY
[ ] ALMOST STRIKING OBJECT OR VEHICLE
[ ] DRIVING INTO OPPOSING TRAFFIC
[ ] WEAVING
[ ] SIGNALING INCONSISTENTLY
[ ] DRIVING ON OTHER THAN DESIGNATED ROADWAY
[ ] SLOW RESPONSE TO TRAFFIC SIGNALS
[ ] SWERVING
[ ] STOPPING INAPPROPRIATELY
[ ] SLOW SPEED (10 MPH OR MORE BELOW SPEED LIMIT
[ ] TURNING ABRUPTLY OR ILLEGALLY
[ ] STOPPING WITHOUT CAUSE IN TRAFFIC LANE
[ ] ACCELERATING OR DECELERATING FAST
[ ] FOLLOWING TOO CLOSELY
[ ] HEADLIGHTS OFF (NIGHT TIME)

Phase II (Personal Contact)

Clothing:
 HAT OR CAP: [description]
JACKET OR COAT: [description]
SHIRT OR DRESS: [description]
SHOES (TYPE): [description]
PANTS OR SKIRT: [description]

Condition:
[ ] DISORDERLY [ ] SOILED [ X ] MISUSED [ ] ORDERLY

Breath
[ X ] STRONG [ ] MODERATE [ ] FAINT [ ] NONE

Attitude
[ X ] GOOD [ ] FAIR [ ] POOR [ ] COMBATIVE [ ] COCKY [ ] INDIFFERENT

Color of Face
[ X ] PALE [ X ] FLUSHED [ ] NORMAL [ ] OTHER

Eyes
[ X ] BLOODSHOT [ X ] WATERY [ ] NORMAL: EYEGLASSES: [ ] CONTACT LENSES: [ ]

Pupils
[ ] NOT EQUAL SIZE [ ] CONSTRICTED [ X ] DILATED [ ] NORMAL

Unusual Actions
[ ] HICCOUGHING [ ] BELCHING [ ] VOMITING [ ] FIGHTING [ ] CRYING [ ] LAUGHING
[ X ] NONE

Speech
[ ] NOT UNDERSTANDABLE [ X ] MUMBLED [ X ] SLURRED [ ] THICK TONGUED [ ]
NORMAL

Phase III (Pre-Arrest Screening)

HORIZONTAL GAZE NYSTAGMUS (0 / 6 Clues)

[ X ] LACK OF SMOOTH PURSUIT: Left Eye

[ X ] LACK OF SMOOTH PURSUIT: Right Eye
[ X ] DISTINCT & SUSTAINED NYSTAGMUS AT MAXIMUM DEVIATION: Left Eye
[ X ] DISTINCT & SUSTAINED NYSTAGMUS AT MAXIMUM DEVIATION: Right Eye
[ X ] ONSET OF NYSTAGMUS PRIOR TO 45 DEGREES: Left Eye
[ X ] ONSET OF NYSTAGMUS PRIOR TO 45 DEGREES: Right Eye
[ X ] VERTICAL NYSTAGMUS

Walk & Turn (0 / 8 Clues)

[ X ] CAN'T KEEP BALANCE

[ X ] STARTS BEFORE INSTRUCTIONS ARE FINISHED
[ ] STOPS WALKING TO STEADY SELF
[ X ] DOES NOT TOUCH HEEL-TO-TOE
[ X ] STEPS OFF LINE
[ X ] USES ARM FOR BALANCE (RAISE MORE THAN SIX INCHES)
[ X ] IMPROPER TURN (STUMBLES, LOSES BALANCE, OR STAGGER)
[ ] INCORRECT NUMBER OF STEPS
One Leg Stand (0 / 4 Clues)

[ X ] SWAYS WHILE BALANCING

[ X ] USES ARMS TO BALANCE (RAISE MORE THAN SIX INCHES)
[ ] HOPPING
[ X ] PUTS FOOT DOWN (BEFORE 30 SECONDS LAPSE)

ABILITY TO UNDERSTAND INSTRUCTIONS: [ ] GOOD [ ] FAIR [ X ] POOR [ ] UNABLE

DID SUBJECT PERFORM TASKS: [ X ] YES [ ] NO

Environment:

SURFACE CONDITIONS: [description]

WEATHER: [description]
LIGHTING: [description]

IMPLIED CONSENT WARNING GIVEN: [ X ] YES [ ] NO

DATE: [mm/dd/yyyy] TIME: [xx:xx] AM / PM

MIRANDA CONSENT WARNING GIVEN: [ X ] YES [ ] NO

DATE: [mm/dd/yyyy] TIME: [xx:xx] AM / PM

Chemical Tests:
[ X ] BREATH: TEST 1: [result] TEST 2: [result]

Vehicle Information:

YEAR: [description]
MAKE: [description]
MODEL: [description]
COLOR: [description]
TAG #: [description]
VIN #: [description]

Passenger(s):

NAME: [first name] [last name]

DOB: [mm/dd/yyyy]
POSITION IN VEHICLE: [description]