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April 20, 2009 (Regular Meeting) <br />OBSERVATION OF SUSPECT BEHAVIOR <br />Supervisor's Name: <br />Employee's Name: <br />Job Title: <br />Page 1331 <br />Description of Work: Managerial Office/Clerical Driver <br />Other: <br />How long has the employee worked for CABARRUS COUNTY GOVERNMENT: <br />How long have you supervised the employee? <br />Was the employee involved in an accident or near-accident? Yes <br />If yes, Description: <br />Date and Time: <br />Extent of Injury to persons/Property: <br />No <br />Employee's Actions: <br />OBSERVATIONS: <br />Speech: Mumbled -Slurred -Confused -Incoherent -Stuttering <br />Condition of Clothes: -Disorderly -Soiled -Rumpled -Orderly <br />Eyes: -Sleepy -Blood Shot _Glassy -watery -Dilated -Closed -Alert <br />Attitude or Demeanor: -Talkative -Hyperactive -Hostile <br />-Nervous -Depressed -Profane -Drowsy -Pleasant <br />Unusual Actions: -Belching Vomiting -Fighting <br />-Crying _Laughing -Runny Nose _ <br />Walking and Turning: -Stumbling -Swaying -Staggering <br />-Falling -Reaching for Suppc <br />Unable to Stand Normal <br />-Irritable <br />Wide Mood Swings <br />-Accident Prone <br />None <br />-Arms Raised for Balance <br />rt -Feet Wide Apart <br />Awareness: -Sleepy or Stupor -Lack of Coordination -Confused -Paranoid <br />Normal <br />OBSERVATION OF SUSPECT BEHAVOR (continued) <br />Indicate other unusual actions or statements, including when first observed: <br />Were your observations made during, just preceding, or just after the period <br />of the workday that the employee was performing covered functions? <br />Yes No <br />HISTORY <br />Number of Mondays missed or tardy in the last two months: <br />Has there been a recent change in the employee's level of performance? <br />Yes No Don't Know <br />SUPERVISOR' S OPINION: <br />Indicate briefly what leads you to suspect drug and/or alcohol influence: <br />