DUI
O vertime
E nforcement
S tat
S heet
Please
r etain
t his
f orm
f or
f our
( 4)
f iscal
y ears.
The
U HSO
m ay
r eview
t hese
r ecords
f or
a uditing
purposes.
Officer
N ame
Badge
#
Employee
#
Agency
Time
s tart
Time
e nd
Event
Activity
D ate
Miles
t raveled
( estimate)
Total
H ours
C laimed
Hourly
W age
S traight
T ime
#of
W arrants
Dollar
A mount
o f
W arrants
Vehicles
S topped
DUI
E nforcement
DUI
A rrests
#
o f
S tate
T ax
I mpound
Alcohol
Drug
Metabolite
Violator's
V ehicle
f or
D UI
#
o f
F ield
S obriety
T ests
G iven
Test
R esults
Blood
T est
Urine
T est
Refusal
BRAC
R esults
Yes No
Yes
No
Yes
Person
1
point
Person
2
point
Person
3
point
Person
4
point
Person
5
point
Comments
Designated
D river
Recovered
S tolen
V ehicle
Fugitives
A pprehended
Violation
Citation
Warning
DUI
Violation
Citation
Warning
Open
C ontainer
Speeding
Youth
A lcohol
Texting
Drug-‐Misdemeanor
Reckless
Drug-‐Felony
Careless
Ignition
I nterlock
V iolation
Failure
t o
Y ield
Alcohol
R estricted
D river
Following
T oo
C lose
Seat
B elt
Improper
T urn
Child
R estraint
Stop
S ign
o r
L ight
Driving
o n
S uspension
Improper
L ane
T ravel
Registration
V iolation
Other
M oving
Other
D L
V iolation
Other
M isdemeanor
No
I nsurance
Other
F elony
Other
N on-‐Moving
I
c ertify
t he
a bove
i nformation
i s
c orrect.
Officer
S ignature
Date
Approved
b y:
Supervisor
o r
T eam
L eader
S ignature
Date