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Case Evaluation Request

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Yes  No  Not Sure
Yes  No
Yes  No
Yes  No
Yes  No
Yes  No
Speed  U-Turn  Red Light  Wrong Way  Weaving  Crossing Line  Traffic Violation  Equipment Problem  Other
Yes  No  Refused
Yes
No
Don't Remember
Yes  No
Yes  No
Yes  No  I refused  Test wasn't offered  Was given a blood test  Not sure
Yes  No  Don't know
Yes  No  Don't know
No blood test  Yes  No  Don't know
Doctor  Nurse  EMT  Officer  Other
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