Field Sobriety Tests Disclaimer:This form is not intended to replace the need to write a general or supplemental police report.HGN HGN Instructions Ask about eye problems or abnormalities. Have remove glasses if worn. Put your feet together with hands at your sides. Keep your head still and follow the movement of my stimulus with your eyes only. Keep following my stimulus with your eyes only until I tell you to stop. Do you understand the instructions? Position the stimulus and begin. CHECK:Equal Pupil Size Yes No Comments: Resting nystagmus Yes No Comments: Equal tracking Yes No Comments: CLUES:Distinct & sustained nystagmus at maximum deviation Left Right Comments: Lack of smooth pursuit Left Right Comments: Onset prior to 45 degrees Left Right Comments: Total # of CLUES(criterion is 4 or more)WALK & TURNInstructions Ask about physical problems or disabilities. Place your left foot on the line. Now place your right foot on the line ahead of your left foot, with the heel of your right foot against the toe of your left foot. Place your arms at you sides. Demonstrate the proper position. Maintain this position until I have completed the instructions. Do not start to walk until I tell you to. Do you understand the instructions so far? When I say begin, take 9 heel-to-toe steps on the line, turn around, and take 9 heel-to-toe steps back on the line. Make your turn by keeping your front foot on the line, and turn by taking a series of small steps with the other foot. Demonstrate 3 steps each way and the turn. Keep your arms at your sides at all times. Watch your feet at all times, and count your steps out loud. Once you start walking, don’t stop until you have completed the test. Do you understand the instructions? Begin and count your first step as one. CLUES:Cannot keep balance while listening to instructions.(Feet must break apart) Yes No Comments: Start too soon(only after told not to start) Yes No Comments: Stops walking(pauses to regain balance) Yes No Comments: Does not touch heel-to-toe(more than ½ inch) Yes No Comments: Steps off the line(one foot entirely off the line) Yes No Comments: Uses arms to balance(more than 6 inches) Yes No Comments: Improper Turn Yes No Explain: Incorrect number of steps(+ or – 9 steps) Yes No Comments: Cannot do test Yes No Explain: Total # of CLUES(criterion is 2 or more)ONE LEG STAND Instructions Place your heels and toes together, and your arms at your sides. Demonstrate the proper position. Do not start until I tell you to. Do you understand? When I tell you to, raise either foot approximately 6 inches off of the ground, keeping your raised foot parallel to the ground. You must keep both legs straight, arms at your sides. Hold that position while you count out loud in the following manner: 1001, 1002, 1003 and so on until I tell you to stop. Demonstrate the position and count. Keep your arms at your sides at all times and watch your raised foot. Do you understand the instructions? Go ahead and perform the test. (Officer begins 30 second timer) CLUES:Sways while balancing(side to side/back & forth) Yes No Comments: Uses arms to balance(more than 6 inches) Yes No Comments: Hopping(keeps one foot raised but hops to keep balance) Yes No Comments: Puts foot down(puts foot down 1 or more times) Yes No Comments: Notes and Footwear Total # of CLUES(criterion is 2 or more)EmailEnter your email address to receive a copy of this form:(Required)