• 12 Hrs Assessment Form

    12 Hrs Assessment Form

  • Date*
     - -

  • Think of the 12 hours before your DUI arrest. Read the following questions and place a check next to the appropriate answer. For some questions you may have to check more than one answer.

  • 1. What would you call the 12 hours before your DUI arrest?*
  • 2. During what hours did you start drinking/using?*
  • 3. Where did you drink/use?*
  • 4. With who did you drink/use?*
  • 5. What did you drink/use?*
  • 6. Approximately how much did you drink/use during this time?*
  • 7. Why did the police stop you?*
  • 8. When were you arrested?*
  • 9. What was the occasion for drinking/using?*
  • 10. Why did you drink/use?*
  • 11. How much are you to blame for the events that led to your arrest?*
  • 12. Do you feel it was fair to be arrested?*
  • 13. What do you believe are your chances of being arrested again on a DUI charge within the next year*
  • 14. How difficult will it be for you to change your behavior that led to your arrest?*
  • 15. How valuable do you feel this course will be for you?*
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  • On submitting the form, the form(s) will be emailed directly to Jackson-Bibby.

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