Drug Driving CalculatorDrug Driving FormName* First Last Email* Telephone Number*What type of specimen did you provide?Swab onlyBloodUrineFail to provideDrug tested positive for Benzoylecgonine Clonazepam Cocaine Delta-9-Tetrahydrocannabinol (cannabis) Diazepam Flunitrazepam Ketamine Lorazepam Lysergic Acid Diethylamide Methadone Methylamphetamine Methadone Lysergic Acid Diethylamide Amphetamine OtherTest given at road side (tick all those that apply) Pupillary Modified Romberg Balance test Walk and turn test One leg stand test Finger to nose testWere you taken to a police station?YesNoDid police clearly explain your rightsYesNoUnsure you understood them fullyDid police explain in detail the process of taking a specimen of blood from you by a health care professional?YesNoDid you receive a sample of blood to be tested for analysis?YesNoDid you take drugs on the day in questionYesNoHave you been convicted of any of the following offencesCausing death by dangerous or careless driving when under the influence of drink or drugsNoIn the last 3 yearsIn the last 10 yearsDriving or attempting to drive while unfit through drink or drugsNoIn the last 3 yearsIn the last 10 yearsDriving or attempting to drive with excess alcoholNoIn the last 3 yearsIn the last 10 yearsFailing to provide a sampleNoIn the last 3 yearsIn the last 10 yearsAggregating CircumstancesWhere you driving an HGV, LGV, PSV etc..? No YesWere the weather conditions or road conditions poor? No YesWere you carrying passengers? No YesIs there any evidence of an unacceptable standard of driving? No YesWere you involved in an accident? No YesWas there a high level of traffic or pedestrian activity? No YesDid you have full UK driving licence AND valid policy of insurance in place? No Yes