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									                                      DUI COURT TRACKING SHEET
                                           Dawson County Superior Court
                                             Potential Client Information
                           (Please Complete Criminal Justice Section on Reverse Side of Form)
_____________________________ _______ _______________________________ _________________
             First Name          MI             Last Name                 Date of Arrest
_____________________ _________________________ ______ _______ _____________________
      Date of Birth           Social Security #      Race    Sex          Ethnicity

            (1) District Attorney Initial Review                            (2) Defense Attorney Conference
 Eligible _______                                              DUI Court Selected ____ DUI Court Declined ____
 Comments: ____________________________________                Comments:_____________________________________
 ______________________________________________                ___________________________________________
 ______________________________________________                __________________________________________
 By:______________________________          ___________        By:_______________________________ _______
        Print Name                              Initials
                                                                     Print Name                    Initials
                    (3) Staff Assessment                                    (4) District Attorney Final Review
 Recommended ______        Not Recommended ______              Recommended ______         Not Recommended ______
 If not recommended, state reasons __________________          If not recommended, state reasons __________________
 ___________________________________________                   ______________________________________________

 __________________________________________                    ______________________________________________

 By:_______________________________ _______                    By:_________________________________ _________
                                                                      Print Name                      Initials
       Print Name                    Initials

                                                   (5) Team Review
 Selected _____ Not Selected _____ Decision Deferred ______ Awaiting Information _____ Other _____
 If not selected, state reasons _________________________________________________________________
 By:___________________________________ _________                           Date______________________________
       Print Name                        Initials

                                                    (6) Court Action

Approved for DUI Court Treatment ______________________
Defendant Declined DUI Court Treatment _________________

Judge ___________________________________________________                          Date _________________________
                                                   (Instructions on back)

September 2006
                                    Instructions for DUI Court Tracking Sheet

The DUI Court Tracking Sheet is designed to be a record of a client’s progress through the screening phase of
the dui court program. It is important that a tracking sheet be initiated on any client who is eligible for

The “Potential Client Identification” data should be completed by the District Attorney’s (DA) office.
“Ethnicity” should be included, if known, to indicate affiliation with any ethnic group, i.e. Hispanic, Puerto
Rican, Honduran, etc. The person who determines that the client is eligible for dui court should complete block
number (1), “District Attorney Initial Review.”

The DA screening team member should bring to the next screening meeting the “DUI Court Tracking Sheet” for
each individual to be screened on that date. Blocks (2), (3) and (4) should be completed at the screening
meeting by the appropriate team member. The screening team’s decision should be recorded in block (5) by the
DUI court services secretary or team recording secretary, who is also responsible for the thorough completion of
the tracking sheet.

On dui court day, the dui court services secretary is responsible for assuring that the original, completed “DUI
Court Tracking Sheet” for each client scheduled to appear is on the judge’s bench at the beginning of dui court.

The presiding judge should complete block (6), “Court Action,” sign, and date the form.

                                      DUI Court Tracking Sheet Distribution

The dui court services secretary is responsible for the proper filing and distribution of the tracking sheet as

        A.       Original to be kept with the client’s file at the treatment center.

        B.       One copy for the judge’s file.

        C.       One copy to be kept in a separate tracking sheet file for each calendar year at the treatment

        D.       Copies to other team members as required.

The following area should be used to continue comments from the other side, if additional space is needed.
Please refer by number to the state continued.

                 [(Questions? Call the Dawson County Treatment Center at (706) 265-8425.)]

September 2006

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