DWI Education BD-2

My Personal Action Plan

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Name*

Email*

Personal Change*

Based on what I know now about the effects of alcohol/drugs on traffic safety and the body, the cost, and signs of alcoholism, I plan to make the following changes:

I plan to:*

Check all that apply.

Stop drinking alcohol and/or using drugs.

Separate my drinking/drug use from driving.

Have a designated driver.

Not drive when taking my medication(s).

Change people, places, and alcohol/drug-related activities.

I can depend on the following people for support in following my plan:*

Check all that apply.

I will get the following benefits from following my action plan:*

Check all that apply.

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Course Date

DWI Education BD-2

Title