The Drug Screen form is a crucial document used to ensure proper collection and handling of drug testing specimens. This form outlines the necessary steps for both the collector and the testing facility, ensuring compliance with federal regulations. To begin the process, fill out the form by clicking the button below.
The Drug Screen form, officially known as the Federal Drug Testing Custody and Control Form, plays a crucial role in the drug testing process, particularly in the workplace and for safety-sensitive positions. This comprehensive document is designed to ensure that every step of the testing process is meticulously documented and follows federal guidelines. The form begins with essential details such as the employer's information, the Medical Review Officer's (MRO) contact details, and the donor's identification number. It also specifies the testing authority—whether it falls under the Department of Transportation (DOT) or another agency—and outlines the reason for the test, which can range from pre-employment screenings to random testing or follow-up evaluations. Furthermore, the form indicates the specific drug tests to be performed, including substances like THC, cocaine, and amphetamines. The collection process is carefully detailed, requiring the collector to monitor the specimen's temperature and document any observations. Chain of custody is a critical aspect, ensuring that the specimen is handled properly from collection to analysis. The form concludes with sections for certifying the results, whether negative or positive, and includes provisions for split testing if needed. In essence, the Drug Screen form is not merely a bureaucratic requirement; it serves as a safeguard for both employers and employees, promoting a fair and transparent drug testing process.
FEDERAL DRUG TESTING CUSTODY AND CONTROL FORM
800-877-7484
SPECIMEN ID NO.
STEP 1: COMPLETED BY COLLECTOR OR EMPLOYER REPRESENTATIVE
LAB ACCESSION NO.
Quest, Quest Diagnostics, the associated logo and all associated Quest Diagnostics marks are the trademarks of Quest Diagnostics Incorporated. © Quest Diagnostics Incorporated. All rights reserved. QD20315-FED. Revised 10/10. SC2K - 111192.
A. Employer Name, Address, I.D. No.
B. MRO Name, Address, Phone and Fax No.
C. Donor SSN or Employee I.D. No. _______________________________________________________________
D. SpecifyTesting Authority: HHS
NRC
DOT – Specify DOT Agency: FMCSA
FAA
FRA FTA PHMSA USCG
E. Reason forTest: Pre-employment
Random
Reasonable Suspicion Cause Post Accident
Return to Duty
Follow-up Other (specify) ____________________________
F. DrugTests to be Performed:
THC, COC, PCP, OPI, AMP
THC & COC Only
Other (specify) ________________________________________________
G. Collection Site Name:
Collection Site Code:
Address:
Collector Phone No.:
City, State and Zip:
Collector Fax No.:
STEP 2: COMPLETED BY COLLECTOR (make remarks when appropriate) Collector reads specimen temperature within 4 minutes.
Temperature between 90° and 100° F? Yes No, Enter Remark
Collection: Split Single None Provided, Enter Remark
Observed, (Enter Remark)
REMARKS
STEP 3: Collector affixes bottle seal(s) to bottle(s). Collector dates seal(s). Donor initials seal(s). Donor completes STEP 5 on Copy 2 (MRO Copy)
STEP 4: CHAIN OF CUSTODY - INITIATED BY COLLECTOR AND COMPLETED BY TEST FACILITY
I certify that the specimen given to me by the donor identified in the certification section on Copy 2 of this form was
SPECIMEN BOTTLE(S) RELEASED TO:
collected, labeled, sealed, and released to the Delivery Service noted in accordance with applicable Federal requirements.
Quest Diagnostics Courier
X
FedEx
Signature of Collector
Other
AM
PM
(Print) Collector's Name (First, MI, Last)
Date (Mo./Day/Yr.)
Time of Collection
Name of Delivery Service
RECEIVED AT LAB OR IITF:
Primary Specimen
Bottle Seal Intact
Yes No
Signature of Accessioner
If No, Enter remarks
in Step 5A.
(Print) Accessioner’s Name (First, MI, Last)
STEP 5A: PRIMARY SPECIMEN REPORT - COMPLETED BY TEST FACILITY
NEGATIVE
POSITIVE for:
Marijuana Metabolite ( 9-THCA)
6- Acetylmorphine
Methamphetamine
MDMA
DILUTE
Cocaine Metabolite (BZE)
Morphine
Amphetamine
MDA
PCP
Codeine
MDEA
REJECTED FOR TESTING
ADULTERATED
SUBSTITUTED
INVALID RESULT
REMARKS:
Test Facility (if different from above):
I certify that the specimen identified on this form was examined upon receipt, handled using chain of custody procedures, analyzed, and reported in accordance with applicable Federal requirements.
Signature of Certifying Scientist
(Print) Certifying Scientist's Name (First, MI, Last)
STEP 5b: COMPLETED BY SPLIT TESTING LABORATORY
RECONFIRMED FAILED TO RECONFIRM - REASON ____________________________________________
___________________________________________
I certify that the split specimen identified on this form was examined upon receipt, handled using chain of custody
procedures, analyzed and reported in accordance with applicable Federal requirements.
Laboratory Name
Laboratory Address
OMB No. 0930-0158
PRESS HARD - YOU ARE MAKING MULTIPLE COPIES
Filling out the Drug Screen form requires careful attention to detail to ensure accurate processing. Follow these steps to complete the form correctly. After submission, the specimen will be analyzed, and results will be reported according to federal guidelines.
What is the purpose of the Drug Screen form?
The Drug Screen form is used to document the collection and testing of urine specimens for drug testing. It ensures that the process follows federal guidelines, maintaining a clear chain of custody from collection to laboratory analysis. This form is crucial for employers who need to comply with regulations regarding drug testing in the workplace.
Who completes the Drug Screen form?
The form is completed by a collector or an employer representative at the time of specimen collection. This individual is responsible for ensuring that all required information is accurately filled out to maintain the integrity of the testing process.
What information is required on the form?
Essential details include the employer's name and address, the Medical Review Officer's (MRO) contact information, the donor's Social Security Number or employee ID, the testing authority, the reason for the test, and the specific drug tests to be performed. Accurate completion of this information is vital for the testing process.
What types of drug tests can be performed?
The form allows for various drug tests, including those for THC (marijuana), cocaine, PCP, opiates, and amphetamines. The employer can specify which tests are required based on the circumstances of the testing, such as pre-employment or random testing.
How is the chain of custody maintained?
Chain of custody is maintained by documenting each step of the specimen's journey from collection to analysis. The collector must seal the specimen bottle and date the seal, while also ensuring that the donor initials it. This process helps prevent tampering and ensures that the specimen remains secure throughout testing.
What happens if a specimen is rejected for testing?
If a specimen is rejected, it will be documented on the form, and the reason for rejection will be noted. Common reasons include issues like adulteration, substitution, or an invalid result. This information is crucial for both the employer and the donor to understand the next steps in the testing process.
What does it mean if a test result is reported as positive?
A positive test result indicates the presence of drugs or their metabolites in the donor's system. The specific substances detected will be listed on the report. It is important to note that a positive result may lead to further action, including confirmation testing or disciplinary measures, depending on the employer's policy.
Can a donor request a retest if they disagree with the results?
Yes, donors have the right to request a retest of their specimen, especially if they believe the results are inaccurate. This request typically involves the analysis of a split specimen, if available. The process for retesting should be outlined in the employer's drug testing policy.
How should the Drug Screen form be stored and disposed of?
The Drug Screen form should be stored securely to protect the confidentiality of the donor's information. It is essential to follow legal requirements for record retention. When disposing of the form, ensure that it is shredded or otherwise destroyed to prevent unauthorized access to sensitive data.
Who can I contact for more information about the Drug Screen form?
For further inquiries regarding the Drug Screen form, you can contact the testing facility or the employer's human resources department. They can provide additional guidance and clarify any questions you may have about the testing process.
Filling out the Drug Screen form requires careful attention to detail. Mistakes can lead to delays or invalid results. One common error occurs when individuals fail to provide accurate personal information. This includes the donor's Social Security Number or Employee ID. Omitting or incorrectly entering this information can complicate the identification process and delay testing results.
Another frequent mistake is not specifying the testing authority. The form requires the selection of an authority such as HHS or DOT, along with the appropriate agency if DOT is chosen. Leaving this section blank or making an incorrect selection can result in the test being deemed invalid.
Many individuals also overlook the reason for the test. Whether it is for pre-employment, random selection, or post-accident testing, the reason must be clearly indicated. A missing or vague explanation can lead to confusion about the context of the test.
In addition, failing to specify the types of drug tests to be performed is another common oversight. The form allows for multiple selections, but if this section is left incomplete, the laboratory may not conduct the necessary tests, potentially resulting in insufficient information.
Collectors play a crucial role in the process, and errors can occur at this stage as well. One mistake includes not reading the specimen temperature within the required timeframe. The temperature must be taken within four minutes of collection, and if this step is skipped or improperly documented, it could raise questions about the integrity of the sample.
Another collector-related error involves the collection method. The form requires the collector to indicate whether the collection was split, single, or none provided. Failing to make this notation can lead to misunderstandings regarding the sample handling and analysis.
Donor initials are also important. The donor must initial the seal on the specimen bottle. If this step is neglected, it can lead to complications in the chain of custody and affect the test's validity.
Furthermore, when the specimen is released to a delivery service, it is essential that the collector documents this accurately. Errors in the delivery service's name or the collector’s signature can hinder the tracking of the specimen and may raise concerns during the testing process.
Lastly, individuals often forget to review the remarks section. Any unusual circumstances or observations during the collection should be noted. Neglecting to document these remarks can result in a lack of clarity and potential disputes over the test results.
The Drug Screen form is a critical document in the drug testing process, ensuring that all necessary information is collected and handled correctly. Alongside this form, several other documents may be required to facilitate the testing and reporting process. Here’s a brief overview of these essential forms and documents.
Each of these documents plays a vital role in the drug testing process, helping to maintain accuracy, integrity, and compliance with legal requirements. Together, they support a fair and transparent approach to drug screening in various settings.
The Drug Screen form is a crucial document in the drug testing process, particularly in employment settings. It shares similarities with several other legal forms that serve different but related purposes. Here’s a list of eight documents that are similar to the Drug Screen form, along with an explanation of how they are alike:
When filling out the Drug Screen form, it is important to follow specific guidelines to ensure accuracy and compliance. Here are five things you should and shouldn't do:
Following these guidelines will help ensure that the drug screening process runs smoothly and effectively.
Here are ten misconceptions about the Drug Screen form:
When filling out and using the Drug Screen form, it is important to follow specific guidelines to ensure accuracy and compliance. Here are some key takeaways: