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Drug Screen Template

The Drug Screen form is a critical document used in the process of drug testing, particularly in workplace settings. It ensures that the collection, handling, and analysis of urine samples are conducted according to federal regulations. Understanding this form is essential for both employers and employees to navigate the drug testing landscape effectively.

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The Drug Screen form is a crucial document in the process of drug testing, particularly within the context of federal regulations. It serves multiple purposes and contains essential information that ensures the integrity of the testing process. At the outset, the form requires details about the employer and the medical review officer (MRO), including names, addresses, and contact information. Additionally, it captures the donor's identification through their Social Security Number or employee ID. The form also specifies the testing authority, which may include agencies like the Department of Transportation (DOT) or the Department of Health and Human Services (HHS). Furthermore, it outlines the reason for the test, whether it be pre-employment, random selection, or post-accident, among others. A critical section of the form details the specific drug tests to be performed, such as tests for THC, cocaine, or opiates. The collection site information is also included, providing the location and contact details for the collector. The form has several steps, each requiring careful completion by the collector, from checking the specimen's temperature to sealing the specimen bottle and maintaining a chain of custody. This meticulous process is designed to uphold the accuracy and reliability of the drug testing results, which can have significant implications for both employers and employees.

Key takeaways

Filling out the Drug Screen form requires attention to detail. Here are some key takeaways to ensure accuracy and compliance:

Complete All Required Sections: Make sure to fill in all necessary information, including employer details, donor identification, and testing authority. Incomplete forms can lead to delays or invalid results.
Document the Collection Process: The collector must accurately record the specimen temperature and collection method. This step is crucial for maintaining the integrity of the sample.
Maintain Chain of Custody: Follow the chain of custody procedures meticulously. Each person handling the specimen should sign and date the form to ensure accountability.
Review Test Results Carefully: After testing, review the results and any remarks provided by the testing facility. Understanding the outcomes helps in addressing any potential issues promptly.

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Documents used along the form

The Drug Screen form is an essential document in the drug testing process. It ensures that all necessary information is collected and recorded accurately. Along with this form, several other documents are often used to facilitate the testing and reporting process. Here’s a brief overview of those documents.

Chain of Custody Form: This document tracks the handling of the specimen from collection to testing. It ensures that the sample remains uncontaminated and that the results are reliable.
Consent Form: The donor must sign this form to give permission for the drug test. It outlines the testing process and informs the donor about their rights.
Test Result Report: This report contains the results of the drug test. It indicates whether the test was negative or positive and provides details about any substances detected.
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Medical Review Officer (MRO) Report: An MRO reviews the test results and may contact the donor to discuss any positive findings. This report includes the MRO's conclusions and recommendations.
Laboratory Certification Document: This document certifies that the laboratory conducting the test meets all regulatory standards. It ensures that the testing process is valid and reliable.
Follow-Up Testing Authorization Form: If a donor tests positive, this form is used to authorize additional testing. It outlines the procedures for follow-up tests and ensures compliance with regulations.

These documents work together to create a comprehensive framework for drug testing. Each plays a crucial role in ensuring that the process is fair, transparent, and compliant with regulations.

Dos and Don'ts

When filling out the Drug Screen form, it is crucial to follow certain guidelines to ensure accuracy and compliance. Here are eight important dos and don'ts to keep in mind:

Do read the entire form carefully before filling it out.
Do provide accurate information for all required fields, including your name and contact details.
Do ensure that the specimen temperature is recorded within the specified time frame.
Do check that the bottle seal is intact before submitting the specimen.
Don't leave any required fields blank; incomplete forms can lead to delays.
Don't use any abbreviations that may confuse the reader; clarity is essential.
Don't forget to initial the bottle seal; this step is important for chain of custody.
Don't submit the form without reviewing it for errors; double-checking can prevent issues.

By adhering to these guidelines, you can help ensure a smooth testing process and avoid potential complications. Remember, attention to detail is key.

Common mistakes

Filling out the Drug Screen form accurately is crucial for ensuring a smooth testing process. However, individuals often make mistakes that can lead to delays or complications. One common error is failing to provide the correct identification number. This includes either the Social Security Number (SSN) or the Employee ID number. If this information is missing or incorrect, it can result in the test being misattributed or even invalidated.

Another frequent mistake involves not specifying the testing authority. The form requires the selection of an authority such as HHS, NRC, or DOT. Omitting this detail can create confusion about the testing requirements and potentially lead to non-compliance with federal regulations.

In addition, many people overlook the reason for the test. Whether it is for pre-employment, random, or post-accident purposes, this section must be completed accurately. Failure to specify the reason can raise questions about the legitimacy of the test and may complicate the results interpretation.

Another area where errors often occur is in the drug tests to be performed. Selecting the wrong tests or failing to indicate specific drugs can lead to incomplete results. For instance, if a test for THC is required but not indicated, the results may not reflect the necessary information.

People also sometimes forget to fill out the collector's information completely. This includes the collector's name, phone number, and other contact details. Incomplete information can hinder communication and may delay the processing of the test.

Moreover, the section regarding the temperature of the specimen is often mismanaged. The collector must read the temperature within four minutes of collection. If this step is neglected or not documented properly, it can lead to questions about the integrity of the specimen.

Lastly, not ensuring that the chain of custody is properly documented can be a significant mistake. This includes affixing the bottle seals and ensuring that all signatures are collected. Any lapse in this procedure can result in the test being deemed invalid or compromised.

File Characteristics

Fact Name	Description
Form Title	This is the Federal Drug Testing Custody and Control Form.
Contact Information	The form includes a contact number: 800-877-7484.
Employer Information	Sections A, B, and C require the employer's name, address, and donor's identification.
Testing Authority	Donors must specify the testing authority, which may include HHS, NRC, or DOT.
Reason for Testing	Common reasons include pre-employment, random testing, and post-accident evaluations.
Chain of Custody	The collector initiates the chain of custody, ensuring proper handling and documentation.
Results Reporting	Test results can indicate negative, positive, or invalid outcomes and must be certified by a scientist.

Form Sample

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
		Signature of Collector
				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		SPECIMEN BOTTLE(S) RELEASED TO:
	X				Bottle Seal Intact
	X				Yes No
		Signature of Accessioner			Yes No
		Signature of Accessioner
					If No, Enter remarks
					in Step 5A.
		(Print) Accessioner’s Name (First, MI, Last)		Date (Mo./Day/Yr.)	in Step 5A.

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)

Date (Mo./Day/Yr.)

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

___________________________________________

Signature of Certifying Scientist

(Print) Certifying Scientist's Name (First, MI, Last)

Date (Mo./Day/Yr.)

Laboratory Address

OMB No. 0930-0158

PRESS HARD - YOU ARE MAKING MULTIPLE COPIES