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Free Drug Screen Template

The Drug Screen form, officially known as the Federal Drug Testing Custody and Control Form, is essential for documenting the collection and testing of urine specimens in drug testing programs. This form ensures compliance with federal regulations and maintains the integrity of the testing process. To participate in drug screening, please fill out the form by clicking the button below.

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Table of Contents

The Drug Screen form, officially known as the Federal Drug Testing Custody and Control Form, is a critical document used in the drug testing process for various organizations. This form serves multiple purposes, including identifying the employer and the Medical Review Officer (MRO), as well as detailing the reason for the drug test, such as pre-employment or post-accident testing. Each section of the form requires specific information, including the donor's Social Security Number or employee ID, the testing authority, and the drugs to be tested, which can range from THC to cocaine metabolites. The form also includes important steps for collectors, such as ensuring the specimen's temperature is within an acceptable range and documenting the chain of custody to maintain the integrity of the sample. Additionally, it outlines the responsibilities of the testing facility and certifying scientists, ensuring that all procedures comply with federal regulations. The comprehensive nature of this form highlights its importance in promoting safety and accountability in workplaces that require drug testing.

Document Specifics

Fact Name	Description
Form Purpose	The Drug Screen form is used to document the collection and testing of urine specimens for drug testing in compliance with federal regulations.
Governing Body	This form is governed by the Department of Health and Human Services (HHS) regulations for workplace drug testing.
Specimen Identification	Each specimen is assigned a unique Specimen ID number to ensure traceability throughout the testing process.
Testing Authorities	The form allows for various testing authorities, including the NRC and DOT, with specific agencies like FMCSA and FAA specified as needed.
Reasons for Testing	Common reasons for testing include pre-employment, random testing, reasonable suspicion, and post-accident evaluations.
Drug Tests Included	Tests can screen for various substances, such as THC, cocaine, PCP, and amphetamines, with options for specific combinations.
Chain of Custody	The form includes a chain of custody section to track the specimen from collection to analysis, ensuring integrity and security.
Certification Requirement	Certifying scientists must sign and date the form, confirming that the specimen was handled and analyzed according to federal standards.

Similar forms

The Drug Screen form shares similarities with several other documents commonly used in drug testing and workplace compliance. Each of these documents serves a specific purpose in the process of drug screening, ensuring that proper procedures are followed and that results are accurately recorded. Below is a list of six documents that are similar to the Drug Screen form, along with an explanation of how they relate.

Chain of Custody Form: This document tracks the handling of a specimen from the time it is collected until it is analyzed. Like the Drug Screen form, it emphasizes the importance of maintaining a clear record to prevent tampering and ensure the integrity of the test results.
Laboratory Test Report: After analysis, this report provides the results of the drug test. Similar to the Drug Screen form, it includes details about the substances tested and the outcome, ensuring that all information is documented clearly for review.
Consent Form: Before testing, donors often sign a consent form acknowledging their understanding of the testing process. This form parallels the Drug Screen form in that it captures the donor's agreement to participate, which is crucial for legal and ethical compliance.
ATV Bill of Sale: Essential for all transactions involving all-terrain vehicles, this form ensures legal ownership transfer in California. For more detailed information and to access the form, visit California PDF Forms.
Pre-Employment Screening Checklist: This checklist outlines the steps that need to be completed before hiring a candidate, including drug testing. It is similar to the Drug Screen form as it helps employers ensure that all necessary procedures, including drug tests, are conducted systematically.
Incident Report Form: When a workplace incident occurs, an incident report may be generated. This form can include drug testing as part of the investigation process, similar to how the Drug Screen form documents the rationale for testing in various scenarios, such as post-accident situations.
Employee Handbook: This document typically outlines company policies regarding drug use and testing. It is similar to the Drug Screen form in that it sets expectations for employees and provides information about the testing process, ensuring everyone is informed about the rules and procedures.

Free Drug Screen File

Drug Screen Example

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

Understanding Drug Screen

What is the purpose of the Drug Screen form?

The Drug Screen form is used to document the process of collecting and testing a urine specimen for drugs. It ensures that the testing is conducted according to federal guidelines and provides a clear record of the chain of custody from the donor to the testing laboratory.

Who is responsible for completing the Drug Screen form?

The form is typically completed by the collector or an employer representative. They fill out the necessary sections to ensure all relevant information about the donor, testing authority, and reason for the test is accurately recorded.

What information is required from the donor?

The donor must provide their Social Security Number or Employee ID, which helps identify the individual being tested. This information is crucial for maintaining accurate records and ensuring the right person is associated with the test results.

What types of drug tests can be performed?

The form allows for various drug tests, including those for THC (marijuana), cocaine (COC), PCP, opiates (OPI), and amphetamines (AMP). The specific tests to be performed can be specified on the form based on the requirements of the testing authority.

What happens if the specimen temperature is not within the acceptable range?

If the specimen temperature is not between 90°F and 100°F, the collector must make a remark on the form. This could indicate a potential issue with the specimen, such as tampering, and may require further investigation or a different collection.

What is the chain of custody process?

The chain of custody process ensures that the specimen is securely handled from the time it is collected until the results are reported. The collector must document each step on the form, including sealing the specimen and transferring it to the testing facility. This process helps maintain the integrity of the test results.

What does it mean if a test result is reported as "adulterated" or "invalid"?

An "adulterated" result indicates that the specimen has been tampered with or contains substances that may interfere with the test. An "invalid" result means that the test could not be accurately performed for some reason, such as an unusual specimen. In either case, further testing or a new specimen may be required.

How can I contact Quest Diagnostics for questions about the Drug Screen form?

If you have questions about the Drug Screen form or the testing process, you can contact Quest Diagnostics at 800-877-7484. They can provide assistance and clarify any concerns you may have regarding the testing procedure.

Dos and Don'ts

When filling out the Drug Screen form, it’s important to follow certain guidelines to ensure accuracy and compliance. Here’s a list of things you should and shouldn’t do:

Do double-check all information for accuracy before submission.
Do ensure that the collector reads the specimen temperature within 4 minutes.
Do specify the reason for the test clearly, such as “Pre-employment” or “Random.”
Do sign and date the form where required to confirm your participation.
Don’t leave any required fields blank; fill in all necessary information.
Don’t alter or tamper with the form in any way, as this could invalidate the results.
Don’t forget to provide accurate contact information for the collector.
Don’t ignore any instructions provided on the form regarding the collection process.

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