Free Drug Screen PDF Form

How to Fill Out Drug Screen

Filling out the Drug Screen form is a critical step in the drug testing process. It’s important to complete every section accurately to ensure the test results are valid and properly recorded. This guide will help simplify the process.

1. Step 1: Completed by Collector or Employer Representative
   • Fill in the Employer Name, Address, I.D. No. in the designated space.
   • Provide the MRO (Medical Review Officer) Name, Address, Phone and Fax No.
   • Enter the Donor's SSN or Employee I.D. No.
   • Specify the Testing Authority by checking the appropriate box (HHS, NRC, DOT) and specify the DOT Agency if applicable.
   • Select the Reason for Test (Pre-employment, Random, etc.) and specify if selecting "Other".
   • Indicate the Drug Tests to be Performed, checking the appropriate boxes or specifying other tests if needed.
   • Complete the Collection Site information, including name, code, address, phone, fax, city, state, and zip.
2. Step 2: Completed by Collector
   • Check the temperature of the specimen within 4 minutes, ensuring it's between 90° and 100° F and make any necessary remarks.
   • Indicate the type of collection (Split, Single) and remark if observed or if none provided.
3. Step 3
   • The collector affixes bottle seal(s) to the bottle(s), dates the seal(s), and has the donor initial them.
4. Step 4: Chain of Custody
   • The collector initiates the chain of custody, indicating the specimen was collected, labeled, sealed, and released according to Federal requirements.
   • Fill in the collector's and delivery service's details, including time and date of collection.
5. Step 5A & 5B: Completed by Test Facility & Split Testing Laboratory (If applicable)
   • This section is typically filled out by the testing facility and split testing laboratory, documenting the examination, handling, analysis, and results of the specimen.

After completing all relevant sections of the form, verify all entries for accuracy. This form acts as a legal document throughout the testing process, maintaining the integrity and confidentiality of the drug testing procedure. Following the completion of this form, the collected specimen along with the form will be forwarded to the designated laboratory for testing. Ensuring accuracy in filling out this form is essential for a smoothly conducted drug screening process.

What is the purpose of the Federal Drug Testing Custody and Control Form?

The Federal Drug Testing Custody and Control Form is used to document the collection and handling of a drug test specimen. This form ensures that the process is carried out in accordance with federal regulations, maintaining a documented chain of custody from the time the specimen is collected until it is analyzed by the lab. It serves to protect the rights of the person being tested and to ensure the integrity and accuracy of the test result.

Who completes the Federal Drug Testing Custody and Control Form?

The form is completed by several individuals throughout the drug testing process. Initially, it is filled out by the collector or employer representative who oversees the specimen collection. The collector plays a key role in observing the collection (when required), securing the sample, and initiating the chain of custody. As the specimen moves through testing, the form is further completed by laboratory personnel, including accessioners who receive the specimen at the lab, and certifying scientists who report the test results. Each individual's role is critical in maintaining the specimen's integrity and ensuring the reliability of the test result.

What does the "Specify Testing Authority" section refer to?

The "Specify Testing Authority" section identifies the specific federal agency under whose authority the drug test is being conducted. Different agencies, such as the Department of Health and Human Services (HHS), Nuclear Regulatory Commission (NRC), and Department of Transportation (DOT) among others, may have distinct requirements or guidelines for conducting drug tests. Specifying the testing authority ensures that the test is administered in compliance with the relevant federal standards and regulations.

Can you explain the importance of the temperature check in the collection process?

The temperature of the urine specimen is checked within 4 minutes of collection to ensure its authenticity. A temperature between 90° and 100° F is considered normal for a fresh specimen. This step is crucial for detecting whether the specimen has been adulterated or substituted, as temperatures outside this range may indicate tampering. The collector notes the temperature reading on the form, which is an essential part of maintaining the specimen’s chain of custody and verifying its validity.

What is indicated by the drug tests to be performed section?

This section specifies which substances will be screened for in the specimen. It can range from a wide panel including substances like THC (marijuana), COC (cocaine), PCP, OPI (opioids), and AMP (amphetamines) among others, to more targeted testing for specific substances. Choosing the substances to be tested can depend on the requirements of the employer, the relevant federal agency, or the specific circumstances prompting the test such as pre-employment or reasonable suspicion.

What happens if a specimen bottle seal is not intact when received at the lab?

If the seal on a specimen bottle is found not to be intact upon arrival at the laboratory, this is documented in the "remarks" section on the form. An unbroken seal is vital for ensuring that the specimen has not been tampered with or contaminated. A compromised seal can lead to the specimen being rejected for testing, as the chain of custody is broken. This ensures the integrity of the test results and upholds the reliability of the drug testing process.

How is a positive test result confirmed?

A positive test result is typically confirmed through a two-step process. Initially, a primary screening test identifies potential positives, which are then confirmed by a more specific and sensitive secondary test, such as Gas Chromatography-Mass Spectrometry (GC-MS). The confirmatory test ensures that over-the-counter medications or other substances do not falsely contribute to a positive result. In cases where split specimens are used, a second portion of the sample can be tested by a different laboratory for verification, as detailed in the steps outlined by the form. Once confirmed, results are reported to the Medical Review Officer (MRO) for interpretation and verification before being released to the employer.

Filling out the Federal Drug Testing Custody and Control Form requires attention to detail. Mistakes can lead to delays or invalidation of tests. It's important to review and ensure accuracy in every section to support a smooth process. Here are eight common mistakes:

1. Incorrect Employer Information: Employers sometimes input incorrect names, addresses, or ID numbers, leading to confusion and potential administrative errors.
2. Misunderstanding Collection Site Details: Failure to correctly specify the collection site's name, code, and contact information can disrupt the testing process.
3. Incomplete Donor Information: Omitting the donor’s Social Security Number or Employee ID can invalidate the test, as this information is crucial for identification.
4. Not Specifying the Testing Authority: Neglecting to indicate the relevant testing authority or selecting the wrong authority can lead to tests not being performed according to the required standards.
5. Incorrect Reason for Test: Selecting the wrong reason for testing, such as 'Pre-employment' when it should be 'Post-accident', may affect how results are processed or interpreted.
6. Failure to Specify Tests to be Performed: Not clearly stating which substances should be tested for can result in an incomplete screening, causing potential retests or delays.
7. Errors in Collection Type: Misidentifying whether the collection was 'Observed' or whether a 'Split' or 'Single' sample was provided can impact the integrity of the test and its outcome.
8. Improper Handling of Custody and Control Procedures: Failing to ensure that the specimen bottle’s seal is intact and correctly initialed by the donor, or mismanaging the chain of custody documentation, can question the specimen's authenticity.

Avoiding these mistakes is crucial for the accuracy and validity of the testing process. It enhances the reliability of the results and supports a fair and efficient drug testing program.

When conducting drug tests, especially in the workplace or under federal regulations, it's important to know that the Drug Screen Form is just one part of a comprehensive process. This form serves as a critical tool in the testing procedure, ensuring that the specimen collection and testing adhere to the necessary standards. However, several other forms and documents often work in conjunction with the Drug Screen Form to ensure a thorough and lawful testing process. Here’s a brief overview of these accompanying documents.

• Consent and Release Form: This document is signed by the employee or individual being tested, giving formal permission to conduct the drug test and release the results to the authorized parties.
• Chain of Custody Form: Although part of the Drug Screen Form, it's worth noting separately. This form tracks the sample from collection to the testing laboratory, ensuring its integrity and security at every step.
• Medical Review Officer (MRO) Report Form: An MRO reviews the test results for accuracy and validity before they're reported. This form documents their findings and conclusions.
• Substance Abuse Professional (SAP) Report Form: In cases of positive results, this form outlines the evaluation and recommended treatment plan by a qualified SAP.
• Employee Background Check Authorization Form: Often used in pre-employment screening alongside drug testing, this form authorizes the employer to conduct a background check.
• Employee Health Assessment Form: This may collect relevant health information to interpret the drug test results accurately or determine if an employee is fit for duty.
• Accident Report Form: In the event of a workplace accident leading to a drug test (post-accident testing), this form details the incident and subsequent necessity for testing.
• Results Notification Form: This document formally communicates the outcome of the drug test to the employee or individual tested.
• Return-to-Duty Agreement Form: Following a positive test result and completion of any required treatment or suspension period, this form outlines the conditions under which an employee can return to work.
• Follow-Up Test Schedule Form: For individuals in a follow-up testing program, this document schedules subsequent tests as per regulatory or employer requirements.

Incorporating these additional forms and documents streamlines the drug testing process, ensuring compliance with legal standards and supporting the integrity of the results. By understanding the role each document plays, employers, collectors, and testers can more effectively manage the intricacies of drug testing in a professional and law-abiding manner.

• Employment Application Forms: These documents are similar to Drug Screen forms because they often include sections for personal identification details such as name, address, and social security number or employee ID, just as the Federal Drug Testing Custody and Control Form requests in its initial section. Employment application forms also might include consent sections, similar to how Drug Screen forms obtain consent for testing.

• Medical History Forms: Like Drug Screen forms, Medical History Forms also collect sensitive personal information and require disclosure of substances that could affect one's health or the outcome of medical tests. Both forms maintain a strict confidentiality aspect regarding the information provided.

• Consent for Treatment Forms: These forms, used in healthcare settings, are similar to Drug Screen forms by documenting individuals' consent to undergo certain medical procedures or treatments. They ensure that the procedure, including any drug tests, is performed legally and with explicit permission.

• Laboratory Requisition Forms: Sharing a close resemblance to Drug Screen forms, these forms are used to specify tests ordered by healthcare providers, detail the necessity of the tests, and provide clear instructions to the laboratory. Both sets of documents are pivotal in ensuring precise, accurate handling and testing of specimens while maintaining chain of custody.

• Background Check Authorization Forms: Such forms are similar to Drug Screen forms in that both require the subject's consent for the procedure and personal information to verify the individual's identity. Both forms are integral to pre-employment screening processes and aim to ensure suitability for a position.

• Incident Report Forms: These documents are filled out after an event occurs, particularly in the workplace. They are similar to the section in the Drug Screen form that specifies "Reason for Test," including post-accident verification, resembling the reactive nature of both documents to specific incidents.

• Consent to Release Information Forms: Like Drug Screen forms, these documents involve the consent to share personal or confidential information with specific parties or for specific reasons. Both types of documents treat the individual's information with a high level of confidentiality and share it based on consent and need.

• Compliance Documentation: These forms are required in regulated industries to ensure that companies and their employees comply with legal standards. The Drug Screen form serves a compliance role by ensuring that the process adheres to federal testing requirements, similar to other compliance documents.

• Insurance Claim Forms: These require detailed personal and incident-related information to process claims, much like how Drug Screen forms require detailed documentation of the collection and testing process. Both are necessary for the respective parties to fulfill their obligations based on documented evidence.

• Government Identification Forms: Similar to the Drug Screen form, government ID applications often require detailed personal information, verification of identity, and sometimes, background checks. Both forms are foundational to establishing or verifying the individuals' credentials and eligibility for services or benefits.

Filling out a drug screen form, particularly the Federal Drug Testing Custody and Control Form, is an important step in the drug testing process. It requires accuracy and attention to detail to ensure the integrity of the process. Here are six dos and don'ts to help navigate the completion of this form:

• Verify the information: Ensure that your personal details such as your social security number or employee ID, and the employer's details are correctly entered.
• Understand the test reasons: Be clear about the reason for the test—whether it’s pre-employment, random, post-accident, or another reason—and make sure it’s correctly marked on the form.
• Confirm the type of test: Double-check which drugs will be screened (e.g., THC, COC, PCP) and make sure the correct boxes are ticked.
• Identify the collection site accurately: Include the complete name, address, and contact information of the collection site without errors.
• Review the form before submission: Go through each section of the form to make sure no fields have been missed and all information is accurate.
• Ensure the chain of custody is initiated properly: Pay attention when the collector initiates the chain of custody process, which affirms that the sample was collected, labeled, and sealed in your presence, maintaining the test's integrity.

• Skip any sections: Even if a section seems not to apply, confirm its irrelevance with the collector rather than leaving it blank by assumption.
• Use nicknames or abbreviations: Always use your full legal name and avoid abbreviations to prevent any issues with your test results.
• Forget to check specimen temperature remarks: If the collector has marked any remarks related to specimen temperature, understand what it means and ask questions if necessary.
• Overlook the collector and lab information: Ensure that the collector has filled out their section correctly, including the time of collection and their signature.
• Ignore remarks on bottle seal integrity: Notice if there are any remarks about the bottle seal being intact or not, as this could affect the validity of your sample.
• Leave the facility without ensuring all copies are complete: Before leaving the collection site, ensure that the collector has provided you with your copy of the form and that it matches the collector's copy for accuracy.

There are several misconceptions about the Drug Screen form used in federal drug testing programs. Understanding these misconceptions is crucial for employees, employers, and all parties involved in the testing process.

• Only illegal drugs are tested: Many believe drug screenings only search for illegal substances. However, the form explicitly mentions various drugs, including legal prescription drugs, that can impair an employee's ability to perform safely and efficiently at work.

• The form is used only for pre-employment screenings: While pre-employment testing is common, the form outlines several other reasons for testing, such as random testing, reasonable suspicion, post-accident, return to duty, follow-up, and others. Employers use drug screenings in various situations beyond the hiring process.

• Positive results immediately lead to termination: A positive test does not automatically result in job loss. Steps include verification by a Medical Review Officer (MRO) and potential follow-up testing. Employers may consider various factors, including the employee's role and history.

• All tests include observation: The form mentions "Observed" as an option for collection remarks, implying that observation is not standard for all tests. Observation is primarily used in specific situations to ensure the integrity of the sample.

• The process lacks privacy: The form and associated procedures are designed with confidentiality in mind, detailing steps like specimen ID numbers and controlled access to results, to protect employee privacy.

• Any lab can process the tests: The testing and reporting process must comply with federal requirements, including the use of specified labs. Not every lab is qualified or certified to conduct federal drug screenings.

• Employers have immediate access to results: Before an employer receives results, the specimen undergoes analysis, and positive findings are reviewed by an MRO. This review process can delay when results are relayed to an employer, ensuring accuracy and fairness.

• Drug screens only test for current impairment: Drug tests, especially those searching for metabolites (such as THC-COOH for marijuana), do not measure current impairment but rather indicate recent use. The science of testing focuses on identifying use that could impact safety and performance.

Dispelling these misconceptions helps foster a fair and transparent environment for drug testing, crucial for workplace safety and compliance with federal regulations.

Understanding the Federal Drug Testing Custody and Control Form is crucial for ensuring compliance with federal regulations and maintaining the integrity of the drug testing process. Here are key takeaways to consider when filling out and using this form:

• Accurately complete employer and donor information: Sections such as Employer Name, Address, I.D. No., and Donor SSN or Employee I.D. No. must be filled out completely and accurately to avoid any confusion or misidentification.
• Determine the appropriate testing authority: Clearly specify the testing authority (HHS, NRC, DOT, etc.) and the relevant DOT agency if applicable. This helps in ensuring the test is conducted under the correct regulatory standards.
• Select the reason for the test: Indicate the specific reason for the drug test (e.g., Pre-employment, Random, Reasonable Suspicion/Cause, etc.), as this can affect how the test results are handled and interpreted.
• Specify the drugs to be tested: Clearly mark the drugs for which the donor is being tested. This ensures the lab knows exactly what substances to look for in the specimens.
• Collection site information is vital: Complete information regarding the collection site, including the name, address, and contact details, is essential for any future queries or issues that may arise.
• Ensure correct specimen handling: The collector's steps, such as checking the temperature and ensuring the specimen is properly sealed and initialed by the donor, are critical for the integrity of the test.
• Chain of custody must be maintained: Every step of the process, from collection to testing, must be documented accurately to maintain the chain of custody. This includes signatures and dates from the collector, delivery service, and testing facility personnel.
• Understand the outcomes reported by the testing facility: The test results, whether negative, positive, adulterated, substituted, or invalid, and any remarks, must be properly interpreted according to federal guidelines.

Each of these steps is an integral part of the drug testing process, helping to ensure that the results are reliable and legally defensible.