Free Printable Drug Screen Result Form STEP 1 COMPLETED BY COLLECTOR OR EMPLOYER REPRESENTATIVE Specimen ID Number COLLECTION SITE COMPANY NAME NAME ADDRESS CITY SUITE STATE PHONE DONOR SSN DRIVER S LICENSE or EMPLOYEE I D NO FAX POSTAL CODE ID VERIFIED BY PHOTO ID q EMPLOYER REP q DONOR NAME Last First REASON FOR TEST Pre Employment q Random q
Create Document Updated September 19 2023 A drug and alcohol testing consent form is used by employers to screen applicants and employees for drug and or alcohol use This form may also be justified by reasonable suspicion of drug or alcohol abuse Federal Drug Testing Custody and Control Form 0000001 A Employer Name Address I D No B MRO Name Address Phone No and Fax No Specify Testing Authority HHS NRC Specify DOT Agency FMCSA FAA FRA FTA Reason for Test Pre employment Random Reasonable Suspicion Cause Post Accident Return to Duty Follow up
Free Printable Drug Screen Result Form
Free Printable Drug Screen Result Form
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Drug Test Results Form Template Best Professional Templates
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Drug Test Form Free Printable Documents
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Step One Download the template Access the free 10 Panel Drug Test Report via the link provided on this page or through the Carepatron app Alternatively you can find it in our general practice management software s resources library Step Two Fill out personal information Fill out and download the Preliminary Drug Screen Result Form Stat Test online Create a professional looking document in minutes with our user friendly form template Easily save or print the completed form as a PDF Get the blank version in PDF or Word format for free
Certification Information Signatures of both parties required I hereby certify that the specimen provided is my own and has not been substituted or adulterated I further agree and grant permission for the testing of my specimen for drug metabolites and or alcohol I hereby certify that I have collected the specimen provided by the URINE INITIAL DRUG SCREEN RESULT FORM Daytime Phone Evening Phone Date of Birth Print Donor s Name First MI Last Date Mo Day Yr Date Mo Day Yr X Signature of Donor STEP 2 COMPLETED BY DONOR
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Drug test results forms Easy to use just print from your computer Contact Us 1 866 323 7336 0 items 0 0 items 0 Blue Grass Drug Screen Inc Address P O Box 676 Pewee Valley KY 40056 Phone Free Shipping on Orders Over 75 First How many tests were conducted What test was conducted Click or drag files to this area to upload You can upload up to 5 files basic This template includes features available in WPForms Basic Compare Plans Are you a lab or other health facility that regularly processes drug test results
Additional Resources DOT s Am I Covered Tool Find out if you re subject to drug and alcohol testing regulations DOT 5 Panel Drug Testing Notice Moving Ahead for Progress in the 21st Century Act MAP 21 P L 112 141 DOT Direct Observation for All Return to Duty Follow Up Drug Testing Notice Federal Drug Free Workplace Programs Introduction The Drug Abuse Screening Test DAST 10 is a 10 item brief screening tool that can be administered by a clinician or self administered Each question requires a yes or no response and the tool can be completed in less than 8 minutes This tool assesses drug use not including alcohol or tobacco use in the past 12 months
Drug Screen Form Template Fill Out And Sign Printable PDF Template SignNow
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Micro Disturbing Preliminary Drug Screen Result Form Fill And Sign Printable Template Online
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STEP 1 COMPLETED BY COLLECTOR OR EMPLOYER REPRESENTATIVE Specimen ID Number COLLECTION SITE COMPANY NAME NAME ADDRESS CITY SUITE STATE PHONE DONOR SSN DRIVER S LICENSE or EMPLOYEE I D NO FAX POSTAL CODE ID VERIFIED BY PHOTO ID q EMPLOYER REP q DONOR NAME Last First REASON FOR TEST Pre Employment q Random q
https://eforms.com/consent/drug-and-alcohol-testing/
Create Document Updated September 19 2023 A drug and alcohol testing consent form is used by employers to screen applicants and employees for drug and or alcohol use This form may also be justified by reasonable suspicion of drug or alcohol abuse
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Free Printable Drug Screen Result Form - STEP 2 COMPLETED BY DONOR DONOR CONSENT I certify that I provided my specimen to the collector that the specimen container was sealed with a tamper proof seal in my presence and that the information provided on this form tests to the health care provider In the case of screening for employment or pre employment I also authorize release of
