TCM – Random Pool Management

Use the following form to submit quarterly testing pools, document who received pre-employment tests and inform Health Enhancement Center as to which employees were terminated in the preceding quarter.

See also: FMCSA Part 382 CONTROLLED SUBSTANCES AND ALCOHOL USE AND TESTING § 382.305: Random testing.

Form Submitted By:*
Submitted By Phone:
-
Submitted By E-mail:
Company Name:
DER Name:*
DER E-mail:
DER Phone:
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New Pre-Employment Tests (Names and ID)
These Employees Where Terminated.
MODE
Pool Member, ID, Mode (1):
Name, ID, Mode (2)
Name, ID, Mode:(3)
Name, ID, Mode:(4)
Name, ID, Mode:(5)
Pool Member+ID:(6)
Pool Member+ID:(7)
Pool Member+ID:(8)
Pool Member+ID:(9)
Pool Member+ID:(10)
Pool Member+ID:(11)
Pool Member+ID:(12)
Pool Member+ID:(13)
Pool Member+ID:(14)
Pool Member+ID:(15)
Pool Member+ID:(16)
Pool Member+ID:(17)
Pool Member+ID:(18)
Pool Member+ID:(19)
Pool Member+ID:(20)
Pool Member+ID:(21)
Pool Member+ID:(22)
Pool Member+ID:(23)
Pool Member+ID:(24)
Pool Member+ID:(25)
Pool Member+ID:(26)
Pool Member+ID:(27)
Pool Member+ID:(28)
Pool Member+ID:(29)
Pool Member+ID:(30)
Pool Member+ID:(31)
Comments:

Copyright © 2015 Health Enhancement Center

Health Enhancement Center
8615 Commerce Drive
Easton, MD 21601
Jim Proctor, President
410-822-8690 (office)
410-822-9434 (fax)

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