TCM – Reasonable Suspicion Testing

Reasonable Suspicion Testing

See also: FMCSA Part 382 CONTROLLED SUBSTANCES AND ALCOHOL USE AND TESTING § 382.307: Reasonable suspicion testing. Link: http://www.fmcsa.dot.gov/regulations/title49/section/382.307

Use the following form to document a Reasonable Suspicion Event.

Reasonable Suspicion Event Date:
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Event Time:
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Form Prepared By:
Preparer's Phone:
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Preparer's E-mail:
DER:
DER Phone:
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DER E-mail:
Employer Name:
Employee Name:
Employee ID:
Observed Behavior:
Observed By:
Observed By Title:
Behavior Witnessed By:
Witness Title
Date of Incident:
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Time of Incident:
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Shift Start Time:
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Shift End Time:
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Alcohol Screen Date:
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Alcohol Screen Time:
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Urine Collection Date:
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Urine Collection Time:
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If Alcohol Screen Not Conducted Within 2 hrs. of incident, state reason here:
CCF Number:
BAT Number:
Notes and Comments:

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

 

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