FTA Suggested “Collection Site Drug Test Correction ...
EMPLOYER NAME/LOGODrug and Alcohol Testing NotificationThe Federal Transit Administration (FTA) drug and alcohol testing regulation (49 CFR Part 655) requires all safety-sensitive employees must submit to drug and alcohol testing as a condition of employment in a safety-sensitive position. Employee Information:Employee Name: Employee ID/SSN: Date of Notification: Time of Notification: AM/PMEmployee Transported? NO YES Transported by: Collection Site Information:Name: Address: City, State, Zip: Order for Testing: Type of Test: Alcohol Drug BothTesting Authority: DOT/FTA Non-DOTTest Type: Pre-Employment Random Post-Accident Reasonable Suspicion Return-to-Duty Follow-upObserved Collection:YES NO-95253683000To be filled out by Collection Site Personnel: Time of Arrival: AM/PMCollector Name: Return this form with the Employer Copy of CCF and/or ATF to: DER Name: Employer Address:Employer City, State, Zip: ................
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