US DOT Alcohol Testing Form

Question 1

Components of step 1

Answer 1

1. Employee name
2. SSN or employee ID
3. Employer contact information
4. DER name and phone number
5. Reason for test

Question 2

Reasons for test

Answer 2

1. Random
2. Reasonable suspicion
3. Post accident
4. Return to duty
5. Follow-up
6. Pre-employment

Question 3

Step 2 is to be completed by….

Answer 3

The employee

Question 4

Components of step 2

Answer 4

1. Alcohol technician must read statement printed in step 2 to employee
2. Employee must sign and date

Question 5

Step three is to be completed by…

Answer 5

Alcohol technician

Question 6

What happens if the technician conducting the screening test is not the same technician conducting the confirmation testing?

Answer 6

Each technician must complete their own form

Question 7

Types of technician

Answer 7

1. BAT

2. STT

Question 8

Devices for alcohol testing

Answer 8

1. Saliva

2. Breath

Question 9

When is step 4 completed and by whom?

Answer 9

Employee completes if test result is 0.02 or higher

Question 10

Step 1 is to be completed by….

Answer 10

Alcohol technician